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Pharm (716) > Opioids > Flashcards

Opioids Flashcards

1
Q

indications of opioids

A
  • analgesia

- antitussive (ex: codeine)

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2
Q

opioid routes

A

PO, rectal, IM, IV, topical, subcut infusion, edpidural, intrathecal, intranasal, transmucosal

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3
Q

opioid MOA

A

bind opioid receptors in CNS to inhibit ascending pain pathways

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4
Q

what are the 3 main opioid receptors, and what do they all have in common?

A
  • mu, delta, kappa
  • all produce analgesia
  • all have AEs of respiratory depression and slowed GI motility
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5
Q

tell me about the mu receptor

A
  • euphoria
  • AEs: bradycardia, emesis (vomiting), pruritus (itching)
  • high potential for abuse/dependence
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6
Q

tell me about the delta receptor

A
  • has a lower abuse potential

- no AEs unique to this receptor

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7
Q

tell me about the kappa receptor

A
  • can produce spinal analgesia
  • AEs: miosis (excessive pupil constriction), constipation, sedation, dysphoria
  • has a lower abuse potential
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8
Q

common AEs of opioids (DNC)

A
  • drowsiness
  • nausea
  • constipation
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9
Q

contraindications of opioids

A
  • GI obstruction
  • paralytic ileus (blocked intestine)
  • respiratory depression
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10
Q

Boxed warnings for opioids include…

A
  • increased levels with ethanol use
  • addiction/abuse/misuse
  • life-threatening respiratory depression
  • severe AE with epidural or intrathecal admin
  • neonatal opioid withdrawal syndrome
  • death from accidental ingestion
  • lethal medication errors
  • life-threatening sedation/respiratory depression in combo with benzodiazepines or CNS depressants
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11
Q

what does the beers list say about opioids?

A

cautions against taking opioids in combo with 2+ CNS active meds; if history of falls or fracture

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12
Q

what are the strong mu agonists?

A
  • morphine (MS Contin, Kadian)
  • fentanyl (Actiq, Duragesic, Fentora, Sublimaze, Subsys)
  • hydromorphone (Dilaudid, Exalgo)
  • meperidine (Demerol)
  • methadone
  • oxycodone (Oxycontin; with acetaminophen: Percocet)
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13
Q

indications of strong mu agonists

A

severe pain

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14
Q

what should you watch out for with strong mu agonists?

A
  • active metabolites
  • morphine: can accumulate after extended dosing even if normal renal function
  • meperdine: neurotoxic metabolite, especially if ↓ liver/renal function = anxiety, seizures
  • hydromorphone: neuroexcitatory metabolite
  • oxycodone: usually negligible levels of metabolite; often combined with acetaminophen or aspirin for additive effect
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15
Q

special considerations with fentanyl

A
  • do NOT use for chronic pain management if opioid naive
  • physical activity/heat on the patch can increase drug delivery in a negative way, causing OD or increasing AEs
  • properly dispose of patch so it is out of reach of children and pets
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16
Q

what are the mild-moderate mu agonists (weak opioids)?

A

codeine and codeine combinations

17
Q

indications of mild-mod mu agonists

A

moderate pain

18
Q

tell me about codeine

A
  • codeine is a prodrug, meaning it must be metabolized and converted to morphine in order to produce any effects; can get lingering metabolites
  • codeine has antitussive effects, so it is used in cough syrup (abuse - purple drank, sizzurp)
19
Q

tell me about partial mixed agonists

A
  • Ex: buprenorphine (Suboxone)
  • Agonist with high affinity mu receptor
  • Lower analgesic efficacy than other opioids (lower Emax on dose-response curve)
  • Antagonist at delta and kappa receptors
  • Reduce withdrawal symptoms when tx opioid dependence
20
Q

tell me about tramadol

A
  • Weak mu and kappa agonist
  • Inhibits reuptake of norepinephrine and serotonin (neurotransmitters in descending pain pathway)
  • Less risk of dependence, but not impossible
  • Risk of seizures, so avoid if hx or in combo w other drugs that can increase risk (antidepressants)
21
Q

drugs used for neuropathic pain (4)

A
  • duloxetine (Cymbalta)
  • pregabalin (Lyrica)
  • gabapentin (Neurontin)
  • amitriptyline
22
Q

duloxetine (Cymbalta)

I was tired and nauseous from my new antidepressants, and then my brother crashed his deluxe cymbals so loud it gave me a headache!

A
  • Class: serotonin-norepinephrine reuptake inhibitor (SNRI), antidepressant
  • AE: nausea, dry mouth, headache, dose-related fatigue and drowsiness
23
Q

pregabalin (Lyrica)

Ever since pre-K, Lyrica has gained weight and is always tired. She got dizzy going down the slide at recess and started convulsing.

A
  • Class: GABA analogs, anticonvulsant

- AE: dizziness, drowsiness, headache, fatigue, peripheral edema, weight gain

24
Q

gabapentin (Neurontin) = more basic version of pregabalin

A
  • Class: GABA analog, anticonvulsant
  • AE: dizziness, drowsiness
  • Common due to cost
25
Q

amitriptyline

Am I trippin, or did riding a tricycle make me have to poop, pee, drink water, and use eye drops?

A
  • Class: tricyclic antidepressant (TCA)
  • AE: sedation, anticholinergic effects (blurred vision, dry mouth, urinary retention, constipation)
  • Less common due to AE
26
Q

types of cancer pain (3)

A
  • bone pain (metastases; necrosis due to radiation)
  • aching pain (compressed neural tissue)
  • visceral pain (chemo, radiation-induced fibrosis, scar tissue from surgery)
27
Q

treatment for mild cancer pain

A
  • NSAIDs
  • acetaminophen
  • short-acting opioids
28
Q

treatment for moderate cancer pain

A

short-acting opioids with titration

29
Q

treatment for severe cancer pain

A
  • strong opioids

- long-acting + immediate for breakthrough pain

30
Q

naloxone (Narcan)

A
  • opioid antagonist/reversal agent
  • For acute opioid overdose or respiratory depression with therapeutic opioid doses
  • Competitive antagonist at μ-, κ-, and δ-receptors
  • Highest affinity for the μ-receptor = rapidly reversing respiratory depression and euphoria with less impact on analgesia
  • IV, IM, subcut, intranasal

Pharm (716) (39 decks)

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