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Pharm 313 > Opioids and Non Opioids > Flashcards

Opioids and Non Opioids Flashcards

1
Q

What do opioids bind to?

A

Mu and Kappa receptors in the CNS

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2
Q

What are 3 receptors in CNS and which do opioids work on?

A

MU, KAPPA, delta

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3
Q

Which receptor is responsible for analgesia, rep. depression, sedation, physical dependence, and euphoria?

A

MU

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4
Q

Which receptor is responsible for analgesia, sedation, and psychotomimetic effects (hallucination/thought disturbance)

A

KAPPA

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5
Q

how does an AGONIST fxn?

A

drug that OCCUPIES receptors and ACTIVATES them

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6
Q

How does an ANTAGONIST work?

A

drug that OCCUPIES a receptor but does NOT ACTIVATE

–BLOCKS receptor activation by AGONISTS

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7
Q

Which gives you full activation? agonist, antagonist, or combo?

A

agonist

ex: morphine

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8
Q

With a combo of agonist/ antagonist what is happening with Mu and Kappa

A

overall less activation

  • AGONIST effect @ KAPPA
  • ANTAGONIST effect @ MU
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9
Q

What does a full antagonist do? example?

A
  • no analgesia
  • will precipitate withdrawal
  • Narcan, Naloxone
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10
Q

Which drug is the gold standard opioid that all other opioids are compared to?

A

Morphine

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11
Q

Opioids have no analgesic _____

A

ceiling!

- can increase dosing as high as needed to manage pain

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12
Q

All of the opioid sxs are limited to person developing a tolerance except

A
  • miosis

- constipation

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13
Q

What is the main cause of opioid death with overdose?

A

respiratory depression

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14
Q

Common opioid side effects

A
  • resp depression
  • sedation
  • constipation
  • nausea
  • itching
  • postural hypotension
  • urinary retention
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15
Q

Less common opioid side effects

A
  • neurotoxicity
  • miosis
  • euphoria/dysphoria
  • anxiety/unease
  • increase ICP
  • biliary colic
  • immune depression w/ long term use
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16
Q

2 beneficial uses of opioid side effects

A
  • anti-tussive

- anti-diarrheal

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17
Q

2 patiennt conditions when should not use opioids

A
  • head injury –> increase ICP

- cholecystitis –> biliary colic

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18
Q

When do you see respiratory depression with IV, IM, SubQ opioids?

A
  • IV: within 7 min
  • IM: within 30 min
  • SubQ: within 90 minutes
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19
Q

How long can respiratory depression with opioids last?

A

4-5 hours

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20
Q

if < 12 RR/minute with opioids

A
  1. elevate HOB
  2. arouse
  3. treat with naloxone
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21
Q

What can make respiratory depression worse with opioid usage?

A

if using with other CNS drugs, elderly, or other resp problems

*less likely to happen with chronic use

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22
Q

How do you prevent constipation with opioids?

A

increase fluid/fiber, prune juice, activity

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23
Q

Meds for opioid constipation use for prevention and treatment

A
  1. softener - ducosate/colace

2. stimulant laxative- senna/senokot

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24
Q

What position helps with nausea from opioids?

A

recumbent

-ambulation makes it worse

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25
Q

what causes nausea with opioids?

A

stimulation of chemoreceptors in medulla

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26
Q

Nausea is common in the opioid _____ but gets better with____

A

naive, more doses

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27
Q

How do you deal with itching caused by opioids?

A
  • premedicate with antipruretic

- change to different opioid

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28
Q

If BP is low ____

A

do not give opioid

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29
Q

How to deal with hypotension from opioids?

A
  • change position slowly
  • only up with assistance
  • do not give if BP is too low
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30
Q

How to manage urinary retention from opioids

A
  • monitor
  • encourage fluids
  • may need I&O
  • avoid anticholinergic drugs
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31
Q

List the 5 strong opioids

A
  1. Morphine Sulfate
  2. Hydromorphone (Dilaudid)
  3. Fentanyl
  4. Methadone (Dolophine)
  5. Meperidine (Demerol)

(many horny females mate madly)

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32
Q

Fentanyl is ____ times stronger then morphine and is dosed in ____.

A

80X, micrograms

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33
Q

When is fentanyl used? chronic or acute?

A

chronic

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34
Q

Fentanyl also comes in which 2 unique routes

A

patch an nasal spray

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35
Q

What is methodone used for?

A

low dose to treat opioid addiction

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36
Q

Why is methadone difficult to dose?

A

long half life

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37
Q

Methadone can’t be used with which population?

