Opioids

Question 1

Phenantherane Alkaloids drugs

Answer 1

Morphine, Codeine (Natural) Hydromorphone, Tramadol (Semisynthetic):
Derived from opium poppy

Question 2

Phenylpiperidines derrivtives (synthetic)

Answer 2

Meperidine, fent, sufent, alefent, remi

Question 3

Diphenylheptane

Answer 3

Methadone

Question 4

Most likely to cause histamine release?

Answer 4

Morphine, codeine, meperidine

Question 5

Cross-class allergy?

Answer 5

Cross-sensitivity exists within classes, however, no cross-sensitivity between the 3 classes

Question 6

Gold standard for potency comparison?

Answer 6

Morphine sulfate (=1) - purely serve as guideline because each patient response can vary drastically

Question 7

Highest concentration of opioid receptors in the body?

Answer 7

Likely in the GI nervous system compared to CNS

Question 8

High dose opioids?

Answer 8

Only provide analgesia, additional drugs needed to provide anesthesia/amnesia/unconsciousness/relaxation

Question 9

Meperidine (Demerol)

Answer 9

Potency: 0.1
Duration: 2-4 hr
Analgesic Dose: 100 mg

Question 10

Fentanyl

Answer 10

Potency: 100
Duration: 1-1.5 hr
Analgesic Dose: 100 mcg

Question 11

Sufentanil

Answer 11

Potency: 500-1,000
Duration: 48-78 min
Analgesic Dose: 10-20 mcg

Question 12

Alfentanil

Answer 12

Potency: 10-20
Duration: 15-25 min
Analgesic Dose: 500-1,000 mcg

Question 13

Remifentanil

Answer 13

Potency: 100 (same as fentanyl)
Duration: 2-5 min
Analgesic Dose: infusion

Question 14

Hydromorphone

Answer 14

Potency: 5
Duration: 2-4 hrs
Analgesic Dose: 2 mg

Question 15

Morphine Sulfate

Answer 15

Potency: 1
Duration: 3-5 hrs
Analgesic Dose: 10 mg

Question 16

Chronic effects of opioids

Answer 16

Tolerance, physical dependence, constipation

Question 17

Never develop a tolerance to (2)?

Answer 17

Miosis, constipation

Question 18

Effect on breathing?

Answer 18

Shift the CO2 response curve to the right, decreased respiratory response to elevated CO2 levels

Question 19

Stronger the opioid?

Answer 19

Higher the likelihood of physical dependence

Question 20

Mu receptor effects

Answer 20

Analgesia (supraspinal and spinal), euphoria, sedation, skeletal muscle rigidity, biliary spasm

Question 21

Kappa receptor effects

Answer 21

Analgesia (supraspinal and spinal), dysphoria, sedation, antishivering

Question 22

Opioid MOA specifics

Answer 22

Binds to G-protein coupled receptor - cAMP activation, depression of voltage gated Ca channels, activated inward rectifier K channels (K efflux)

Question 23

Opioid MOA general

Answer 23

Activate opiate receptors on pre-synaptic (1st order) sensory neurons resulting in a decreased amount of substance P (excitatory NT) to be released into synaptic cleft - blocks transmission of pain signal

Question 24

Endogenous opioid peptides

Answer 24

Enkephalins, endorphins, dynorphins

Question 25

SuRF in the AM Man - potency

Answer 25

Sufentanil, Remifentanil/Fentanyl, Alfentanil, Morphine, Meperidine