Opioids

Question 1

action of pure agonists

Answer 1

all receptors are turned on

Question 2

mixed agonist-antagonist action

Answer 2

some receptors are turned on while others turned off
- get pain relief with out the other side effects

Question 3

pure antagonists

Answer 3

reverse the side effects of the agonists, and help with constipation by blocking receptors in gut but cannot cross BBB so you still get pain relied

Question 4

side effects of agonists

Answer 4

respiratory depression
constipation
euphoria
decrease cough reflex
sedation
mitosis (no pupil dilation)

Question 5

side effects of agonists and antagonists

Answer 5

analgesic ceiling: maximum level of pain relief (increase dose = no more pain relief)
hallucinations
dysphoria= opposite of euphoria
when switching to this form from a pure agonist it is important to understand there will be risks of withdrawal because receptors differ with drug class

Question 6

what is not tolerance built to

Answer 6

miosis and constipation

Question 7

cross tolerance

Answer 7

when switching from one agonist to another there is a chart that will show you the converted does, when completing this it is important that we decrease that does of the new drug to 25-50% in case toe cross over of tolerance is not complete
EX: 25 mg morphine= 50 mg codine and we reduce that to 25-50% which equals 25-37.5mg of codine

Question 8

dependence vs addiction

Answer 8

dependence is the body gets use to the drug
addiction is the mental crave of the drug not for the intended use

Question 9

how long chronically when taking an opioid will you develop withdrawl

Answer 9

2 weeks

Question 10

examples of withdrawal

Answer 10

sweating, irritablity, tremor, nausea, vomitting, spasms

Question 11

how to minimize the withdrawal symptoms

Answer 11

tapering the drug over 3-7 days

Question 12

what effects how long you taper a drug

Answer 12

dose and the how long been on the drug

Question 13

how do younger and older age individuals differ in response to agonists

Answer 13

need lower dosing

Question 14

renal impact and morphine

Answer 14

morphine contains active byproducts which are removed via the kidney and when patients have bad kidneys the byproducts build up and amplify the effects of morphine and exacerbate pain

Question 15

morphine vs other agonists

Answer 15

morphine is not absorbed well orally

Question 16

tramadol vs agosnists

Answer 16

blocks norepinephrine and serotonin, good for nerve pain
weak form and morphine so be aware of same side effects

Question 17

codine pharacogenics

Answer 17

codine is turned into morphine via CYP2D6 which normally there is 2 copies and converts 15% of codeine. some individuals do not have this enzyme so they get no pain relief. others who are UM have 13 copies and they have more morphine effects which can lead to harm if unknown

Question 18

who are at risk for codine

Answer 18

children <12 no, <18 no if rest issues
post part women because if UM then transferring the morphine to infant via breast milk

Question 19

agonists

Answer 19

morphine, codine, oxycodone, hydrocodone, hydromorphone, tramadol

Question 20

agonist and antagonist

Answer 20

buprenorphine

Question 21

resp depression can have a tolerance but what will exacerbate the tolerance and make it disapate

Answer 21

other CNS depressants (alc and Xanax)