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BB Test 4 > Opioid Use Disorder > Flashcards

Opioid Use Disorder Flashcards

1
Q

(T/F) Any substance that may bind to an opioid receptor is considered an opioid.

A

True.

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2
Q

What are the natural opioids, aka opiates?

A
  • Morphine
  • Codeine
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3
Q

What are the semisynthetic opioids?

A
  • Heroin
  • Oxycodone
  • Hydrocodone
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4
Q

What are the synthetic opioids?

A
  • Methadone
  • Levo-α-acetylmethadol (LAAM)
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5
Q

What are the endogenous opioids?

A
  • β-endorphine
  • Enkephalins
  • Dynorphin
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6
Q

What are the common opioid antagonists?

A
  • Naloxone
  • Naltrexone
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7
Q

What is the opioid partial agonist/antagonist?

A
  • Buprenorphine
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8
Q

Morphine is derived from the poppy plant. It may also be converted into ____________ by synthetic methods.

A

Heroin

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9
Q

Codeine is derived from the poppy plant. It may also be converted into ____________ and ____________ by synthetic methods.

A

Oxycodone and hydrocodone

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10
Q

What are the three different opioid receptors?

A
  • δ (delta)
  • κ (kappa)
  • μ (mu)
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11
Q

The (δ/κ/μ) opioid receptor primarily modulates analgesia, endocrine changes, and dysphoria.

A

κ (kappa)

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12
Q

The (δ/κ/μ) opioid receptor primarily modulates tolerance.

A

δ (delta)

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13
Q

The (δ/κ/μ) opioid receptor primarily modulates analgesia. It may be activated by morphine, along with serving as the primary action site for all other opioids. It is located primarily within the CNS and GI tract, and has also been linked to abuse and dependence.

A

μ (mu)

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14
Q

What are the most common acute effects associated with opioid ingestion?

A
  • Analgesia (thalamus)
  • Sedation and euphoria (VTA and nucleus accumbens)
  • Respiratory depression (medullary respiratory center)
  • Miosis (Edinger-Westphal nucleus) - Except meperidine
  • Nausea and vomiting (chemoreceptors in area postrema)
  • Antitussive
  • Constipation (decreased peristalsis)
  • Contraction of smooth muscle (biliary tract, increased ureter and bladder sphincter tone, and reduction in uterine tone)
  • Flushing
  • Pruritus (itching of the skin)
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15
Q

Opioids cause (mydriasis/miosis). The exception to this rule is ____________.

A
  • Miosis
  • Exception is meperidine
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16
Q

Opioids cause respiratory (depression/stimulation). They do this by affecting the ____________________ of the brain.

A
  • Depression
  • Medullary respiratory centers
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17
Q

Opioids cause sedation and euphoria. They accomplish this by affecting the _________________ and _________________ of the brain.

A
  • Ventral Tegmental Area (VTA)
  • Nucleus accumbens (NAc)
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18
Q

Opioids may also cause nausea and vomiting. This is brought about by effects on the ________________ of the brain.

A

Area postrema

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19
Q

(T/F) Opioids may serve as antitussives.

A

True.

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20
Q

Opioids cause (increased/decreased) peristalsis in the intestines. This can cause (constipation/diarrhea).

A
  • Decreased peristalsis
  • Constipation
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21
Q

Opioids cause the (contraction/relaxation) of smooth muscle within the biliary tract.

A

Contraction

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22
Q

Opioids may cause (decreased/increased) ureter and bladder sphincter tone.

A

Increased

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23
Q

Opioids can also cause (increased/decreased) uterine tone.

A

Decreased

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24
Q

(T/F) Opioids can cause flushing and a burning sensation on the skin.

A

False. Opioids cause flushing and pruritus, an intense itching sensation on the skin.

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25
Q

Opioids have (increased/decreased) protein binding capabilities compared to most other analgesics.

A

Increased

26
Q

Opioids most commonly undergo (renal/hepatic) metabolism.

A

Hepatic

27
Q

What are the two most common methods of opioid excretion?

A
  • Kidney
  • GI tract (bile)
28
Q

What are some of the clinical uses for opioids?

A
  • Analgesia
  • Cough suppression
  • Treatment of diarrhea
  • Anesthesia
  • Opioid dependence treatment
29
Q

(T/F) Opioids are most often administered alone

A

False. Opioids are most often administered in combination with APAP or NSAIDs.

30
Q

The US consumes about ___% of the world’s opioid supply annually.

A

80%

31
Q

The main causes of mortality seen in opioid abuse are ___________ and __________.

A
  • HIV/AIDS (from sharing needles)
  • Overdose
32
Q

Opioid Use Disorder is characterized by the presence of two criteria occurring within a twelve month period. What are these criteria?

A
  • Use results in failure to fulfill roles at work, school, or home
  • Use in situations where it is physically hazardous
  • Continued use in spite of social or interpersonal problems
  • Tolerance
  • Withdrawal
  • Substance taken in larger amounts or over longer period than intended
  • Unsuccessful efforts to cut down use
  • Great deal of time devoted to obtaining substance
  • Important activities are given up because of use
  • Use is continued despite knowledge of having problem
  • Cravings or strong desires to use substance
33
Q

A patient is in (early/sustained) remission if no criteria for opioid use disorder is present for 12 months or longer. Craving is the exception and may still be present.

