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445- Pain and Mental Health > Opioid Management > Flashcards

Opioid Management Flashcards

1
Q

naturally occurring substances with morphine like properties

A

opiate

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2
Q

includes synthetic substances that have affinity for opioid receptors

A

opioid

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3
Q

natural opioids include

A

morphine, codeine

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4
Q

semisynhetic opioids include

A

hydromorphone, oxycodone, hydrocodone, heroin

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5
Q

synthetic opioids include

A

buprenorphine, diphenoxylate, fentanyl, loperamide, meperidine, methadone, pentazocine, tapentadol, tramadol

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6
Q

opioid MOAs

A

Opioid inhibits inhibitory GABAergic neuron acting on pain inhibitory neuron at spinal cord (medulla)

are full or partial agonists of μ, δ, к receptors

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7
Q

the conversion from PO to IV doses are usually

A

2x higher for PO dose

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8
Q

how to approach opioid initiation

A

define goals before start
individualize opioid selection, dosing
short acting opioids may be safer
start low, go slow

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9
Q

Around the clock or basal dose for opioids is usually are

A

regularly scheduled IR or CR/SR release

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10
Q

breakthrough PRN dose for opioids is usually ____ of the total daily dose in IR formulation

A

10-15%

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11
Q

when to adjust Short acting IV/ SQ or IR given PRN only

A

dose by dose

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12
Q

when to adjust Short acting IV/SQ or IR given ATC

A

q24h

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13
Q

when to adjust CR/SR dose

A

48-72hrs

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14
Q

when to adjust fentanyl patch dose

A

q3-6 days

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15
Q

how to calculate new dose if pt is using lots of breakthrough doses

A

total up all regular and breakthrough doses in last 24hrs, divide by 3 for new regular doses, times by 10-15% for new breakthrough doses

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16
Q

it is recommended to restrict prescribed LT opioid dose for chronic noncancer pain to ____ morphine equivalents daily

A

90mg

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17
Q

list 3 RF for opioid abuse/ misuse/ addiction

A

poorly defined pain condition, personal and family hx of alcohol or drug abuse, presence of psychiatric illness, cigarette use, hx of preadolescent sexual abuse, prior hx of aberrant drug related behaviours, =<45yrs, hx of legal problems, associates with others who abuse drugs

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18
Q

which of the following AEs do opioid users not build tolerance to? (pick 2)
1. respiratory depression
2. constipation
3. N/V
4. cognitive effects
5. neuroendocrine and sleep effects

A

2, 5

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19
Q

how to treat opioid respiratory deprsesion

A

naloxone

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20
Q

how to treat opioid induced constipation

A

laxatives and methylnaltrexone

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21
Q

how to treat N/V from opioids

A

dose reduction or rotation
switch to other routes of admin
dopamine antagonists
anticholinergics
ondansetron
treat constipation

22
Q

how to treat pruritius from opioids

A

antihistamines, opioid rotation, naloxone in refractory cases

23
Q

how to treat cognitive effects from opioids

A

stimulants or refrain from certain tasks

24
Q

how to treat neuroendocrine effects from opioids

A

testosterone in men

25
Q

how to treat sleep disturbances from opioids

A

appropriate sleep hygeine

26
Q

T or F: tolerance to opioid induced sleep disturbances can be build

A

F

27
Q

T or F: most opioid allergies are AEs and should not have cross sensitivity with different structural classes

A

T

28
Q

if there is a true allergy to morphine or codeine, what can be done?

A

try a synthetic or semisynthetic opioid

29
Q

opioid tolerance mechanisms

A

receptor desensitization
superactivation of cAMP pathway

30
Q

opioid tolerance management

A

increase dose
use longer acting opioids
add nonopioid analgesics
add drugs that prevent/ delay tolerance

31
Q

opioid induced hyperalgesia MOAs

A

sensitization of primary afferent neurons
activation of dynorphin and central glutamatergic systems

32
Q

opioid induced hyperalgesia management

A

taper dose
add NMDA agent
try longer acting opioids
rotate opioids

33
Q

worsening pain state MOA if the patient is on opioids (3 points)

A

disease progression
neuropathic pain mechs
enhanced opioid metabolism

34
Q

worsening pain state AE management strategies

A

increase dose
add nonopioid analgesics
treat for neuropathic pain/ other pain mechs

35
Q

opioid rotation may be useful for ________________

A

balancing analgesia and AEs if AEs are believed to be due to accum of opioid metabolites

36
Q

what is the codeine conversion factor to morphine

A

0.15

37
Q

what is the oxycodone conversion factor to morphine

A

1.5

38
Q

what si the hydromorphone conversion factor to morphine

A

5

39
Q

after getting a MEDD, what should you do to get new dose

A

reduce dose for incomplete cross tolerance

40
Q

how much should be reduced for incomplete cross tolerance if previous dose was 91MEDD and there were SEs

A

lower by 50%

41
Q

how much should be reduced for incomplete cross tolerance if previous dose was 50MEDD? give a range

A

25-40%

42
Q

4 times to stop an opioid

A

pain resolved
AEs > benefits
risks > benefits
opioid ineffective

43
Q

should you d/c an opioid if it did little to control pain but did well in controlling anxiety

A

yes- is considered ineffective

44
Q

a rapid taper includes decreasing the dose by _____% q___d and is often completed in ____

A

10-20%
q1-3d
in 1-2wks

45
Q

a slow and gradual taper is decreasing the dose by ____% q___wksand is often completed in ____

A

5-10%
q2-4wks
in 1-6mths

46
Q

in a slow and gradual taper, once 1/3 of dose is reached, what can improve success?

A

slowing down taper to decrease of 5% q4-8wks

47
Q

a rapid taper is more for those who are

A

severe AEs
highly motivated
on low doses

48
Q

opioid agonist therapy may be useful for

A

tapering/ switching pts with opioid use disorder
concurrent psych conditions
LT opioid use (>5yrs)
pregnant

49
Q

opioid drug interactions include

A

CNS depressants like ethanol and BZs
serotonergic agents
those that interfere with CYP3A4 and 2D6

50
Q

which opioids have serotonergic components

A

tramadol, methadone

445- Pain and Mental Health (21 decks)

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