Opioids and Non-opioids Flashcards
5 cardinal signs of inflammation
dolor - pain
calor - heat
rubor - redness
tumor - swelling
functio laesa - loss of function
what do opioids and non-opioids manage
manage pain but not inflammation
define opioids vs opiates
opiate: natural from poppy
opioids: synthetic or lab made
naturally occurring
morphine
codeine
thebaine
semi-synthetic
hydrocodone
oxycodone
hydromorphone
buprenorphine
synthetic
fentanyl
tramadol
nalbuphine
methadone
discuss the opium poppy plant
illegal to have
MC in turkey
scarring of pods will release seeds that becomes alkaloids
what are alkaloids
chemical substances that have active ingredients
morphine, codeine, thebane
discuss morphine
gold standard opoid
new drugs are compared to this
longest existing and has proven efficacy
discuss codeine
on cough syrups
antitussive: prevent cough
discuss thebane
source of heroin - highly addictive and illegal
can reverse effect of opioids
discuss characteristic of opioids
relieve mod to severe pain: 4-9
binds to receptors in CNS - inehrent
can cause physical dependence
targets brain, SC and peripheral nerves
mechanism of action to the brain
binds to pain receptors and inhibits neurons for pain transmission
stims descending pathway - dorsal horn of SC
mechanism of action to the SC
dec release of pain mediating substances
hyperpolarizes postsynaptic neuron: makes more negative hence di ma ddepolarize = no conduction of pain
mechanism of action to the peripheral nerves
dec excitability of A delta and C fibers
discuss Mu receptors
supraspinal areas: PAG, medial thalamus, hypothalamus, limbic
supraspinal analgesia
euphoria
respi depression
high abuse potential
discuss Kappa receptors
dorsal horn of gray matter - SG
deep layers of cerebral cortex
spinal analgesia
sedation
pressed flexor reflexes
low abuse potential
discuss Delta receptors
substantia nigra
globus pallidus
corpus striatum
other limbic structures
euphoria and sedation
low abuse potential
discuss Sigma receptors
hippocampus and CV
dysphoria
hallucinations
CV stim - inc HR and BP
low abuse potential
discuss analgesia as opioid effect
pain relief or absence
para makaka PT
discuss sedation and drowsiness as opioid effect
mild sedated: full awake but s anxiety
mod sedated: may close eye or nap but awaken c stim and converses
heavy sedated: vigorous stim needed to awaken and converse
discuss respi depression and apnea as opioid effect
should count RR in full min
discuss OH and bradycardia as opioid effect
OH: dec BP in upon standing
bradycardia: < 60 bpm
discuss constipation as opioid effect
dec in freq of passing stool
hard stool or dec peristaltic movements
kaya nag bibigay din laxatives pag naka opioids
discuss nausea and vomiting as opioid effect
nausea: wanting to vomit
vomiting: forceful expulsion of gastric contents
antiemetic drugs: to control nausea and vomiting
discuss miosis as opioid effect
pupillary constriction - eliminate pos opioid overdose
discuss suppression of cough reflex as opioid effect
prod: give expectorant
non-prod: give opioids to supress
discuss histamine release as opioid effect
be careful
mild: rashes. itchy, swelling of eyes
severe: diff breating
discuss euphoria as opioid effect
highness and extreme happiness
to give better disposition in cancer pt
can be abused
discuss color coding on co-oxycodone and tramadol
color for diff doses
easier to know esp sa geria
discuss nalbuphine
injected - hospital and clinic
discuss fentanyl
most recent - 100x more potent but higher side effects
injectable or transdermal
last 72 hrs - 75 mcg/hr
what is tolerance
receptor down regulation - dec effect of drugs
need to shift or inc dosage as safe range
what is withdrawal
sx happens when you stop taking the drug
abstinence syndromes
body aches
diarrhea
fever
gooseflesh
insomnia
nausea/vomit
runny nose
shivering
sneezing
stomach cramps
loss of appetite
sweating
tachycardia
weakness
fatigue
uncontrollable yawning
discuss comprehensive dangerous drugs act of 2002
basta bawal ang ket ano galing sa opium poppy
discuss acetaminophen/paracetamol
classic non-opioids
active metabolite of Phenacetate - good analgesic but bad to liver and kidney
milder phenacetin sha
effect of acetaminophen/paracetamol
analgesic - 1-6 pain
antipyretic
not anti-inflammatory
- weak prostaglandin inhib
- non-platelet inhib
- inhib COX3
peak blood concentration of acetaminophen/paracetamol
30-60 mins
metabolism of acetaminophen/paracetamol
hepatic microsomal enzymes
metabolites of acetaminophen/paracetamol
acetamine sulfate
glucoronide
N-Acetyl-P-Benzoquinone
nephrotoxic or hepatotoxic
half life of acetaminophen/paracetamol
2-3 hrs
indications of acetaminophen/paracetamol
mild to mod pain
fever
allergy to aspirin
adverse effects of acetaminophen/paracetamol
mild inc of hepatic enzymes
central lobular necrosis
dizziness
excitement and disorientation
acute renal tubular necrosis
hemolytic anemia
methemoglobinemia