A

elderly

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38
Q

Methadone has which unique risk/adverse affect?

A

Toursad de Pointe

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39
Q

How long should Meperidine (Demerol) be used for?

A

2 days max!

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40
Q

Why can you only use Meperidine for a short time?

A

-makes a toxic metabolite called “normaperidine” which can cause seizures

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41
Q

Half life of Meperidine?

Half life of normaperidine?

A

2-4 –> frequent dosing

24-48 hours with normal renal fx

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42
Q

How would normaperidine toxicity manifest?

A

nervousness, temors, seizure

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43
Q

Meperidine is a ____opioid and gives patients a sense of ____

A

synthetic, euphoria

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44
Q

List 4 moderate to strong opioids

A
  1. Codeine and Tylenol (Tylenol #3)
  2. Hydrocodone and Tylenol (Vicodin or Loratab)
  3. Oxycodone and Tylenol (Percocet, Tylox)
  4. Oxycontin Extended Release
45
Q

Why give tylenol with moderate to strong opioids?

A

-potentiates giving synergistic effect

46
Q

Which of the moderate to strong opioids is the most widely used RX in the USA?

A

Hydrocodone + Tylenol (vicodin, loratab)

47
Q

Which of the moderate to strong opioids has a high abuse potential and is thus being used less?

A

oxycontin extended release

48
Q

What class does Tramadol (ultram) fall under?

A

Non-opioid centrally acting Analgesic

49
Q

How does Tramadol (ultram) work?

A
  • analog of codeine
  • weak action at MU receptors
  • BLOCKS Norepinephrine and Serotonin
50
Q

How long until Tramadol (Ultram) takes effect? How long last?

A
  • onset within 1 hour

- work for 6 hours

51
Q

Side effects of Tramadol (Ultram)

A

(non-opioid centrally acting analgesic)

-sedation, dizziness, headache, dry mouth, constipation, serious risk of suicide

52
Q

How do opioid agonist- anatgonists work?

A

bind as AGONIST on KAPPA

weak ANATAGONIST on MU

53
Q

What are the benefits of Agonist- antagonist opioids?

A

-decrease analgesia and respiratory depression –> decrease abuse potential

54
Q

Side effects of opioid agonist-anatagonist?

A

-psychomimetic effects due to Kappa binding

55
Q

What happens if give agonist-antagonist to patient who is physically dependent on an opioid?

A

withdrawal

56
Q

Examples of opioid agonist- anatagonist?

A

Butophanol (stadol)

Pentazocine (Talwin)

57
Q

Which class of drugs is frequently used in Labor and Delivery and why?

A

Agonist/antagonist due to decrease risk of respiratory depression in neonate

58
Q

What is the fxn of opioid antagonist?

A
  • BIND to MU and KAPPA but no analgesia

- used to reverse overdose/sedation

59
Q

Examples of opioid antagonist

A

Naloxone (narcan)

-

60
Q

Duration of opioid agonist Naloxone

A

1 hour

61
Q

Route for opioid agonist Naloxone

A

IV, IM, SubQ , Nasal

62
Q

Naloxone is only effective on opioid ____ or _____

A

agonist or agonist/antagonist

63
Q

What fxn of is Alvimopan (Entereg)?

A
  • opioid ANTagonist
  • works on selective Mu receptors in bowel
  • blocks adverse effects on bowel action- no effect on analgesia
64
Q

Why would you used Alvimopan (Entereg)?

A

-short term use to prevent ileus in bowel resection surgery and accelerate bowel recovery

65
Q

Alvimopan (Entereg) can only be used in ____ patients due to increase risk of ____

A

hospitalized, heart attack

66
Q

2 types of non-opioids for pain?

A
  1. NSAID (nonsteroidal anti inflammatory drug)

2. Acetaminophen

67
Q

Acetaminophen and NSAIDS both work on what enzyme?

A

cyclooxygenase

68
Q

Where is cyclooxygenase found?

A

in all tissues

69
Q

Cyclooxygenase is divided into what 2 categories?

A

Cox 1 and Cox 2

70
Q

What is the function of Cox2 ?

A

-mediates pain, inflammation, fever

71
Q

What is the function of Cox 1?

A

GI mucosal protection, renal flow, platelet thomboxane (clotting)

72
Q

What do prostaglandins do?

A

mediate pain, inflammation, fever, GI mucosal protection

73
Q

Whose good, cox 1 or cox 2? and why?

A

Cox 1

  • protects stomach
  • protects renal fxn
  • protects against bleeding
74
Q

Whose bad, Cox 1 or 2? and why?

