Opioids

Question 1

Why is there a higher dose for oral?

Answer 1

Due to first past effect

Question 2

What are strong opioid agonists?

Answer 2

Morphine, Fentanyl, Meperidine (Demerol), and Methadone

Question 3

What are moderate opioid agonists?

Answer 3

Codeine, oxycodone, and hydrocodone

Question 4

What does PCA stand for?

Answer 4

Patient controlled analgesia

Question 5

Why is it better to have a fixed drug schedule rather than PRN?

Answer 5

Better to manage pain instead of chasing it and ultimately needing to give higher doses

Question 6

Clinical manifestations of toxicity?

Answer 6

coma, respiratory depression, and pinpoint pupils

Question 7

What is the tx for overdose?

Answer 7

Ventilatory support and antagonist: Naloxone (Narcan)

Question 8

MOA for Narcan?

Answer 8

Blocks receptor sites

Question 9

Why is Narcan not given PO?

Answer 9

D/t first pass effect

Question 10

Which drug is 100 times stronger than Morphine?

Answer 10

Fentanyl

Question 11

Why is Meperidine (Demerol) not given as often?

Answer 11

It has toxic metabolite accumulations, short half life, and interacts adversely with other drugs

Question 12

Why is Vicodin (Hydrocodone + Tylenol) the most abused medication?

Answer 12

It is not a scheduled narcotic

Question 13

MOA of Tramadol (Ultram)?

Answer 13

inhibits reuptake of serotonin and norepinephrine

Question 14

What drugs should be avoided when taking Tramadol?

Answer 14

MAOIs, SSRIs, TCA, Triptans, and SNRIs

Question 15

T/F. Sedation comes before respiratory depression

Answer 15

True

Question 16

What are the routes for Fentanyl?

Answer 16

IV, transdermal, and transmucosal

Question 17

Why are IV opioids pushed slowly?

Answer 17

Too fast can cause the pt to experience hypotension or respiratory depression

Question 18

Why do we need to assess for SI with the use of Tramadol?

Answer 18

It is often used as a vehicle for suicide

Question 19

What 2 drugs make up Percocet?

Answer 19

Tylenol and Oxycodone

Question 20

Routes for Naloxone?

Answer 20

IM, IV, Subcut, and nasal spray outpatient

Question 21

What does opioid tolerant and naive mean?

Answer 21

Tolerant: pt has been taking at least 60mg of morphine or equal analgesic dose of another opioid for a week or longer.

Naive: pt’s who do not meet opioid tolerant criteria and have not had narcotics of at least 60mg for a week or more.

Question 22

What is the most critical assessment we need to do in patients using PCA pump?

Answer 22

Sedation assessment (Pasero, Ramsay, or Richmond Agitation or Sedation Scale)

Question 23

What are other assessments we need to do with PCA pump use?

Answer 23

1. Is the patient able to effectively use the tool?
2. opioid tolerant or opioid naive?
3. consistent use of pain scale.
4. Sedation assessment w/ resp assessment