opioids and OUD

Question 1

What opioids should you use when the patient has liver or kidney disease?

Answer 1

hydromorphone, fentanyl and methadone

Question 2

What drugs should you use for mild pain? Moderate pain? Severe pain?

Answer 2

mild - acetominophen and NSAIDs
moderate - codeine, oxycodone, hydrocodone, oral morphine and tramadol
severe - methadone, fentanyl, IV morphine, hydromorphone

Question 3

What are the adverse side effects of opioids (morphine)

Answer 3

sedation
nausea
constipation
cardio and respiratory depression/bradycardia
miosis
decreased GI motility -> constipation
urinary retention and decreased production
pruritis

Question 4

Patients develop tolerance to the effects of opioids. What effects do patients become tolerant to in days? weeks? months to a year?

Answer 4

days - sedation, respiratory depression, bradycardia
Weeks - nausea, pruritis
months to a year - miosis, constipation

Question 5

What are the three opioid antagonists?

Answer 5

naloxone, naltrexone, methylnaltrexone

Question 6

What are the clinical indications for opioids?

Answer 6

acute, neuropathic or cancer pain (NOT chronic pain or lower back pain)
cough suppressant
anti-diarrheal
anti-dyspneic for shortness of breath

Question 7

What receptor do opioids act on? what is opioids mechanism for analgesia?

Answer 7

Act on mu opioid receptors. Inhibit GABAergic neurons that synapse onto dopaminergic neurons -> lower inhibition of dopaminergic neurons -> greater release of dopamine