Opioids Dr. Izard Flashcards
highest class of pain killers are the what opioids
Phenylpiperidines
Opioid Agonists
Morphine Hydromorphine Methadone Meperidine Fentanyl Codeine Oxycodone Hydrocodone = can go all the way up to coma and death Propoxyphene
Mixed Agonist/Antagonist (Partial Agonist) opioids
Pentazocine Nalbuphine Buprenorphine Butorphanol = plataus up to a certain point
Opioid Antagonist
Naloxone
Naltrexone
= no effect
oral and IV opioid time to effect pt
ORAL = 30min IV = 5-10min (can shut CNS down immediatly)
settings where to use opioid 9
- MI
- Sickle cell
- Post op precedures
- Trauma
- cancer
- kidney stones
- Back pain
- Anti-diarrhea (Loperamide)
- with anesthesia
acute effects of opioid
sedation, euphoria, slow NS, slow HR, X cough reflex, N/V, coma/death
opioid interact with what 3 drug classes
- MOA
- Sedative/hypnotics
- Anti-psychotic agents
u (mu) opioid receptor has affinity for
Endorphins > Enkephalins > Dynorphins
Delta receptor opioid (has affinity for what)
Enkephalines > Endorphins > dynorphins
Kappa opioid receptor has affinity for
Dynorphins > Endorphins > Enkephalins
Morphine uses what opioid receptor
mu, delta, kappa
Methadone uses what opioid receptor
mu
Buprenorphine uses what opioid receptor
mu, delta, kappa
Naloxone uses what opioid receptor
mu, delta
Morphine
- contraindications
- used for
- sulfur hypersensitivity, bronchial asthma or resp problems
- management of pain
Fentanyl use when
- manage persistent mod to severe chronic pain (continuous adminitsration) last resort
(100 x more potent then morphine)
Methadone used when
- abstinence sx management + tx opioid disorder + heroin disorder
(not dosed high enough for pharmacologic response)
Hydrocodone used for and is similar to what drug + usually combined with what
- mod to mod severe pain + antitussive (relieve cough)
- codeine
- usually combined with acetaminophen (hepatic problems if OD)
Pentazocine MOA, used for, NOT used for, contraindications
- partial agonist
- when no other pain med is enough severe pain needing opioid + preoperative + with anesthesia
- not for tx addiction
- not take with benzodiazepines or other depressants , preg (neonatal opioid WD syndrome)
Meperidine MOA, used for, RISK for what, interacts with
- agonist
- opioid needed pain
- misuse by anesthesiologists since they have access to it
- partial agonists + antagonists
Codeine used for, special for, risk, important to know with the use of this
- antitussive (cough)**, mild pain, Diarrhea
- least opioid activity drug of all
- addiction, OD
- gradually taper to stop medication
Loperamide used for, what can be given if OD, special thing about this one
- Diarrhea, OTC
- Naloxone
- taken my morphine addicts when they cant find it
Buprenorphine MOA, used for, interacts with
- partial agonist
- opioid and narcotic pain reliever addiction TX, pain
- CYP3A4 inhibitor or inducer **
Naloxone MOA, used for, risks
- opioid antagonist
- opioid overdose (inhibits receptors and takes over them) to reverse effects
- releases catacholamines –> lead to acute WD or pain (need to monitor)
Naltrexone MOA, used for, risks
- opioid antagonist (mu receptors) (so even if pt takes opioid they get no effect, receptors are blocked)
- alcohol and opioid addiction or overdose = rehab drug
- pt after this can be way more sensitive to opioid in future (can die from what they thought was normal dose), can give WD and pain symptoms **
