Opioids and Pain Medications

Question 1

Codeine

Answer 1

• Opioid Agonist
• Prodrug of Morphine (CYP2D6)
• Side effects of resp. and card. dep.
• Used for pain, not much anymore

Question 2

Fentanyl

Answer 2

• Opioid agonist
• Side effects of resp dep w/out card dep
• Antagonized by Naloxone (IV) or Naltrexone (Oral)
• PO, epidural, IV, intrathecal, transderm patch
• High lipid solubility, high potency, fast onset short duration
• Used for pain, premedication for general anseth where it reduces MAC requirements

Question 3

Heroin

Answer 3

• Opioid agonist
• Prodrug converted to monoacetylmorphine in the blood and morphine in the brain
• Side effects of resp and card dep.
• Rapid onset
• Used for pain and to get high as fuck

Question 4

Hydrocodone

Answer 4

• Opioid agonist used in combo with acetaminophen
• Metabolized to hydromorphone (CYP2D6) active met.
• Resp and card dep.
• Pain

Question 5

Hydromorphone

Answer 5

• Opioid agonist
• IV or PO
• More lipid soluble than Morphine, thus 5x more effective
• Fast onset
• Safer for Pts with renal failure

Question 6

Merperidine

Answer 6

• Opioid agonist
• Converted to normerperidine by hepatic metabolism
• Faster onset than morphine but less potent
• Side effects include serotonin syndrome
• prolonged 1/2 life in pts with renal disease

Question 7

Morphine

Answer 7

• THE BIG DADDY, YOU MUST HAVE THIS DOWN COULD
• Opioid agonist
• Slow onset, long duration, narrow theraputic dose
• Resp dep, sedation, miosis, urinary ret, renal failure

Question 8

Methadone

Answer 8

• Opioid agonist
• PO
• Ultra long acting, cheap
• Maintence for opiod addiction
• Few euphoric effects
• Also used for pain

Question 9

Oxycodone

Answer 9

• Opioid agonist
• Usually given in combo with acetaminophen
• Prodrug. Oxymorphone active met (CYP2D6)
• ABUSE

Question 10

Buprenorphine
Nalbuphine
Pentazocine

Answer 10

• Opioid mixed antagonist/agonist
• Kappa agonist, mu partial agonist
• Buprenorphine is #1 prescribed opioid
• Side effects: high mu affinity, remember partial agonist acts like antagonist to strong agonist. thus hard to control pain following surgery
• has use in addition control
• available as transderm patch for acute short term pain (7-day)

Question 11

Tramadol

Answer 11

• Opioid partial agonist
• Met by CYP2D6 and CYP3A4
• Side effects include serotonin syndrome
• Mild to moderate acute and chronic pain

Question 12

Tapentadol

Answer 12

• Opioid partial agonist
• Mu receptor affinity
• Less pharmacogentic variability to responses
• Met by CYP2C9 and CYP2C19
• used for mild to moderate acute and chronic pain

Question 13

Alvimopan

Answer 13

• Opioid ANTAGONIST
• Absorbed poorly PO
• Used to antagonize opioid GI effects

Question 14

Methylnaltrexone

Answer 14

• Opioid ANTAGONIST
• IV admin
• Peripherally restricted (4-ammonia derivative, cationic)
• Used to treat constipation

Question 15

Diphenoxylate

Loperamide

Answer 15

• Antidiarrheal opioid

* Poorly absorbed PO

Question 16

Naloxone

Answer 16

*Opioid ANTAGONIST