opioid and non opioid and adjuvant analgesics Flashcards

1
Q

MOE of opioids ?

A

inhibition of excitation of transmission of neuron ( inhibit glutamate )
inhibition of postsynaptic neurone
inhibition of descending inhibitory pathways

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2
Q

MOE of NSAIDS ?

A

inhibition of release of mediators of inflammation

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3
Q

what kind of receptors are opioid receptors ?

A

gi/go protein coupled receptors

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4
Q

effects of opioids including analgesia, euphoria and respiratory depression are due to the action of what type of receptor ?

A

μ receptors

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5
Q

sign of opioid overdose ?

A

miosis

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6
Q

what type of opiod is associated with cough suppression ?

A

codeine

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7
Q

what CVD effect do opioids induce ?

A

bradycardia except with meperidine - causes tachycardia

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8
Q

effect of opioids on the GIT

A

decrease tone and motility and cause constipation

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9
Q

effect of opioids on the biliary tract ?

A

biliary colic

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10
Q

effect of opioid on the renal system

A

antidiuretic effect
decreases renal function

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11
Q

effeect of opiods on the uterus ?

A

may prolong labour

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12
Q

side effects of chronic frequent use of opioids

A

tolerance
addiction
physical dependence

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13
Q

what are thee clinical uses of opioids in terms of their analgesic effect ?

A

pain associated with cancer
obstetrics labor
management of severe pain of renal and biliary colic
used in surgeries

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14
Q

what is the best next step in management in GI disturbances that prevent the administration of oral sustained release morphine ?

A

fentanyl transdermal system ( fentanyl patches )

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15
Q

what is the problem with using opioids in labour and how is this problem solved ?

A

opioids can cross the placental barrier and cause neonatal respiratory depression
managed by using naloxone

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16
Q

what type of opioid is more commonly used in obstetrics practice ?

A

Phenylpiperidines

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17
Q

what are the indications of opioid uses in acute pulmonary oedema ?

A

pulmonary oedema associated with LVHF
painful myocardial ischaemia with pulmonary oedema

18
Q

what opiodd is used for shivering ?

A

meperidine

19
Q

what is thee absorption of opioids ?

A

well oral absorption
but has 1st pass effect

20
Q

how are opioids metabolized and excreted ?

A

metabolized in the liver
excreted by thee kidneys

21
Q

what is morphine metabolized into ?

A

more potent form of morphine

22
Q

what type of interaction occurs between opioids and sedatives/hypnotics ?

A

increased CNS depression
especially respiratory depression

23
Q

what is the effect of using both opioids and antipsychotics together ?

A

increased sedation
accentuation of CVD effect

24
Q

what is the absolute contraindicated drug to be used with opioids ?

A

monamine oxidase inhibitor (anti depressant )
due to high incidence of hyperprexic comas

25
what are the specific uses for methadone ?
1- racemic mixture blocks NMDA receptors 2- used when morphine fails to control pain 3- opioid rotation with morphine
26
true or false , methadone tolerance develops quickly
false
27
give an example of a synthetic opioid analogue
fentanyl
28
what must partial agonists not be administered with ?
pure agonists associatedd with abstinence syndrome
29
examples of partial agonists ?
buprenorphine nalbuphine
30
effect of naloxone on buprenorphine ?
resistant to the antagonist
31
what is the contraindicated class of drugs that should not be used alongsidde buprenorphine ?
any CYP3A4 any azoles macrolides HIV protease inhibitors
32
MOE of tramadol
blocks serotonin and norepinephrine
33
what is the absolute contraindication to tramadol use ?
history of seizures
34
what is the risk of thee co-administration of SSRIs with tramaddol ?
incidence of serotonin syndrome
35
what is the effect of tramadol on respiration ?
no significant effect
36
what is the optimal method of administration of naloxone ?
usually given by injection due to complete metabolization by the liver - parenteral or inhalation
37
what are the clinical uses of naloxone ?
treating acute opioid overdose low dose naloxone for treating SE of IV or epidural opioid induced constipation
38
how is a diagnosis of opioid overdose confirmed with naloxone ?
If IV or nasal insufflation of naloxone shows prompt sign of recover→confirms opioid overdose diagnosis
39
absolute contraindications generally when it comes to the use of opioids ?
1. Use of pure agonists with weak partial agonists 2. Use in patients with head injuries 3. Use during Pregnancy 4. Use in patients with impaired pulmonary function 5. Use in patients with impaired hepatic or renal function 6. Use in patients with reduced blood volume → more susceptible to vasodilation 7. Histamine release by morphine → exacerbate asthmatic attack or evoke allergic reaction 8. Use in patients with endocrine disease
40
NSAID associated with highest GI safety ?
COX-2 inhibitor
41
how is paracetamol different from NSAIDs ?
no anti inflammatory effect does not induce gastric ulceration or bleeding
42
metabolization of paracetamol vs ibuprofen
paracetamol in the liver ibuprofen in the kidneys