Opioids: adverse effects, contraindications

Question 1

morphine

Answer 1

typical opoid sxs:

• resp depression
• histamine release (hypotension, bronchoconstriction, pruritis)
• confusion, miosis
• nausea, constipation
• abuse potential

CONTRAINDICATION:

• airway prob (asthma, URT obstruction)
• paralytic ileus

Question 2

hydromorphone

Answer 2

same as morphine except less histamine release
ie. less hypotension, pruritis, bronchoconstriction

Contraindications:
resp problems; paralytic ileus

Question 3

meperidine

Answer 3

same as morphine except NO MIOSIS

Contraindication:
- SSRI/MAOI –> fatal serotonin syndrome

Question 4

methadone

Answer 4

same as morphine
also a/w delayed resp depression and prolonged QT

contraindications:
resp problems; paralytic ileus

Question 5

fentanyl

Answer 5

same as morphine but

• LESS severe S/E
• no histamine release (ie. no bronchoconstriction, hypotension, pruritis)

contraindications:
- resp problems; paralytic ileus

Question 6

codeine

Answer 6

same as morphine but
- MORE severe histamine s/e (ie. increased bronchoconstriction, pruritis, hypotension)

contraindications:
- resp problems, paralytic ileus

Question 7

oxycodone and hydrocodone

Answer 7

same as morphine

often combined with acetamenophen –> risk of liver toxicity (contraindication: liver dz, etoh)

Question 8

pentazocine

Answer 8

dose dependent resp depression

KOR agonist S/E:

• psychotomimetic effects
• dysphoria

Question 9

buprenorphine

Answer 9

similar to morphine and SEDATION

little histamine release –> less severe bronchoconstriction, hypotension

contraindications: resp problems, paralytic ileus

Question 10

naloxone

Answer 10

cardiac arrythmia
HTN or hypotension
pulm edema
hepatotoxicity

contraindations: CAD patients, but risk/benefits considered during times of opioid OD

Question 11

dextromethorphan

Answer 11

rare but serious allergic reaction (bronchoconstriction, pruritis, hypotension)

no MOR-related problems