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555 > Opioids > Flashcards

Opioids Flashcards

1
Q

Should a patient ‘tough out’ acute pain?

A

-probably not
-can lead to higher risk of chronic pain(delayed ambulation, long-term use of opioids)

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2
Q

Numerical Rating Scale

A

0-10 scale based on the work of Clevland and Brief Pain Inventory

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3
Q

NSAIDS vs Opioids

A

-there is no statistical significance is in opioids being more effective than NSAIDs
-both equally effective after 30 minutes

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4
Q

non drug therapies for Lower Back pain

A

-gentle exercise
-rehab
-local heat pack
-mindfulness stress reduction

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5
Q

non drug therapies for lower back pain with little evidence

A

-spinal manipulation
-acupuncture
-massage

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6
Q

Drug treatment for lower back pain

A

-Acetaminophen
-NSAIDS(better)
-muscle relaxants(little evidence in chronic back pain)
-tramadol and strong opioids

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7
Q

Non-malignant chronic pain

A

-studies are typically short
-opioids are commonly no better than NSAIDs and other drugs

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8
Q

Cancer related pain

A

-More likely to respond to opioids
-caution still needed in initiation and titration
-adjuvants are still appropriate

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9
Q

FDA tolerance definition

A

-patients who are taking, for 1 week or longer, at least:
-60 mg morphine/day
-30 mg oxycodone
-8 mg hydromorphone
-25 mcg transdermal fentanyl

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10
Q

How long does it take to become dependent on opioids?

A

-dependences can be presumed to occur when one has developed tolerance
-faster onset with shorter half life

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11
Q

Pros of Urine testing

A

-confirm use of opioids
-identify use of unprescribed opioids or drugs of abuse

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12
Q

Cons of Urine screening

A

-increase cost for patient
-test may be misinterpreted
-test may be adulterated

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13
Q

What is opioid misuse?

A

defined as use in
any way not directed by a doctor, including use without a prescription of one’s own; use in greater amounts, more
often, or longer than told; or use in any other way not
directed by a doctor.

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14
Q

When choosing an opioid, what should you typically avoid?

A

-Codeine +/- APAP: bc it’s a prodrug and it has varied metabolism throughout the population
-Tramadol: increased seizure risk, serotonin syndrome, drug interactions, hypoglycemia
-Meperidine: seizures

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15
Q

Meperidine

A

-short acting, cause seizures due to metabolite build up
-not reversed by naloxone
-COMMONLY used IV as a single dose for the treatment of severe rigors

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16
Q

Pros of morphine oral formulations

A

-least expensive
-multiple ER and IR formulations, including liquids
-few drug interactions

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17
Q

Cons of morphine oral formulation

A

-15 mg size of IR tablet is an awkward starting dose
-accumulation of neurotoxic morphine-3-glucuronide metabolite in high doses and/or renal dysfunction often leads to adverse effects

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18
Q

morphine characteristics

A

-peak concentration after IR dose is within 1 hour
-glucuronidated by the liver: Morphine-6-G 5x more potent, M3G: neurotoxicity (delirium, dysphoria, hallucinations, myoclonic jerking)
-glucuronides are renal excreted: avoid morphine for GFR < 30 mL/min

19
Q

Oxycodone as an alternative to morphine

A

-less dependent on kidneys for elimination
-slightly more potent than morphine
-use 2 mg oxycodone:3 mg morphine
-use 1:1 when converting from oxy TO morphine

20
Q

Hydrocodone with APAP

A

-less dependence on kidneys for elimination
-NOT commonly used in cancer pain and palliative care because of combination with APAP

21
Q

Fentanyl as a alternative to morphine

A

-metabolized to inactive metabolites: good for patient’s with renal inpairment
-Tansdermal patch 1:1 to IV infusion

22
Q

What patients can use transdermal fentanyl patches?

A

-have established opioids needs AND
-who are already tolerant to opioids
-same with ER oral dosage of other opioids

23
Q

Morphine in renal insufficiency

A

-not completely contraindicated for GFR < 60 with monitoring

24
Q

Oxycodone and hydromorphone in renal insufficiency

A

-can be used in moderate renal impairment
-initial dose must be lower than usual, and the size and frequency of dose smaller

25
Q

Best opioids in moderate/severe renal dysfunction

A

fentanyl and methadone

26
Q

opioid in liver disease

A

-CAUTION in methadone and fentanyl
-start low and go slow(not contraindicated)

27
Q

Concurrenent medications with opiods

A

-SCHEDULED laxatives
- non-opioid analgesics
-Naloxone

28
Q

Scheduled Laxatives

A

-Senna +/- DOSS
-PEG (MIRALAX) and others(17 Gm 1-2 x/day with 12 oz water)
-add additional PRN laxatives for constipation

29
Q

Starting dose for oxycodoned in adults

A

2.5-5 mg every 4 hrs PRN

30
Q

Dangerous practices if not opioid tolerant

A

-do NOT start opioid basal infusion
-do no you ER formulation
-no fentanyl pathches

31
Q

ER/SR opioids

A

-60-75% or original IR dose -> SR dose/day
-provided 10-20% daily SR dose every 2-3 hours as needed

32
Q

Morphine PCA

A

0.5-1 mg with q12-15 min lockout
-basal infusion not indicated unless chronic opioid needs
-based on previos oral dose in 24 hours
-3 mg oral/ 1 mg IV

33
Q

hydromorphone PCA

A

0.1-0.2 mg q12-15 min lockout

34
Q

fentanyl

A

10-20 mcg q8-10 min lockout

35
Q

Patient Bolulses (PID)

A

50-100% of basal rate

36
Q

RN initiated bolus (RNID)

A

100-200% of basal rate

37
Q

Hyperalgesia

A

-perception of pain is worse than expected due to CNS sensitization

38
Q

-Allodynia

A

-perception of pain when none was expected

39
Q

Methadone

A

-useful opioid analgesic but may be difficult to use
-variable kinetics
-drug interactions
-pronlong QTc

40
Q

COWS

A

-scale to show stages of withdrawal
-used to determine treatment

41
Q

Risk factors for opioid overdose

A

-combining opioids and benzos
-daily doses > 100 morphine mg equivalents
-ER formulations
-long term use >3 months
-<2 weeks since initiation long acting formulation
-age
-renal or hepatic impairment
-depression
-substance use disorder
-history of overdose
-sleep-breathing disorders

42
Q

Naloxone

A

-primary medication used for reversal of opioid overdose

43
Q

naltrexone

A

-pure opioid antagoinist

44
Q

Buprenorphine

A

-partial mu agonist and weak kappa antagonist activity

555 (12 decks)

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