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Pharmacology > Opioids > Flashcards

Opioids Flashcards

1
Q

Why do we use opioids in animals?

A

Primarily analgesia for acute pain
Sedation in some patients.

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2
Q

How can we avoid inducing withdrawal in a patient that has received opioids for several days?

A

Taper over 1-2 days

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3
Q

What are the differences between general anesthesia and analgesia?

A

Analgesia: loss of sensitivity to pain
Anesthesia: total loss of sensation in part of the body (local block) or the whole body (general anesthesia)

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4
Q

What are the two main opiate receptors targeted clinically?

A

Mu and Kappa

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5
Q

What are endorphins?

A

Endogenous opioid ligands
Any endogenous chemical that naturally exhibits pharmacological properties of morphine

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6
Q

What do endorphins do?

A

Modulate effects on CNS
Mediate analgesia

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7
Q

What is the most potent endogenous opioid peptide mediating analgesia?

A

Beta endorphin - important in injury and stress, but limited amounts produced

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8
Q

Are opioids more effective for acute or chronic pain?

A

Acute pain, but role in chronic debilitating pain and cancer pain
Less effective over time

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9
Q

What is opioid induced hyperalgesia?

A

Increased pain after discontinuation of opioids

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10
Q

What is a full mu agonist?

A

Max amount of analgesia
Affinity and activity at all receptors
Fentanyl, hydromorphone, methadone, morphine, heroin

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11
Q

What is a partial mu agonist?

A

Binds partially, provides less analgesia
Buprenorphine

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12
Q

What is a mu agonist-antagonist?

A

Agonist at kappa receptors, antagonist at mu receptors
Less analgesia, but less side effects
Butorphanol

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13
Q

What is naloxone?

A

High affinity for mu and kappa receptors
Competitive antagonist
Reverses effects of opioids

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14
Q

Why is affinity of an opioid to the opiate receptor important to know?

A

Binding ability affects duration of action and drug interaction

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15
Q

Which opioid is difficult to reverse due to high binding affinity?

A

Buprenorphine

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16
Q

What is pharmacokinetic tolerance?

A

Induced synthesis of hepatic microsomal enzymes, leading to tolerance

17
Q

What is pharmacodynamic tolerance?

A

Cellular adaptations such as changes in the number, affinity, and function of the receptors, leading to tolerance

18
Q

What is the difference between opioid analgesic potency and efficacy?

A

Potency: directly related to affinity of drug to receptor
Effect: maximal effect that drug can induce (analgesia)

19
Q

What is an equi-analgesic dose of hydromorphone (potency 5) to morphine given at a dose of 0.5 mg/kg

A

Hydro @ 0.1 mg/kg

20
Q

Is butorphanol (potency 5) more or less effective than morphine for the treatment of severe, acute pain in the dog?

A

Less effective
Butorphanol activates more kappa receptors so there is a ceiling effect.

21
Q

What are two reasons that butorphanol is not a great choice to treat severe pain in a dog?

A

Agonist-antagonist = ceiling effect for analgesia
Short duration of action (0.5-2hrs)

22
Q

What factors influence the degree of analgesia provided by an opioid?

A

-Degree of tissue trauma and pain
-acute vs chronic pain
-central vs peripheral sensitization
-degree of fear, anxiety, stress
-route of admin
-dose and interval
-other pain treatments

23
Q

Are opioids good sedatives in dogs and cats?

A

Usually not good sedatives on their own in healthy, young animals.
Depends on age, health status, presence of pain

24
Q

What is dysphoria?

A

Unpleasant feeling in response to opioid analgesic.
-Disoriented, restless, fear, hiding, vocalizing, painful

25
Q

What are the effects of opioids on respiratory function?

A

Respiratory depression
Decrease response in brainstem centers to CO2

26
Q

How do the resp depressant effects of butorphanol compare to those of morphine?

A

Torb less resp depression than morphine

27
Q

Are opioids used for cough suppression?

A

Yes, directly suppress cough center in medulla. antitussives do not necessarily decr respiration (hydrocodone)

28
Q

What effect do opioids have on GI motility?

A

Horses: Slow GI motility: ileus and colic w/ high doses
(butorphanol better)
Other species: constipation

29
Q

Which opioid is most likely to induce vomiting in dogs and cats?

A

morphine > hydromorphone

30
Q

How does tramadol work?

A

Weak mu opioid agonist
Inhibits NE and serotonin reuptake

31
Q

What is the advantage of a fentanyl transdermal patch?

A

Long duration of action (-3 days)

32
Q

What are the potential consequences of morphine-induced histamine release?

A

Vasodilation and hypotension
or bronchoconstriction

33
Q

Do opioids lower the seizure threshold?

A

No

34
Q

What is the predominant cardiovascular effect of hydromorphone in the dog?

A

Bradycardia

35
Q

How could you completely reverse the effects of hydromorphone?

A

Naloxone

36
Q

Common opioids by potency:

A
  1. Fentanyl
  2. Hydromorphone
  3. Methadone
  4. Morphine

Pharmacology (17 decks)

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