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Pharmacology > Opioids > Flashcards

Opioids Flashcards

1
Q

what are narcotics

A
  • ‘opioids’ = any natural or synthetic drug that has morphine-like pharmacological action
  • major effects of opioids are on CNS and bowel
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2
Q

what binding sites are called the opiate receptors (for opioids to act as agonists) in the CNS

A
  • mu
  • delta
  • kappa
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3
Q

what are pure agonists (opioids)

A
  • activate both Mu and Kappa receptors
  • strong or moderate in producing an analgesic (relief of pain) effect
  • ex. morphine
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4
Q

what are mixed agonists-antagonists (opioids)

A
  • activate Kappa receptors but block Mu receptors
  • analgesic (relief of pain) effect with some antagonist activity
  • ex. pentazocine (talwin)
  • butorphanol (stadol)
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5
Q

what are pure antagonists/blockers (opioids)

A
  • inhibit both Mu and Kappa receptors
  • no analgesic effects; used in opioid overdose
  • ex. naloxone, naltrexone (revia)
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6
Q

what are some opiate agonists with moderate efficacy

A
  • codeine
  • hydrocodone (hycodan)
  • oxycodone (oxycontin)
  • combined with acetaminophen = Percocet
  • combined with ASA = percodan
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7
Q

what are some opioid agonists with high efficacy

A
  • hydromorphone (dilaudid)
  • meperidine (demerol)
  • morphine
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8
Q

what are some other effects of opioids besides analgesia

A
  • suppress cough reflex
  • slow GI motility
  • depress CNS
  • sedation
  • euphoria
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9
Q

what are some adverse effects of opioids on the CNS

A
  • respiratory depression
  • cough suppression
  • nausea/vomiting
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10
Q

what is an adverse effect of opioids in the GI tract

A
  • constipation
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11
Q

what are some other adverse effects of opioids in general

A
  • tolerance can develop

- physical and psychological dependence

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12
Q

what drugs will interact poorly with opioids

A
  • antihistamines, sedative/hypnotics, alcohol and psychotropics
  • increased CNS effects (e.g. sedation)
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13
Q

at what dose will morphine reduce severe pain or eliminate pain

A
  • 5-10 mg
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14
Q

what are the central actions or morphine (and some other opioids)

A
  • analgesia
  • drowsiness and sleep
  • cough suppression
  • vomiting (due to stimulation of chemoreceptor trigger zone in the brain)
  • hypotension
  • miosis (papillary constriction)
  • respiratory depression (high doses): major toxic effect and cause of death because no tolerance is developed to respiratory depression
  • euphoria (ecstacy; develop tolerance rapidly to euphoric actions)
  • increased release of ADH (antidiuretic hormone), which causes urinary retention
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15
Q

what are some other minor activities (peripheral actions) caused by morphine and some other opioids

A
  • constipation (due to slowing of peristalsis)

- body warmth/flushing/itching (due to histamine release)

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16
Q

when is morphine used

A
  • severe pain due to trauma, cancer, or heart attack
  • severe and chronic pain
  • pre-anaesthetic medication
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17
Q

what does morphine do (pharmacodynamically)

A
  • binds with mu and kappa receptor sites
  • analgesia, euphoria, constriction of pupils, stimulation of cardiac muscle
  • relieves SOB with heart failure and pulmonary edema
  • for relief of chest pain due to heart attack
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18
Q

what are some side effects of morphine

A
  • dysphoria (restlessness, depression, anxiety)
  • hallucinations
  • nausea
  • constipation
  • dizziness
  • itching sensation
  • in cases of overdose, respiratory depression, cardiac arrest
  • do not take with alcohol -> both are CNS depressants
  • tolerance and cross tolerance can develop, as well as physical and psychological dependence
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19
Q

what is methadone

A
  • long-acting synthetic morphine derivative used orally in the treatment of opioid (usually heroin) addiction
  • used to ‘wean’ patients off narcotics because it does not produce euphoria
  • it is still abused
20
Q

what is meperidine

A
  • also called demerol
  • less effective analgesic than morphine with half the duration of action (75 mg meperidine IM = 10 mg morphine IM)
  • used for moderate to severe pain
21
Q

what is oxycodone and hydrocodone

A
  • semisynthetic morphine derivatives
  • respiratory depression, antitussive, constipation and dependence
  • moderate to severe dental pain
  • it is most effective when combined with NSAIDs, aspirin, or acetaminophen (eg Percocet, percodan)
22
Q

