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OMS - 2 Neuro Final > Opioids > Flashcards

Opioids Flashcards

1
Q

Define narcotic

A
  • Addictive properties
  • Produces analgesic and sedative effects
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2
Q

Morphine is primarily ____ receptor-mediated

A

Mu

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3
Q

Opiate is derived from _____.

A

Opium

(ex: morphine and codeine)

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4
Q

Opioid is a drug (natural or synthetic with ______ qualities.

A

morphine-like

(narcotic)

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5
Q

Opioid analgesics are collectively called _______ (3).

A
  1. Narcotic
  2. Opiate
  3. Opioid
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6
Q

Opioid abstinence syndrome: symptoms (4)

A
  1. Muscle aches
  2. Chills
  3. Nausea
  4. Diarrhea

(overdose would cause coma)

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7
Q

What is an opioid agonist/antagonist used for?

A

Opioid rehab programs

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8
Q

Opioid types (made for a certain symptom) (4)

A
  1. Analgesic
  2. Anesthetic
  3. Antitussive
  4. Antidiarrheal
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9
Q

Moderate opioid Agonist: 2 examples

A
  • Codeine (robitussin AC)
  • Hydrocodone
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10
Q

Combination opioid meds typically have ______ and are _______ at lower doses.

A
  • acetaminophen combination
  • Synergistic
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11
Q

Why are opiates a concern for geriatric patients?

A

Significantly depress the CNS

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12
Q

_____ may produce varied analgesic responses due to a genetic polymorphism.

A

Codeine

(metabolized by 2D6)

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13
Q

Which weak opiate agonist are used for a diarrhea (2)?

A
  • Loperamide (imodium)
  • Dephenoxylate (lomotil) combine w/atropine
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14
Q

What is the first line in treating heroin patients (2)

A
  • Methadone
  • Then mixed opioid antagonist
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15
Q

Opioid MOA

A

mu, kappa, delta receptor agonist

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16
Q

List the endogenous opioids that modulate the pain gate pathway

A
  1. Endorphins
  2. Dynorphins
  3. Enkephalins
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17
Q

Opioid receptor locations in the CNS (in order of abundance).

A
  1. cerebral cortex
  2. amygdala
  3. septum
  4. thalamus
  5. hypothalamus
  6. midbrain
  7. spinal cord
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18
Q

Opioids: 3 primary sites of action

A
  1. Spinal cord
  2. Thalamus and limbic system
  3. Brainstem
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19
Q

Opioid: mechanism of action

A

TQ!!

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20
Q

Morphine: uses (3)

A
  1. Severe and chronic pain (post-op, cancer)
  2. Acute pulmonary edema
  3. Palliative
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21
Q

Morphine: contraindications (4)

A
  1. Respiratory compromise
  2. Asthma
  3. Pregnancy
  4. Increased ICP
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22
Q

What makes morphine a unique opioid?

A

Initially causes nausea and vomiting, but it releases histamine so it can cause bronchospasm, blepharitis and hypotension

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23
Q

Tell-tale sign of patient on morphine

A

Meiosis (“pinpoint pupils”)

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24
Q

Morphine: peripheral effects (4)

A
  1. Cardio: vasodilation, decreases blood pressure negative ionotropic response
  2. Skin: histamine release→ itchiness
  3. Pulmonary: bronchospasm
  4. GI: constipation (decreased motility)
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25
Q

Morphine: effect on smooth muscle (4)

A
  1. Biliary tract: tenfold increase of normal pressure (contraction of sphincter of Odi)
  2. Urinary bladder: increased detrusor tone
  3. Bronchospasm
  4. Uterus: reduced tone (may prolong labor)
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26
Q

Which opiate is recommended during labor and delivery (2)?

A
  1. Meperidine (demerol)
  2. Fentanyl
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27
Q

Metabolism of morphine

A
  • Undergoes conjugation to active metabolites: morphine 6β glucoronide (6xs the analgesic potential) and morphine 3β glucoronide .
  • Renal excretion

(can sequester in adipose tissue)

28
Q

List 3 strong opioids

A
  1. morphine
  2. meperideine
  3. methadone
29
Q

Which strong opioid is used during labor and delivery, as a pre-op medication, and comes in a transdermal patch for chronic pain patients?

A

Fentanyl (sublimaze, duragesic)

(rapid onset, short-acting)

30
Q

Side effects of meperidine (demerol) (2)

A
  1. normeperidine (metabolite) → seizures
  2. Normeperidine inhibits serotonin reuptake → serotonin syndrome

(TQ!!! Also avoid in renal dysfunction pts)

31
Q

Why is methadone used for heroin rehabilitation (3)?

A
  1. Long-acting (half-life 24 hrs)
  2. As potent as morphine (strong)
  3. Low addiction potential

(can also displace any left-over heroin)

32
Q

How is heroin administered (3)?

