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Pharmacology > Opioids > Flashcards

Opioids Flashcards

1
Q
  • Physical therapy
  • Cognitive behavioral therapy
  • Yoga
  • Ice, heat, stretching
  • pet and music therapy
  • acupuncture
A

Non-Pharmacologic Pain Strategies

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2
Q

Pain management strategy that combines 2 or more analgesic agents/techniques that act by different mechanisms to provide analgesia

  • Designed by American Society of Anesthesiologists (ASA)
  • Guideline: all pts should receive around-the-clock regimen of a non-opioid agent
A

Multimodal analgesia

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3
Q
  • NSAIDs (Non-steroidal anti-inflammatory drugs)
    or COXIBs (Cyclooxyrgenase- 2 specific drugs)
  • Acetaminophen
A

Non-opioid agents

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4
Q
  • ↓ opioids requirement to manage pain
  • ↓ side effects of opioid-related AVE
  • better pain relief
  • better pt satisfaction
  • improves pt functional outcomes
  • ↓ length of stay
  • avoids safety concerns and contribution to opioid epidemic :
    addiction, dependence, and dependence diversion
A

Benefits of Multimodal Analgesia

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5
Q

pt who has taken opioids and their body can handle/tolerate opioids

A

Opioid tolerate pts

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6
Q
  • watch vital signs: make sure respiratory rate is not too low and BP
  • pain assessment: chart b/f and after, reassess 30 min to 1 hr after adm.
    • know when med is expected to take effect
  • secure meds
  • give IV opioids slowly over min
  • opioids are sedating - don’t give w/ other sedating drug (ex. Benzodiazepine)
A

Safe opioid administration

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7
Q
  • abruptly stop taking these drugs

- fetus develops during preg

A

Dependence (Abstinence Syndrome)

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8
Q

Overdose Tx (Antidote) for opioids

A

Naloxone (Narcan)

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9
Q

Non-opioid! CNS acting

  • MOA:
    • binds to Mu&raquo_space; WEAK opioid activity
    • inhibit norep. and serotonin - reuptake in SPINAL neurons
  • S/S:
    • pain - neuropathic pain
    • restless leg
  • Interactions:
    • Monoamine Oxidase Inhibitors (MAOIs) and Selective Serotonin Reuptake Inhibitors (SSRIS) and carbamazepine&raquo_space; can induce serotonin syndrome
    • ALCOHOL&raquo_space; sudden DEATH
A

Tramadol

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10
Q
  • estimates risk of opioid-related aberrant (odd) behaviors
  • pain meds should NOT be withheld for painful conditions b/c a pt is deemed “high risk”
    • these pts should be considered for other modalities of pain control, if appropriate
  • high risk pts may be appropriate candidates for referral to pain management
  • adm on initial visit
A

Opioid Risk Tool

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11
Q
  • 0-3: low
  • 4-7: moderate
  • 8+ : high
A

Opioid Risk Tool scoring

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12
Q 
- family & personal history of substance abuse
• alcohol
• illegal drugs
• Rx drugs
- age
- history of preadolescent sexual abuse
- psychological disease
• ADD, OCD, bipolar, schizophrenia
• depression
A

Opioid Risk Tool contributing factors

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13
Q

Antagonist at mu
agonist at kappa

  • Less potential for abuse
  • Psychomimetic
    • anxiety
    • nightmares
    • hallucinations
    • strange thoughts
A

buprenorphine

  • pentazocine
  • nalbuphine
  • butorphanol
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14
Q

Opioid Agonist - binds to a receptor and causes a response

Source - seedpod of the poppy plant

IV admin slowly over 4 to 5 minutes

Not very lipid soluble, so does not cross blood-brain barrier easily

A

Morphine

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15
Q

5-7 times more potent than morphine

Tolerance and physical dependence is more intense than morphine because of high potency

May cause less nausea than morphine

A

Hydromorphone

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16
Q

High potency – 100 times that of morphine

Intravenous – surgical analgesia, ICU sedation

Transdermal–chronic pain only, opioid tolerant pts
Fold used patches and put in biohazard container
Onset of action may be up to 24 hours

Transmucosal
Lozenge, “lollipop”, buccal tablets/films, sublingual sprays/tablets – breakthrough cancer pain

A

Fentanyl

17
Q

(+): Toxic metabolite accumulation - Can cause seizures

(-): Less likely to depress fetal RR contractions (shorter half life)

A

Meperidine

18
Q

(+): Pain, Opioid addiction (prevents withdrawal symptoms)

(-): Prolongs QT interval – fatal dysrhythmias

A

Methadone

19
Q

moderate pain

Antitussive; side effects are dose limiting, used infrequently

A

Codeine

20
Q

moderate pain

combined with acetaminophen

Antitussive; analgesia similar to codeine

A

Hydrocodone

21
Q

moderate pain

analgesia equal to codeine combined with aspirin, or acetaminophen

A

Oxycodone

22
Q

moderate pain

extended release oxycodone given every 12 hours for ATC analgesia

A

Oxycodone ER

23
Q
  • Reversal of opioid OD
  • Reversal of postoperative opioid effects
  • Reversal of neonatal respiratory depression
A

Naloxone

24
Q

Non-opioid! CNS acting

Alpha 2

  • Severe Hypotension
  • Rebound hypotension
  • bradycardia
A

Clonidine

25
Q
  1. Assessment
    a. Pain assessment before administration + 1 hour after administration
  2. Dosage determination
    a. Adjust to accommodate individual variation
  3. Dosing schedule
    a. Fixed schedule
  4. Avoid withdrawal
A

DOSING GUIDELINES

Pharmacology (9 decks)

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