A

Sustained

34
Q

A patient is in (early/sustained) remission if no criteria for opioid use disorder is present for at least 3 months but less than 12 months. Craving is the exception and may still be present.

A

Early

35
Q

A patient is specified as (“on maintenance therapy”/”in a controlled environment”) if in a setting where access to opioids is restricted.

A

In a controlled environment

36
Q

A patient is specified as (“on maintenance therapy”/”in a controlled environment”) if naltrexone, naloxone, methadone, or buprenorphine is being administered and none of the criteria for Opioid Use Disorder is met, except for tolerance and withdrawal.

A

On maintenance therapy

37
Q

What are the severity specifiers in relation to opioid use disorder?

A
  • Mild: 2-3 criteria
  • Moderate: 4-5 criteria
  • Severe: 6 or more criteria
38
Q

(Mild to moderate/Severe) opioid intoxication is a life threatening medical emergency.

A

Severe

39
Q

(Mild to moderate/Severe) opioid intoxication presents as euphoria or sedation and is relatively not life threatening.

A

Mild to moderate

40
Q

Eventually, patients develop tolerance to opioids through chronic use and abuse. (Minimal/Increased) tolerance is seen for constipation, miosis, and sweating.

A
  • Minimal tolerance
    • Patient will still experience these effects no matter the dose.
41
Q

Eventually, patients develop tolerance to opioids through chronic use and abuse. (Minimal/Increased) tolerance is seen for euphoria, sedation, respiratory depression, vomiting, and analgesia.

A
  • Increased tolerance
    • Patients require increasing doses to elicit these effects.
42
Q

(T/F) If the patient exhibits physical dependence symptoms, administration of naloxone or naltrexone may precipitate withdrawal.

A

True.

43
Q

For clinical diagnosis of opioid intoxication, what must be observed in the patient?

A
  • Pupillary constriction (required)
  • Drowsiness or coma
  • Slurred speech
  • Impairment in speech or memory
  • Abnormal mental status
44
Q

What is the opioid overdose “toxicity triad”?

A
  • Miotic pupils
  • Abnormal mental status
  • Respiratory depression ( <12/min)
45
Q

What is the general supportive treatment for opioid intoxication?

A
  • Maintain airway
  • Stabilize breathing
  • Administer naloxone
  • Monitor circulation

Always be nice, children.

46
Q

____________ is a pure opioid antagonist administered in overdose cases. It has a very quick onset of around 2 minutes and a relatively short half life of approximately 64 minutes.

A

Naloxone

47
Q

Why is being familiar with naloxone’s half life clinically important?

A

If a patient has overdosed on a drug that has a half life of longer than one hour, they will begin to display overdose symptoms again once the naloxone has been broken down.

  • Must dose frequently
48
Q

___________ is a long-acting, pure opioid antagonist with a long half life, able to block heroin’s effects for up to 48 hours. It is primarily used in alcohol dependence to decrease alcohol cravings.

A

Naltrexone

49
Q

Opioid withdrawal is (fatal/not fatal)

A

Not fatal

50
Q

Most withdrawal symptoms may be linked to hyperactivity of the ___________ within the brain, providing a stimulatory effect for the body.

A

Locus ceruleus

51
Q

What are the signs of opioid withdrawal?

A
  • One of the following:
    • Prolonged and heavy reduction in opioid use
    • Administration of opioid antagonist after use
  • Accompanied by three of the following:
    • Dysphoria
    • Nausea/vomiting
    • Muscle aches
    • Lacrimation or rhinorrhea
    • Pupillary dilation, piloerection, sweating
    • Diarrhea
    • Yawning
    • Fever
    • Insomnia
52
Q

____________ is most often given in opioid withdrawal cases to attenuate the α-adrenergic effects caused by the locus ceruleus.

A

Clonidine

53
Q

Opioid maintenance therapy decreases mortality rates by ___%.

A

70%

54
Q

_____________ and ____________ are the choices available for opioid maintenance therapy (OMT).

A
  • Methadone
  • Buprenorphine
55
Q

What is the mechanism of action for methadone and buprenorphine?

A

Both provide levels of opioid stimulation that, when administered at prescribed doses, allow the patient to maintain alertness without cravings, withdrawal symptoms, or drug preoccupation.

56
Q

(Methadone/Buprenorphine) is a partial opioid agonist. It is dispensed in sublingually dissolved tablets. Its half life is around 72 hours.

A

Buprenorphine

57
Q

(Methadone/Buprenorphine) is a full opioid agonist. It is dispensed in liquid form with a half life of 24-36 hours. Steady state doses are achieved with this drug in 3-7 days.

A

Methadone

58
Q

Methadone is metabolized by ___________, a cytochrome P450 enzyme.

A

CYP3A4

59
Q

(T/F) Methadone causes decreased QT intervals in patients.

A

False. Methadone causes prolonged QT intervals in patients.

60
Q

(Methadone/Buprenorphine) is the gold standard for use in pregnant patients.

A

Methadone

  • However, in MOTHER study, Buprenorphine is showed to be equally safe, now the preferred treatment at UAMS

BB Test 4 (14 decks)

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