A
  1. Injected
  2. Snorted
  3. Smoked

(contamination → cardiovascular collapse)

33
Q

Heroin characteristics (3)

A
  1. Lipophilic (enters BBB)
  2. 3 times more potent than morphine
  3. No medicinal value
34
Q

Classification of codeine and hydrocodone

A

Moderate opioid Agonist

(Next Step Up from NSAIDs)

35
Q

Codeine uses (2)

A
  1. Antitussive (relieves cough)
  2. Analgesic (dental procedures)

(Low abuse potential; usually combined with acetaminophen)

36
Q

Codeine eventually gets metabolized to _____.

A

morphine

*some people may have an issue w/CyP2D6 → metabolism is not the same for everyone, it affects them differently

37
Q

Propoxyphene is a derivative of_____.

A

methadone

38
Q

Propoxyphene use

A

Analgesic similar to aspirin (usually combined w/acetaminophen)

(weak opioid agonist)

39
Q

Dextromethorphan use

A

Antitussive (Delsym, Robituussin DM)

40
Q

_____ (opioid) should be avoided with patients on antidepressants.

A

Meperidine

(can increase the risk of seizure→serotonin syndrome)

41
Q

If you have a patient who is traveling or away from home and has had unrelenting diarrhea for the past 48 Hours, what do you recommend?

A

Loperamide (Imodium)

(GI effects only; as opposed to Diphenoxylate (Lomotil) which has CNS effects *sedation*also)

42
Q

What would you prescribe a patient who has unrelenting diarrhea that has kept them from sleeping at night?

A

Diphenoxylate

(GI & CNS → sedation)

43
Q

List the two anti-diarrheal opioids

A
  1. Loperamide (Imodium)
  2. Diphenoxylate (Lomotil)
44
Q

Anti-diarrhea opioids cause ______ (2) at high doses.

A
  1. respiratory depression
  2. euphoria
45
Q

Which medications are used to treat heroin withdrawal (3)?

A
  1. Pentazocine (Talwin)
  2. Nalbuphine (Nubain)
  3. Butorphanol (Stadol)
46
Q

Buprenorphine (Subutex) use

A

outpatient opioid detoxification

47
Q

Medication given during opioid overdose?

A

IV Naloxone (narcan)

48
Q

Naloxone: mechanism of action

A
  • Binds to opioid receptor → displacing opioid
  • 10 fold affinity to Mu receptor

(IV Administration→ quick and dramatic reversal)

49
Q

Why might you need to give multiple administrations of naloxone to a patient who is overdosing on opioid?

A

Heroin has a longer half-life than naloxone

50
Q

List the different types of pain

A
  1. Mechanical / nociceptive pain in response to noxious stimuli
  2. Inflammatory pain
  3. Neuropathic pain
  4. Functional pain
51
Q

NSAIDs are used for which type of pain?

A

Mechanical and inflammatory

52
Q

Pain management treatment options (6)

A
  1. Non-opioid
  2. Opioid
  3. Antidepressant
  4. Anticonvulsants
  5. CBT
  6. CAM

(step-wise treatment from weak to strong)

53
Q

Define Fibromyalgia (3)

A
  1. Widespread pain for at least 3 months
  2. Pain on both sides of the body, above and below the waist
  3. Axial skeletal pain
54
Q

Fibromayalgia: pathophysiology

A
55
Q

Fibromyalgia: Rx

A
  1. Pregabalin
  2. Duloxetine/Gabapentin
  3. Tizanidine
56
Q

Migraine: Rx

A

Antiemetic-triptan-NSAIDs combination

(primarily the triptan portion that has the greatest effect; causes vasoconstriction)

57
Q

High yield triptan?

A

Sumatriptan (agonist at 5HT-1D receptors)

58
Q

List four causes of neuropathic pain

A
  1. Peripheral neuropathy
  2. Trigeminal neuralgia
  3. Post-stroke pain
  4. Spinal cord injury
59
Q

5 types of neuropathic pain

(description/feels like…)

A
  1. Burning pain
  2. Cold
  3. Itching
  4. Tingling / prickling
  5. Shooting / stabbing
60
Q

_____ is used to treat post herpetic neuralgia

A

Gabapentin/pregabalin

61
Q

______ is used to treat trigeminal neuralgia

A

Carbamezapine

62
Q

________ is used to treat diabetic peripheral neuropathy

A

Pregabalin/Duloxetine

63
Q

______ is used to treat cancer pain

A

opioids

(must increase as the cancer progresses)

64
Q

Morphine inhibits the release of substance P from the primary afferent nerve endings and spinal cord by_____.

A

inhibition of calcium influx

65
Q

A patient is administered meperidine for pain management and develop seizures. Further investigation reveals she is on medication for psychiatric condition. Which drug most likely potentiated this side effect?

A

Imipramine (TCA antidepressant)

OMS - 2 Neuro Final (36 decks)

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