what is codeine

A
  • naturally occurring narcotic agonist obtained from the opium poppy but in lesser amounts than morphine
  • less potent analgesic than morphine (120 mg of codeine phosphate IM = 20 mg morphine IM; 200 mg codeine oral = 30-60 mg morphine orally)
  • less respiratory depressant and constipation and has less dependance potential
23
Q

what type of drug is codeine

A
  • prodrug (its analgesic activity is the result of a conversion to morphine by cytochrome P450 liver enzymes)
  • usually combined with other non-narcotic drugs such as acetaminophen (Tylenol) for the relief of acute nociceptive mild to moderate dental pain
  • also used as an antitussive in cough syrups
24
Q

dental hygiene guidelines for patients taking codeine

A
  • monitor patient for dry mouth; fluoride rinses if indicated
  • monitor vital signs due to effects on the heart and respiratory system
  • causes drowsiness/sedation
25
Q

what is propoxyphene

A
  • also called Darvon
  • related to methadone with less analgesic activity than codeine
  • abused
26
Q

what is destromethorphan

A
  • agonist opioid without any analgesic activity

- high antitussive effects (used in cough medicines)

27
Q

what is loperamide

A
  • agonist opioid without analgesic effects

- increases smooth muscle tone in the GI tract and is used as an antidiarrheal

28
Q

what is diphenoxylate

A
  • agonist opioid/anticholinergic
  • antidiarrheal
  • combined with atropine in a product called lomotil (can cause severe respiratory depression, coma and death after overdose in children)
29
Q

what is tramadol

A
  • also called ultram
  • agonist, unique analgesic quality having both opiate and central acting adrenergic qualities
  • not a controlled substance; not narcotic
  • approved for moderate to moderately severe pain
  • can cause serious neurotoxicity and is not the first-line drug of choice
30
Q

what is naloxone

A
  • opioid antagonist
  • block both mu and kappa receptors
  • complete or partial reversal of opioid effects
  • reverse opioid symptoms of respiratory depression and CNS depression within minutes
31
Q

what are some side effects of naloxone

A
  • rapid loss of analgesia
  • increased blood pressure
  • tremors
  • hyperventilation
  • nausea/vomiting
  • drowsiness
32
Q

what are signs of withdrawal

A
  • chills, abdominal and muscle cramps
  • severe itching, sweating, restlessness
  • anxiety, yawning, drug-seeking behaviour
33
Q

what is substance abuse

A
  • the use, by self-administration, of a drug that does not conform to the medical or social norms within the client’s given culture or society
34
Q

what are some reasons for substance abuse

A
  • increase performance
  • assist in relaxation
  • alter psychological state
  • fit in with the crowd/peer pressure
35
Q

what are the 3 structures of society substance abuse has an impact on

A
  • economic, social and public health
36
Q

what are some legal substances that are often abused

A
  • alcohol
  • nicotine
  • volatile inhalants (aerosols, paint thinners)
  • narcotics
  • marijuana
37
Q

what are some illegal substances that are often abused

A
  • stimulants
  • hallucinogens (LSD, PCP, psilocybin aka magic mushrooms)
  • narcotics
38
Q

what is addiction

A
  • an overwhelming feeling to take
  • continued use of a substance despite its negative health and social consequences
  • legal prescription drugs rarely cause addiction
39
Q

what is dependence

A
  • overwhelming desire to take drug and cannot stop

- 2 types: physical, psychological

40
Q

what is physical dependence

A
  • the condition of experiencing unpleasant withdrawal symptoms when the substance is discontinued
  • altered physical condition caused by the nervous system adapting to repeated drug use
  • withdrawal symptoms when discontinued
41
Q

what are some drugs that can cause physical dependence

A
  • narcotics
  • alcohol
  • CNS depressants
  • some stimulants
  • nicotine
42
Q

what is psychological dependence

A
  • an unpleasant intense craving for a drug after it has been withdrawn
  • no physical signs
43
Q

what are some drugs that can cause psychological dependence

A
  • marijuana
  • anti anxiety drugs
  • crack cocaine
44
Q

what is classic withdrawal

A
  • unpleasant symptoms experienced when a physically dependent client discontinues use of an abused drug
  • prescription drugs used to reduce severity of symptoms
45
Q

what is conditioned withdrawal

A
  • environment and social contacts contribute to relapse after addict is no longer abusing substance
  • treatment: stop association with past social contacts or relationships
46
Q

what is tolerance

A
  • the individual adapts to the drug over time
  • higher and higher doses needed to produce the same initial effect
  • common with drugs that affect the nervous system
  • does not develop at the same rate for all actions of a drug

Pharmacology (21 decks)

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