Opioid Pain Management Flashcards
T/F opioids are effective for both musculoskeletal and neuropathic pain
true
what type of pain are opioids not recommended for?
back pain
management of acute pain with opioids should rarely exceed _ days
3
why are opioids so addictive and risky?
opioids bind to the nucleus accumbens to release dopamine which leads to euphoria
acute use of opioids causes decreased level of cAMP production. what would we expect to see with chronic use? what about discontinuation of opioids after chronic use?
with chronic use the body adjusts to have increased activity to stabilize cAMP production. If you discontinue opioid you will have an overproduction of cAMP due to the increased activity
how to combat nausea/vomiting from opioids?
take with food, use zofran
how to combat pruritis from opioids?
antihistamines (2nd gen. to avoid sedation)
Morphine:
renal/hepatic adjusments?
has a high occurrence of what SE?
routes of admin?
renal required
pruritis
PO,IV
Oxycodone:
renal/hepatic adjusments?
routes of admin?
hepatic required
PO
Hydrocodone:
renal/hepatic adjusments?
routes of admin?
both required
PO
Fentanyl:
renal/hepatic adjusments?
routes of admin?
no
transderm patch, SL, IV
if using a fentanyl patch, how often does the patch need to be removed and rotated?
3 days
Methadone:
routes of admin?
risk?
uses?
PO and IV
serotonin syndrome, hypotension, and QT prolongation
opioid use disorder or analgesia
DD interaction b/w methadone and alcohol/benzos?
increased resp depression risk
DD interaction b/w methadone and TCAs?
increased anticholinergic effects and QT prolongation
DD interaction b/w methadone and SSRI/SNRIs?
increased risk of serotonin syndrome
DD interaction b/w methadone and CYP450 inducers?
increased methadone metabolism
DD interaction b/w methadone and and CYP450 inhibitors?
decreased methadone metabolism
Meperidine:
renal/hepatic dose adjustment?
use?
not recommended in any renal impairment
post-op shivering
why can codeine be used off label for diarrhea?
high chance of causing constipation
Tramadol:
renal/hepatic dose adjustment?
renal adjustment
all opioids are in the same category except for which 3?
methadone
meperidine
fentanyl
duration of acute opioid use should typically last how many days?
3 days
