Opioids Flashcards
Definition of Opioids
Any drug, natural or synthetic, that has actions similar to morphine
Are all narcotics Opioids?
No, “Narcotics” is a broad category for analgesics, CNS depressant, drugs that can cause physical dependence
How do morphine and pure opioid agonists work?
Mimic the action of endogenous opioid peptides on mu and kappa receptors
Respiratory depression, abuse, and elevated ICP are liabilities
Which opioid receptor is associated with physical dependence and analgesia?
Mu 1
Which opioid receptor is associated with respiratory depression?
Mu 2
A patient comes in suffering from opioid withdrawal. Do you need to worry about this being lethal?
No. The withdrawals that can be lethal are the 3 B’s:
Booze
Benzo
Barbiturate
Triad of symptoms in an opioid OD
Coma
Respiratory Depression
Pinpoint pupils
Fentanyl
synthetic opioid that is 100x stronger than morphine
In order from least potent to most potent, list sufentanil, alfentanil, and remifentanil
ARS
Alfentanil (10x) Remifentanil (100x) Sufentanil (1000x)
Meperidine (Demerol)
Nonmorphine opioid often abused by healthcare workers due to lack of pinpoint pupils.
Also used in obstetric analgesia
Methadone
NMDA antagonist that can treat neuropathic pain and mainly is used for morphine withdrawal.
Can cause Torsades
Heroin
Highly lipid soluble (more than morphine), so gives a great high.
Hydromorphone (Dilaudid)
Similar effects to morphine and reversed with Naloxone
Codeine
moderate/strong opioid agonist
metabolized to morphine by CYP2D6, which some individuals have mutations in.
Hydrocodone
Similar to Codeine but combined with other drugs:
Vicodin- Acetaminophen + hydrocodone
Opioids that are Mu antagonists and K Agonists
Pentazocine
Butorphanol
Opioid that is a Mu agonist and K antagonist
Buprenorphine
Buprenorphine
primarily for addicts
Can cause Torsades and Pancreatitis
Opioid Antagonists
Naloxone
Naltrexone
Opioid Withdrawal Syndrome
Non-lethal: Myalgias Tachycardia Restlessness Anxiety Dilated pupils
Naltrexone
used for alcohol and opioid abuse
Reduces craving for alcohols
Methylnaltrexone
Mu antagonist that is used to treat opioid induced constipation in end-stage diseases
Loperamide
Mu-agonist that is indicated for acute/chronic diarrhea
Is it better to give fixed interval doses or PRN doses of Opioids?
Fixed schedule
What opioid is ok to give to both renal and hepatic insufficiency patients?
Fentanyl
What are potential side effects of Opioids with Anticholinergics?
Can exacerbate constipation and urinary retention
