Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 2 > Opioids > Flashcards

Opioids Flashcards

1
Q

rx length

A

Up to 3 days for most things; up to 7d max

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MOA

A

Most bind to and stimulate the Mu opioid receptors (agonists). Inhibit neurotransmitter (substance P, glutamate, CGRP) release AND reduce transmission of pain signals. Hyperpolarise postysynaptic cell, so less likely to generate any further pain sensations. Raise the pain threshold at the spinal cord level (dorsal horn). Alter the brain’s perception of pain. The stronger the agonist, the greater the effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

opioid contras

A

Use in Head Injuries (can increase intracranial pressure), Use in Pregnancy (stick to short term use), Impaired Pulmonary Function, Impaired Hepatic or Renal Function, Endocrine Disease, Undiagnosed abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

AEs

A

nausea, constipation, respiratory depression. flushing, pruritis, hypotension from release of histamine. Pinpoint pupils that do not respond to light.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

overdose symptoms and treatment

A

Overdose: CNS depression (coma), resp depression (apnea or bradypnea), miosis. Give Narcan (opioid receptor antagonist) IV, IN, IM, or SC, onset in 2-3 min and give 2nd dose at 3 min if still not awake; effect lasts 2 hrs, so pts should be monitored for 4-6 hrs after Narcan; induces opioid withdrawal (agitation, anxiety, confusion, tachycardia, HTN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

interactions

A

“Sedative-Hypnotics: Benzodiazepines, Diphenhydramine, Soma, tramadol
Alcohol
Antipsychotics
MOAIs”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pt counseling - 4

A

“PO initial onset in 20 min, full benefit at 1hr.
take antinausea 20 min before
Let pt know when using combo w/ acetaminophen - caution against taking too much aceta otherwise
Avoid alcohol. don’t take benzodiazepines or diphenhydramine at same time; space out 2-4 hrs if you really need it due to extra sedative effect”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

co-prescribe

A

Co-prescribe antiemetic (Zofran) and senna + bisacodyl; also naloxone if risk factors (prior OD, substance abuse, doses >120MME/d, concomitant benzo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

weakest agonist

A

codeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

codeine contras

A

Absolute: <12 y/o, <18 y/o after tonsillectomy / adenoidectomy. Avoid in <18 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

most constipating opioid

A

codeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MOA: mild-mod agonist. Targets the mu-receptor and inhibits reuptake serotonin and norepinephrine

A

tramadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

tramadol contras

A

Caution in pts w/ seizure hz or those on TCAs or serotonergic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which opioids are only partially antagonised by naloxone

A

tramadol, Tapentadol (Nucynta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

tramadol dose adjustment for whom?

A

CrCl <30 or severe hepatic impairment, dose Q12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

indications: “ped surgery/ED
extended release: neuropathic pain”

A

Tapentadol (Nucynta) PO, IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

AEs: Low GI effects, but risk of seizures, risk of serotonin syndrome when combined with SSRIs. Partially antagonised by Naloxone

A

Tapentadol (Nucynta) PO, IV

18
Q

order of strength of the mild-mod agonists

A

oxycodone > hydrocodone > tramadol > codeine

19
Q

morphine contra

A

avoid in kidney dz

20
Q

AEs: Thought to cause more pruritus, nausea, and sedation than hydromorphone (Dilaudid) or fentanyl

A

morphine

21
Q

interactions: Tapentadol (Nucynta) PO, IV

A

SSRIs

22
Q

switch morphine non-responders to

A

oxy

23
Q

MOA: strong agonist. Synthetic - More potent than Morphine (~50-100x). Rapid onset of action: IV formulation has peak effect on average in 10 minutes.Very short acting. secreted in the stomach and reabsorbed, creating a second peak

A

fentanyl

24
Q

fentanyl dosed in

A

micrograms

25
Q

change fentanyl transdermal patch Q

A

Q72 hrs

26
Q

indication for fentanyl transdermal patch

A

chronic pain once stable

27
Q

fentanyl contras

A

Avoid in patients with obesity hypoventilation syndrome, liver failure

28
Q

pt counseling for transdermal patch

A

Patch: proper disposal in sharps container necessary to protect kids/pets

29
Q

methadone contras

A

Avoid use in older adults for pain, or older adults w/ delirium or at risk

30
Q

when is the peak of opioid withdrawal symptoms?

A

72 hrs after last pill

31
Q

do hospital providers need a x waiver to give buprenorphine to a pt in withdrawal?

A

no

32
Q

when is x waiver needed?

A

Rx for buprenorphine outside of hospital

33
Q

x waiver allows rx for how many pts

A

up to 30

34
Q

MOA: strong agonist. suppress craving and withdrawal symptoms and block the acute effects of other opioids

A

methadone

35
Q

indications: Opioid dependence. Chronic, severe pain. Neonatal withdrawal. Postanesthesia shivering,and blood product-induced rigors. IV: adjunctive sedative for procedures (less common).

A

methadone

36
Q

AEs: Risk for seizure, serotonin syndrome. at common doses, not an effective pain medication, may cause neurotoxicity including delirium, and safer analgesics are available. Prolongs QT interval, constipation, mild drowsiness, ED, low libido

A

methadone

37
Q

MOA: Mixed agonist-antagonist (partial agonist). Long-acting, partial mu agonist, delta and kappa antagonist

A

Buprenorphine (Butrans®)

38
Q

indications: “OUD / opioid withdrawal (flu-like sx, n/v/d, abd pain, HTN, mydriasis, tachycardia, hyperreflexia, insomnia, irritability, anxiety, depression).
Acute pain in opioid naïve pts IM/IV”

A

Buprenorphine (Butrans®)

39
Q

MOA: opioid receptor blockade secondarily diminishes dopamine activity that is otherwise enhanced by alcohol. Mu, Kappa, Delta Antagonist

A

Naltrexone (Vivitrol) PO or long-acting IM

40
Q

indications: alcohol and opioid dependence - Maintenance treatment to prevent relapse

A

Naltrexone (Vivitrol) PO or long-acting IM

Pharm 2 (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions