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Pharmacology > Opioid lecture part 3 > Flashcards

Opioid lecture part 3 Flashcards

1
Q

What is one of the most frequently prescribed opioids in dentistry the is not used as sole agent, aka it is used in combination products with acetaminophen or aspirin

A

codeine

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2
Q

codeine has what percentage the potency of morphine?

A

one-sixth

10 mg morphine = 60 mg codeine

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3
Q

What is the optimum dose of codeine?

A

60 mg is optimum dose

- If exceed 60 mg, no greater analgesic effect, but more side effects

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4
Q

Which is better orally, codeine or morphine

A

Oral morphine is poorly absorbed, so we use codeine, given orally, instead

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5
Q

In dentistry, codeine is used in combination preparations with?

A
  1. aspirin

2. acetaminophen

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6
Q

T or F, codeine is not good for severe pain

A

True (use oxycodone)

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7
Q

What is the drug of choice for cough suppression?

A

codeine

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8
Q

Adverse reactions to codeine

A
  • Nausea
  • Dizziness
  • Excitability
  • Constipation
  • Allergy = skin rash, asthmatic-type reaction
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9
Q

codeine dosing

A

15-60 mg every 4-6 hours when pain is present

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10
Q

Codeine containing preparations are identified by numbers that reflect the mg concentration. give examples

A 
#1 = 8 mg (OTC in Canada, not in US)
#2 = 15 mg
#3 = 30 mg
#4 = 60 mg
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11
Q

Popular codeine preparations:

A
  1. Tylenol with codeine (#1,2,3,4) –> C-III/C-IV
    • acetaminophen 300 mg
    • Most widely prescribed codeine product by dentists is Tylenol #3
  2. Fiorinal w codeine (#1,2,3)
    - relief of complex tension (muscle contraction) headache - C-III
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12
Q

What is the most widely prescribed codeine product by dentists

A

Tylenol #3

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13
Q

T or F, Hydrocodone is 2 times less potent than codeine

A

False, 3 times more potent than codeine

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14
Q

Drug examples of hydrocodone with acetaminophen

A
  1. Vicodin (5/500 mg or 7.5/500 mg)

2. Lorcet/Lortab (5/500 mg; 7.5/500 mg)

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15
Q

Describe the dosing for Norco and why it might be good

A

10 mg hydrocodone with 325 mg acetaminophen

- uses lower dose of acetaminophen in alignment with new FDA recommendations to reduce risk for acute liver damage

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16
Q

dihydrocodeine’s efficacy/potency is what compared to codeine?

A

The same

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17
Q

T or F, dihydrocodeine is no more effective than Tylenol #3

A

True

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18
Q

Drug example for dihydrocodeine

A

Synalgos DC

  • dihydrocodeine = 16 mg
  • aspirin 356.4 mg (avoid if aspirin allergy)
  • caffeine 30 mg
19
Q

T or F, oxycodone is less potent than morphine

A

False, it is AS potent as morphine

  • More potent than codeine
  • Highly addictive
20
Q

Oxycodone is what schedule of drugs

A

Schedule II - used in dentistry in combo products for severe pain

21
Q

Drug examples for oxycodone

A
  1. Percocet (oxycodone 5 mg; acetaminophen 325 mg)
  2. Tylox (oxycodone 5 mg; acetaminophen 325 mg)
  3. Percodan (oxycodone 5 mg; aspirin 325 mg)
  4. Roxicet (oxycodone 5 mg; aspirin 325 mg) *Drug seekers ask by name
22
Q

Combunox includes how much of oxycodone and ibuprofen

A

oxycodone 5 mg with ibuprofen 400 mg

23
Q

Combunox could be used for what?

A

Short term management of acute, moderate-to-severe dental pain
- Used for 3-5 days only

24
Q

fentanyl is how potent in comparison to morphine

A

100 times more potent than morphine

- 500 times more potent than meperidine

25
Q

How is fentanyl used in dentistry

A

for conscious sedation only

- IV, transdermal, lollipop

26
Q

How long is tramadol used for?

A

Use for less than or equal to 5 days for acute dental pain

27
Q

tramadol binds to what receptors?

A

mu opiate receptors in CNS, which inhibits ascending pain pathways, altering perception of and response to pain.

28
Q

tramadol inhibits the repute of what?

A

norepinephrine and serotonin

- also modulates ascending pathway

29
Q

dosing of tramadol

A

immediate release given 50-100 mg every 4 to 6 hours, not to exceed 400 mg/day = titrate up

30
Q

T or F, tramadol is not associated with seizures

A

False, is

31
Q

tramadol can be used with what other non-opioid in a combo product

A

acetaminophen
- acetaminophen 325 mg and tramadol 37.5 mg

  • use for less than or equal to 5 days for post-op dental pain
32
Q

dosing of Ultracet

A

2 tablets every 4-6 hours (maximum 8 tablets per day)

- acetaminophen dictates totally maximum daily dose

33
Q

Describe ketorolac (Toradol) as its classification and use

A

NSAID
Provides analgesia at the opioid level
Indicated for moderate to severe dental pain
Short term use < 5 days

34
Q

Limite opioid use to what? for what reasons?

A

limit use to 3-5 days (acute pain only)

- Write for limited quantities due to the potential for addiction

35
Q

Which opiate agent is the most widely used for the management of dental pain

A

hydrocodone with acetaminophen (Vicodin or Lorcet)

36
Q

Of the codeine preparations, which is the most widely prescribed in dentistry

A

Tylenol #3

37
Q

T or F, oxycodone with acetaminophen is used to treat the more severe degrees of pain

A

True

38
Q

meperidine (Demerol) is useful for patients with a history of what?

A

codeine allergy

39
Q

T or F, morphine and hydromorphone are indicated as analgesics in any dental situation

A

False, NOT indicated

40
Q

T or F, whenever possible, an opiate agent is preferred to an NSAID for pain management because of its potency

A

False, Whenever possible, an NSAID is preferred to a opiate agent for pain management
- Opiates do not reduce inflammation, which is the most common etiology for dental pain

41
Q

T or F, ALL opiates will cause nausea in most patients

A

True

42
Q

T or F, Constipation is usually not a common complaint with patients on opiate drugs

A

False, Constipation is another common complaint for patients on opiate drugs

43
Q

Ranking opiates by potency

A
  1. fentanyl - 100 times more potent than morphine
  2. Morphine = oxycodone
  3. meperidine
  4. hydrocodone = 3x more potent than codeine
  5. codeine = 1/6 the potency of morphine
  6. dihydrocodeine = codeine

Pharmacology (24 decks)

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