Opioids Flashcards

1
Q

What is neuroleptanalgesia?

A

Combining dissociative with an analgesic

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2
Q

T/F: Opioids increase gut motility

A

False

Don’t give if the animal has a toxin or bacterial infection in the gut - increased absorption

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3
Q

T/F: Opioids cause constipation

A

True

they slow gut motility

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4
Q

Common Opioid effects in dogs

A

CNS depression
decreased motor activity
decreased temperature set point
hypothermia

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5
Q

Common Opioid effects in cats/horses

A

CNS stimulation (use with sedative)
mydriasis
increased temperature set point
hyperthermia

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6
Q

T/F: Opioids are contraindicated in patients with head trauma

A

True:
decreased sensitivity to CO2 levels in the blood causing decreased respiration rate, increased CO2 in the brain causing vasodilation and increased intracranial pressure

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7
Q

What Opioids should be used to induce emesis in dogs? cats?

A
Dogs = morphine
Cats = Xylazine
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8
Q

Full µ agonists

A

Most clinically useful
will cause anesthesia
no ceiling effect
not as good for chronic pain

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9
Q

Partial µ agonists

A

Never reach same effectiveness as full µ agonist

ceiling effect

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10
Q

Mixed agonist/antagonists

A

Activate some opioid receptors and block others

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11
Q

Full opioid antagonists

A

Block all opioid receptors

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12
Q

T/F: Opioids have a large Vd

A

True

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13
Q

What is the route of administration of opioids?

A

IM, IV, PO (variable absorption)

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14
Q

Where are opioids metabolized?

A

Liver - glucuronic acid in dogs, sulfuric acid in cats

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15
Q

What is the opioid scheduling?

A

Most full µ agonists = Class 2
Buprenorphone = Class 3
Butorphenol, Tramadol = Class 4

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16
Q

Clinical uses of Morphine

A

Analgesia
Preanesthetic
Histamine release (IV in dogs)
Emesis in dogs

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17
Q

Clinical uses of Codeine and Hydrocodone

A

Antitussive (Codeine is not used in vet med)

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18
Q

Clinical uses of Hydromorphone and Oxymorphone

A

Analgesia

Preanesthetic

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19
Q

Clinical uses of Methadone

A

Used in treating Heroine addiction

Analgesia

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20
Q

Clinical uses of Fentanyl

A

Analgesia (great for severe pain)

Preanesthetic

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21
Q

Clinical uses of Carfentanil

A

Analgesia

Immobilization dart

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22
Q

Special considerations for Fentanyl

A

Very potent
Lipophilic (crosses the BBB - high Vd)
CRI (fast onset, short duration)
Transdermal patch (long onset, long duration)

23
Q

Special considerations for Hydromorphone

A

Less histamine release than Morphine
Lipophilic
Potent
Less expensive than Oxymorphone

24
Q

Special considerations for Oxymorphone

A

Less histamine release and emesis than Morphine
Approved for dogs and cats
Expensive

25
Q

Special considerations for Carfentanil

A

10,000x stronger than Morphine = must have a reversal agent (Naloxone, Naltrexone)

26
Q

Side effects of Opioids in dogs

A

CNS depression, motor depression, decreased temperature set point (hypothermia), miosis, bradycardia, panting at low doses, antitussive (Hydrocodone), constipation, histamine release

27
Q

Side effects of Opioids in cats and horses

A

CNS excitement, convulsion and seizures, increases temperature set point (hyperthermia), mydriasis, antitussive (hydrocodone), constipation, histamine release

28
Q

Contraindications of Opioids

A

Head injury, severe cardiac depression, may need oxygen supplement, toxemia/bacT infection (because they decrease gut motility which would be beneficial for bacteria)

29
Q

What receptors does Beprenorphine influence?

A

partial agonist:
µ agonist
k antagonist

30
Q

What receptors does Butorphanol influence?

A

mixed agonist:
µ agonist/antagonist
k agonist

31
Q

What receptors does Etorphine/M99 influence?

A

µ, k, delta agonist

32
Q

What receptors does Naloxone influence?

A

µ > k = delta competitive antagonist

33
Q

What receptors does Nalmefene influence?

A

µ > k = delta competitive antagonist

34
Q

What receptors does Naltrexone influence?

A

µ = k = delta competitive antagonists

35
Q

What receptors does Diprenorphine influence?

A

µ = k = delta competitive antagonists

36
Q

What receptors does Tramadol influence?

A

M1 antagonist, µ agonist (weak)

37
Q

What receptors does Apomorphine influence?

A

dopamine (D2) agonist

38
Q

Clinical uses of Buprenorphine

A

Neuroleptanalgesia with Acepromazine or Xylazine

39
Q

Clinical uses of Butorphanol

A
Pre-anesthetic with a sedative
Analgesia (cats, dogs, horses)
Antitussive in dogs
Visceral pain
because it is a mixed opioid you can use it to reverse Morphine post-op to relieve some symptoms of Morphine but still getting the analgesic benefits of Butorphanol
40
Q

Clinical uses of Etorphine/M99

A

Immobilization dart

41
Q

Clinical uses of Naloxone

A

Reverse respiratory and CNS depression caused by any µ agonist

42
Q

Clinical uses of Nalmefene

A

Reverse respiratory and CNs depression caused by any µ agonist (same as Naloxone but is longer acting)

43
Q

Clinical uses of Naltrexone

A

Reverse Carfentanil

44
Q

Clinical uses of Diprenorphine

A

Reverse Etorphine

45
Q

Clinical uses of Tramadol

A

Analgesia (dog/cat)
Antitussive
Give PO

46
Q

Clinical uses of Apomorphine

A

Low dose = emesis (treat poisoning)

High dose = Antiemesis

47
Q

Side effects of Tramadol

A

Lowers seizure threshold

48
Q

T/F: There is no ceiling effect with mixed or partial agonists

A

False:

There is no ceiling effect with full µ agonists, but there is a ceiling effect with mixed and partial agonists

49
Q

Contraindications for Tramadol

A

Avoid using unless you know the patient does or doesn’t have seizures
Do not use other SSRI drugs (MAO inhibitors) because it is already an SSRI

50
Q

T/F: Naloxone will reverse the effects of Apomorphine

A

False:

Apomorphine has its effect at dopamine receptors while Naloxone works on µ receptors

51
Q

Special considerations for Buprenorphine

A

More potent than Morphine, slow onset, long duration

Good to use in cats so you don’t have to dose them as often because they are crazy bastards

52
Q

Special considerations for Naloxone

A

Rapid onset, short duration - may re-dose

53
Q

Special considerations for Tramadol

A

Don’t give with other opioids because it will block µ from having full effect

54
Q

Special considerations for Apomorphine

A

IO, IV, IM, SQ

DON’T USE IN CATS