Opioids and Non-Opioids Flashcards
Name the 3 main opiate receptors
Mu (analgesia, resp depression, euphoria, sedation, physical dependence), Kappa (Analgesia, sedation, pschytomimetic effects, psychotic), and Delta (No interaction)
Describe agonist”
drugs that occupy receptors and ACTIVATE them
Describe Antagonist+Agonist
Less activation
-Blocking/antagonist effect at Mu receptor and Activation/agonist effect at Kappa receptor
Agonist Opioids
FULL ACTIVATION; Drugs that bind to Mu and Kappa
Antagonist Opioids
No activation; drugs that occupy receptors, but don’t activate them.
What happens if you administer an antagonist after an agonist?
Withdrawal–> blocks agonist
Why would you use a pure antagonist?
Overdoses, respiratory depression, or sedation. Narcan (naloxone)
List 5 Strong Opioid Agonists
- Morphine Sulfate
- Hydromorphone (Dilauded)
- Fentanyl (Duragesic)
- Meperidine (Demerol)
- Methadone (Dolophine)
For what pain scale would you use a Strong Opioid?
7-10
List 4 Moderate-Strong Opioids
- Codeine & Tylenol (Tylenol #3)
- Hydrocodone & Tylenol (Vicodin, Lortab)
- Oxycodone & Tylenol (Percocet, Tylox)
- Oxycontin (ER oxycodone)
For what pain scale would you use a Moderate-Strong Opioid
4-6
List 4 Agonist-Antagonists
- Butorphanol (Stadol)
- Pentazocine (Talwin)
- Buprenorphine
- Nalbuphine
When would you use an Agonist-Antagonist?
Moderate-Severe Pain,
During birth
What are the SE of Agonist-Antagonists?
WITHDRAWAL, Less analgesia, less respiratory depression, Pstychotomimetic effects, strange thoughts, nightmares, hallucinations, delirium
What can Methadone cause?
Torsad’s De Point
What’s an advantage of Agonist-Antagonists?
Less potential for abuse
Why would you give a mother Agonist-Antagonists during delivery?
Because they reduce risk for respiratory depression
How long does Narcan last?
1 hour. Requires redosing due to long half-life of strong opiates
What vitals should you look at before administering Opioids?
RR (<12 intervene), BP (don’t give if BP is too low, usually systolic <100)
What are the 6 main SE of opioids?
- Respiratory Depression/Sedation
- Constipation
- Nausea/Vomiting
- Itching
- Hypotension/Postural hypotension
- Urinary Retention
Other symptoms:
Neurotoxicity, Miosis, Euphoria/dysphoria, immune depression with prolonged use
Name 2 contraindications (not RR) for opioids
- Increased ICP
2. Biliary colic (can cause spasms in the common bile duct. Use Demerol or Dilaudid)
Special Concerns for Meperidine (Demerol)
Seizures
Discuss Tramadol (Ultram)
Non-opioid, centrally-acting, analog of codeine. Substance 4
Relieves pain through combo of opioid and non-opioid mechanisms (weak action at Mu, AND blocks NE & serotonin) risk for suicide (contraindication)
Discuss Alvimopan (Entereg)
Counteracts ADRs of opioid and bowel function. Used to prevent ileus in bowel resection surgery and accelerate bowel recovery. Stop as soon as pt has BM post-op.
What is the key risk for Alvimopan (Entereg)?
HEART ATTACK!
COX. What it do?
Synthesize prostaglandins (promote inflammation, sensitize receptors to painful stimuli)
Prostaglandins that protect GI mucosa
Synthesize thromoxane for platelet aggregation/clotting
Work on kidneys to promote vasodilation and renal flow
Work in brain to mediate fevers and contribute to pain perception.
Work in uterus to promote uterine contractions
COX-1:
GOOD GUY
- pathway does good for the body.
- Promotes GI protection, bleeding/hemostasis, and renal impairment
COX-2:
BAD BOI
-Promotes pain, inflammation, and fever
Causes the risk for MI/Stroke
NSAIDS
Non-steroidal inflammatory drugs (cyclooxygenase inhibitors) inhibit COX function
1st 1st generation NSAIDS
Aspirin, Goody’s Powder
2nd Generation NSAIDS
Celebrex (Celecoxib)
How much Aspirin is needed to prevent MI? How long does it last?
81mg. 8 days, the lifespan of the prostaglandin
1st generation NSAIDS
ibuprofen, naproxone, diclofenac acid, ketoralac (IV form)
What syndrome is a risk with NSAIDS?
Reye’s syndrome- don’t give to kids if they have viral illness
What organ is most affected by NSAIDS? Acetaminophen?
Kidneys and Liver respectively
What wound one give to reverse an acetaminophen overdose?
Acetylcystine (mucomyst)
