Opioids

Question 1

Definition of Opioids

Answer 1

Any drug, natural or synthetic, that has actions similar to morphine

Question 2

Are all narcotics Opioids?

Answer 2

No, “Narcotics” is a broad category for analgesics, CNS depressant, drugs that can cause physical dependence

Question 3

How do morphine and pure opioid agonists work?

Answer 3

Mimic the action of endogenous opioid peptides on mu and kappa receptors
Respiratory depression, abuse, and elevated ICP are liabilities

Question 4

Which opioid receptor is associated with physical dependence and analgesia?

Answer 4

Mu 1

Question 5

Which opioid receptor is associated with respiratory depression?

Answer 5

Mu 2

Question 6

A patient comes in suffering from opioid withdrawal. Do you need to worry about this being lethal?

Answer 6

No. The withdrawals that can be lethal are the 3 B’s:
Booze
Benzo
Barbiturate

Question 7

Triad of symptoms in an opioid OD

Answer 7

Coma
Respiratory Depression
Pinpoint pupils

Question 8

Fentanyl

Answer 8

synthetic opioid that is 100x stronger than morphine

Question 9

In order from least potent to most potent, list sufentanil, alfentanil, and remifentanil

Answer 9

ARS

Alfentanil (10x) Remifentanil (100x) Sufentanil (1000x)

Question 10

Meperidine (Demerol)

Answer 10

Nonmorphine opioid often abused by healthcare workers due to lack of pinpoint pupils.
Also used in obstetric analgesia

Question 11

Methadone

Answer 11

NMDA antagonist that can treat neuropathic pain and mainly is used for morphine withdrawal.
Can cause Torsades

Question 12

Heroin

Answer 12

Highly lipid soluble (more than morphine), so gives a great high.

Question 13

Hydromorphone (Dilaudid)

Answer 13

Similar effects to morphine and reversed with Naloxone

Question 14

Codeine

Answer 14

moderate/strong opioid agonist

metabolized to morphine by CYP2D6, which some individuals have mutations in.

Question 15

Hydrocodone

Answer 15

Similar to Codeine but combined with other drugs:

Vicodin- Acetaminophen + hydrocodone

Question 16

Opioids that are Mu antagonists and K Agonists

Answer 16

Pentazocine

Butorphanol

Question 17

Opioid that is a Mu agonist and K antagonist

Answer 17

Buprenorphine

Question 18

Buprenorphine

Answer 18

primarily for addicts

Can cause Torsades and Pancreatitis

Question 19

Opioid Antagonists

Answer 19

Naloxone

Naltrexone

Question 20

Opioid Withdrawal Syndrome

Answer 20

Non-lethal: 
Myalgias
Tachycardia
Restlessness
Anxiety 
Dilated pupils

Question 21

Naltrexone

Answer 21

used for alcohol and opioid abuse

Reduces craving for alcohols

Question 22

Methylnaltrexone

Answer 22

Mu antagonist that is used to treat opioid induced constipation in end-stage diseases

Question 23

Loperamide

Answer 23

Mu-agonist that is indicated for acute/chronic diarrhea

Question 24

Is it better to give fixed interval doses or PRN doses of Opioids?

Answer 24

Fixed schedule

Question 25

What opioid is ok to give to both renal and hepatic insufficiency patients?

Answer 25

Fentanyl

Question 26

What are potential side effects of Opioids with Anticholinergics?

Answer 26

Can exacerbate constipation and urinary retention