Opioids

Question 1

3 types of endogenous opioid peptides

Answer 1

enkephalins
beta-endorphins
dynorphins

Question 2

opioids receptors

Answer 2

mu
delta
kappa
non-opioid like (NOP)

Question 3

mu receptor endogenous ligand

Answer 3

beta-endorphin

enkephalin

Question 4

delta receptor endogenous ligand

Answer 4

enkephalin

Question 5

kappa receptor endogenous ligand

Answer 5

dynorphin

Question 6

CYP2D6

Answer 6

potent - codeine to morphine

potent - tramadol to metabolite

hydrocodone and oxycodone variants

Question 7

CYP3A4

Answer 7

fentanyl, buprenorphine, and methadone metabolism

Question 8

CYP3B6

Answer 8

methadone and propofol

women have higher activity

Question 9

mu receptor effect

Answer 9

analgesia
euphoria
sedation
physical dependence
respiratory depression
miosis
constipation
urinary retention
bradycardia
pruitis
skeletal muscle rigidity
biliary spasm

Question 10

kappa receptor effect

Answer 10

analgesia
dysphoria
sedation
low abuse potential
mitosis
antishivering

Question 11

delta receptor effects

Answer 11

analgesia
physical dependence
respiratory depression
constipation
urinary retention

Question 12

opioid histamine release

Answer 12

codeine
morphine
meperidine

Question 13

phenanthrene alkaloids

Answer 13

natural occurring: morphine, codeine, thebaine

semisynthetic: heroin, vicodan, dalaudid, oxycontin, oxymorphone, and antagonists (narcan etc.)
synthetic: levorphanol, butorphanol, nalbuphine, pentazocaine

Question 14

piperidine derivatives

Answer 14

phenylpiperidines: meperidine, loperamide
anilidopiperidines: fentanyl, sufentanil, alfentanil, remifentanil

Question 15

diphenylheptanes

Answer 15

methadone

Question 16

opioid potency ratios are estimates relative to ______

Answer 16

morphine

Question 17

metabolism - remifentanil

Answer 17

non-specific esterase’s

Question 18

opioids effect on CTZ versus vomiting center

Answer 18

stimulate CTZ - short term effect

inhibit vomiting center - long term effect

Question 19

incidence on muscle rigidity with opioids and treatment

Answer 19

dose, speed or administration, use of nitrous oxide, older age, absence of muscle relaxants

treatment: muscle relaxants and airway control

Question 20

opioids - ocular effects

Answer 20

mitosis - excitatory parasympathetic

fentanyl decrease intraocular pressure

Question 21

opioids that inhibits shivering

Answer 21

meperidine

Question 22

treatment for increased biliary pressure

Answer 22

atropine, glycopyrrolate
nitroglycerin
glucagon
narcan

Question 23

what drug is contraindicated in children after tonsillectomy or adenoidectomy

Answer 23

codeine

also contraindicated in all children under 12 and breastfeeding mothers

Question 24

demerol metabolism and contraindications

Answer 24

metabolized to normeperidine which is toxic

contraindicated in elderly, renal failure, and with concurrent use of MAO inhibitors

Question 25

serotonin syndrome

Answer 25

signs: mental status changes, autonomic instability, neuromuscular hyperactivity, hyperthermia
drugs: MAO inhibitors, SSRIs, SNRIs, tricyclic antidepressants, linezolid (antibiotic), meperidine, fentanyl, tramadol, pentazocine, dextromethorphan, reglan, sofrían, herbal products, lithium, tryptophan, and many more…

stop the offending agent, may need paralysis and sedation