Opioid Drugs

Question 1

What are the strong agonists

Answer 1

Morphine
Hydromorphone
Oxymorphone
Heroin
Meperidine
Fentanyl
Sufentanil
Alfentanil
Methadone
Levorphanol

Question 2

What are the Mild to Moderate Agonists

Answer 2

Codeine
Oxycodone
Hydrocodone
Propoxyphene
Tramadol

Question 3

What are the Mixed Agonist/Antagonist

Answer 3

Pentazocine
Butorphanol
Nalbuphine
Buprenorphine

Question 4

What are the Mu, Delta, Kappa Antagonists

Answer 4

Naloxone

Naltrexone

Question 5

What are the Antitussives

Answer 5

Dextromethorphan

Codeine

Question 6

What are the Antimotility Agents

Answer 6

Diphenoxylate

Loperamide

Question 7

What is the standard for Analgesia

Answer 7

Morphine

Question 8

How is Morphine metabolized

Answer 8

M3G causing neuro-excitation

M6G (10%) more potent

Question 9

Can Morphine metabolites cross BBB

Answer 9

No

Question 10

What is a hazard of renal impairment on Morphine metabolites

Answer 10

Increased effect

Question 11

What is Heroin metabolized to

Answer 11

6-MAM then morphine

Question 12

What is unique about 6-MAM and Heroin

Answer 12

Can cross BBB

Question 13

Why does Meperidine have high metabolite toxicity

Answer 13

Normeperidine causes tremor, twitching, mydriasis, hyperreflexia, convulsions

Question 14

What is a major AE of Meperidine

Answer 14

Serotonin Syndrome

Question 15

What is seen in Serotonin Syndrome

Answer 15

Delerium
Hyperthermia
HA, rigidity, coma

Question 16

What do you not give with Meperidine

Answer 16

MAOIs

Question 17

Pt on Meperidine has seizures

Answer 17

Decreased renal function and Normeperidine accumulation

Question 18

Does Meperidine or Normeperidine have a longer t1/2

Answer 18

Normeperidine

Question 19

Which strong agonist has a rapid onset and short duration (100x more potent than morphine)

Answer 19

Fentanyl
Sufentanil
Alfentanil
Remifentanil

Question 20

What are the Fentanyls metabolized by

Answer 20

3A4

Question 21

Equal potency to morphine, but less euphoria and longer acting

Answer 21

Methadone

Levorphanol

Question 22

Opioid withdrawal in Heroin addict

Answer 22

Methadone

Levorphanol

Question 23

What do Methadone and Levorphanol act on

Answer 23

Mu
NMDA antagonist
5-HT/NE reup inhibitor

Question 24

What can cause QT prolongation

Answer 24

Methadone

Levorphanol

Question 25

Which mild/moderate do you combine with Aspirin or Acetaminophen

Answer 25

Codeine Oxycodone Hydrocodone

Question 26

What is metabolized by 2D6

Answer 26

Codeine Hydroxycodone Hydrocodone

Question 27

Affinity of Codeine to opioid receptors

Answer 27

Low

Question 28

No longer on the market

Answer 28

Propoxyphene

Question 29

What about Propoxyphene makes it toxic

Answer 29

Metabolite Norpropoxyphene

Question 30

Good for Neuropathic pain

Answer 30

Tramadol

Question 31

What does Tramadol act on

Answer 31

Weak Mu | 5-HT/NE reup inhibitor

Question 32

What are the Tramadol AE

Answer 32

Risk of seizures | Serotonin Syndrome

Question 33

Why are mixed not routine

Answer 33

Ceiling

Question 34

Which mixed can cause psychotomimetic effects

Answer 34

Pentazocine Butorphanol Nalbuphine

Question 35

Which mixed act on Mu and Kappa

Answer 35

Butorphanol (K ag, Mu anti) | Buprenorphine (Mu ag, K anti)

Question 36

What were Mixed developed for

Answer 36

Reduce addiction potential esp. Buprenorphine

Question 37

What is given for acute opioid overdose

Answer 37

Naloxone

Question 38

What is given to decreased EtOH craving

Answer 38

Naltrexone (also for opioid addicts)

Question 39

What are the most effect cough suppressors

Answer 39

Dextromethorphan | Codeine

Question 40

Is the antitussive effect through opioid receptors

Answer 40

No

Question 41

Diarrhea Tx

Answer 41

Diphenoxylate | Loperadine

Question 42

What do the Antimotility Agents act on

Answer 42

Mu | Delta