Opioids Flashcards
A majority of the drugs in this deck are of what class?
Opioid AGONISTS
What are the 2 Partial Agonists (mixed agonist/antagonist)?
Pentazocine
Buprenorphine
What are the 2 Partial Agonists (mixed agonist/antagonist)?
Pentazocine
Buprenorphine
What are the 2 Opioid Antagonists?
Naloxone
Naltrexone
What are the 2 Opioid Antagonists?
Naloxone
Naltrexone
What is the most potent Opioid Agonist compared to Morphine?
Fentanyl
What is the least potent Opioid Agonist compared to Morphine?
Codeine
MOA for Opioid Agonists?
Bind to opioid receptors in the cns
=> (-) ascending pain pathways and cause CNS depression
List some times when Opioids are used
Pain Anesthesia adjuncts Palliative care Antitussive (prevent cough) Antidiarrheal
What are some general adverse effects of Opioid Agonists?
CNS and Respiratory depression
Constipation
Hypotension
What are some general adverse effects of Opioid Agonists?
CNS and Respiratory depression
Constipation
Hypotension
When Opioid Agonists are combined with Sedative-Hypnotics, what can occur?
Increased respiratory depression
When Opioid Agonists are combined with Antipsychotics, what can occur?
Increased sedation and accentuation of cardiovascular effects
When Opioid Agonists are combined with Monoamine Oxidase Inhibitors, what can occur?
Hyperpyrexic Coma and HTN
From their weakest dose to their strongest, describe the cascade of effects seen with Opioid Agonists?
Antidiarrheal Antitussive Euphoria Nausea Analgesic Sedation Respiratory Depression Coma/Death
What are the 3 Opioid Receptors?
Mu, Delta, Kappa
Describe the highest affinity endogenous opioid peptides for the mu receptor
Endorphins» Enkephalins» Dynorphins
Describe the highest affinity endogenous opioid peptides for the delta receptor
Enkephalins» Endorphins» Dynorphins
Describe the highest affinity endogenous opioid peptides for the kappa receptor
Dynorphins» all the rest
What are some contraindications for Morphine Sulfate? (3)
Bronchial Asthma
Upper Respiratory obstruction
Allergy to Morphine
When if Fentanyl indicated?
Pain that requires continuous around the clock opioid administration and cannot be managed by other means
What is Methadone used for?
Best at managing abstinence symptoms and TREATING OPIOID USE DISORDER in outpatient rehab settings!
What Opioid Agonist is the best at treating opioid use disorder especially for heroin addicts?
Methadone
– manages abstinence symptoms and treats
Hydrocodone is a very common Opioid Agonist. What are its common uses and what is it commonly combined with?
Analgesic and Antitussive
– Commonly combined with Acetaminophen
What adverse effect should you watch for when Hydrocodone is combined with Acetaminophen?
Hepatotoxic
What should Meperidine NOT be used with?
Partial Agonists (mixed agonist/antagonist) Analgesics
What happens if Meperidine is combined with Mixed Agonist/Antagonist Analgesics?
Decreased analgesic effect and may precipitate withdrawal symptoms
What were partial agonists combined with if the patient has decreased analgesic effect and precipitates withdrawal symptoms?
Meperidine + partial agonists
What are 3 indications for Codeine?
Antitussive
Mild pain
Diarrhea
What Opioid Agonist is the best at treating Diarrhea?
Loperamide
Loperamide is the best at treating?
Diarrhea
Loperamide slows GI motility by activating what opioid receptors?
Mu receptors
Can Pentazocine treat addiction to Opioids?
NO
Can Buprenorphine treat addiction to Opioids?
YES
When is Pentazocine used?
Pre-op medication and anesthesia adjunct
If Pentazocine is used during pregnancy, what may occur and what is the sign?
Neonatal Opioid Withdrawal Syndrome
= Shrill cry
When is Buprenorphine used?
Pain and to treat addiction to opioids and narcotic pain relievers
When patients are taking Buprenorphine, what should be monitored?
Potential incorrect dosing when they are starting/ending CYP3A4 activators/inhibitors
MOA for Naloxone?
Displaces Opioids at receptor sites
What drug can displace Opioids from their receptor sites?
Naloxone
When is Naloxone used?
Suspected/known Opioid overdose
Treatment for suspected/known opioid overdose?
Naloxone
Naloxone causes a release of?
Catecholamines
Once Naloxone causes a release of Catecholamines, what can that cause to occur?
Precipitate acute withdrawal or unmask pain with chronic users
MOA for Naltrexone?
Competitive Antagonist with highest affinity for Mu receptors
Naltrexone has the highest affinity to block what receptors?
Mu receptors
What can Naltrexone treat?
Alcohol use disorder
What can treat Alcohol use disorder?
Naltrexone
Once patients are treated with Naltrexone, what can occur?
They will respond to lower opioid doses than previously used
=> life-threatening intoxication if taken again
Naltrexone may precipitate symptoms of acute withdrawal in opioid-dependent patients, what is the sign in neonates?
Shrill cry