A

Cox 2

-promotion of Mi, stroke

75
Q

How do 1st generation NASIDS work?

A
  • nonselective blockage of Cox 1 and Cox 2
  • decrease pain, inflammation, fever
  • increase ulceration, bleeding risk, renal impairment
76
Q

What generation of NSAID is Aspirin?

A

1st generation

77
Q

How does Aspirin Fxn?

A

-irreversible inhibition of COX resulting in long acting effect

78
Q

What chemical family does aspirin belong to?

A

Salicylate

79
Q

Benefits of aspirin

A
  • analgesic for moderate/mild musculoskeletal pain
  • antipyretic
  • anti inflammatory in high doses
  • antiplatelet effect
  • colon cancer prevention in high dose
80
Q

A high dose of aspirin can cause what 2 BENEFICIAL things?

A
  • colon cancer prevention

- anti inflammatory

81
Q

Aspirin and antiplatelet effect, dosing?

A

81 mg

one dose lasts a week for preventing platelet aggregation to prevent stroke/ TIA

82
Q

When not to use aspirin

A
  • Visceral organ pain
  • Kids with previous viral illness (Reyes Syndrome)
  • 1 week prior to surgery
  • Bleeding disorders
  • Alcoholic use disorder (GI bleed risk)
  • Renal impairment
  • Allergic rxn (hx asthma, rhinitis, nasal polyps)
83
Q

Long term side effect from Aspirin?

A

gastric ulceration, perforation, bleeding

84
Q

High dose Aspirin has what toxicity

A

salicylate toxicity

–headache, dizziness, tinnitus, sweating

85
Q

Patient education for Aspirin?

A
  • take with milk/food

- prophylaxsis proton pump inhibitor for high risk population like elderly

86
Q

Examples of non-aspirin 1st gen NSAIDs?

A

IBUPROFEN, naproxen, dilofenac

87
Q

Indication for using ibuprofen?

A
  • analgesic
  • anti-inflammatory
  • antipyretic
88
Q

Side effects of ibuprofen

A
  • gastric ulceration
  • bleeding
  • renal impairment
  • RISK OF MI/STROKE (lower then COX2 though)
89
Q

Who should not take ibuprofen?

A

cardiac history

90
Q

How does ibuprofen work?

A

nonselective blockage of cox 1 and cox 2

91
Q

What is Ketorolac (Toradol)? Duration of use?

A
  • IV formulation of 1st gen non aspirin NSAID

- only use for 5 days

92
Q

Whats up with NSAIDS and Kidneys?

A

If give NSAID it will block prostaglandin making afferent arteriole constrict causing decrease blood flow to the kidney
-prostaglandins keep the afferent arteriole vasodilated

93
Q

How doe 2nd generation NSAIDs fxn?

A

selectively inhibit Cox 2, still effects Cox 1 a little bit

94
Q

Which is more dangerous 2nd or 1st gen NSAID?

A

2nd because of increase risk of MI/ stroke

95
Q

What are the indications of use for 2nd generation NSAID?

A
  • analgesic

- anti-inflammatory

96
Q

Side effects of 2nd generation nsaid?

A
  • gastric erosion/ulcers
  • MI/stroke
  • renal impairment
97
Q

example of 2nd generation NSAID?

A

Celecoxib (Celebrex)

98
Q

What is acetaminophen not?

A

NSAID or Opioid

Anti-inflammatory

99
Q

How does Acetaminophen fxn?

A
  • selective inhibition of COX (enzyme that makes prostaglandins)
  • only works in CNS
100
Q

Indications for using Acetaminophen?

A
  • analgesic

- antipyretic

101
Q

1 side effect of acetamiophen?

A

Liver injury!

102
Q

Max dose of acetaminophen for regular and chronic alcohol abuse

A 
regular = 4 g
alcohol = 2 gram
103
Q

What is treatment for toxicity from acetamiophen?

A

Acetlycystine (Mucomyst)

-minimized liver damage

104
Q

If acetylcystine is given with _____hours there is ___% chance of full recover

A

8-10 hours of overdose, 100%

105
Q

Which medication smells like rotten eggs?

A

acetylcystine

106
Q

Preferred route for acetylcystine is _____ but also comes in ____

A

preferred = oral

comes in - IV

107
Q

Chronic use of NSAIDs can lead to what?

A

hypertension

108
Q

Multimodal pain order

A
  • using adjuvants (gabapentin, antidepressant, flexoril)
  • around the clock order for tylenol and ibuprofen
  • ice therapy
  • heating pad
  • abd binder
  • tens unit
  • local anasethetic

Pharm 313 (26 decks)

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