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Pharmacology > Opioids II/III > Flashcards

Opioids II/III Flashcards

1
Q

Who is most likely to experience dysphoria from morphine?

A

-Females
-Pain-free individuals

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2
Q

Opiates act on the mu-receptors of ___, which is the reward center, and allows for the reinforcing effect

A

Nucleus Accumbens

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3
Q

Why do some patients taking opioids experience nausea?

A

Trigger chemoreceptor trigger zone

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4
Q

What does tolerance not develop to?

A

Constricted pupils
Constipation

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5
Q

Major toxic effect of opiods?

A

Respiratory depression (decreased sensitivity to medullary chemoreceptors)

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6
Q

In what condition can the respiratory depression caused by opioids be useful?

A

Pulmonary edema (“air hunger”)
-Alleviates patient’s conscious awareness of respiratory distress

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7
Q

Why do opioids have anti-tussive effects?

A

-Depress cough control center

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8
Q

What two ways can opioids cause endocrine disturbances in chronic users?

A

1) Decrease prolactin, corticosteroid, and gonadotropin levels
2) Menstrual disturbances (females) and impotence (males)

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9
Q

How do opiods affect smooth muscle?

A

-Increase tone of circular smooth muscle
-Less movement of propensive muscle

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10
Q

True or False:
Urine retention, increased biliary pressure, and decrease intestinal motility are effect of use of opioids?

A

True

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11
Q

True or False: opioids can interfere with cardiovascular system, causing postural hypotension and cutaneous vasodilation (both of which are due to histamine release)

A

True

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12
Q

Why is morphine less potent orally?

A

First pass effect

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13
Q

Can morphine cross the BBB?

A

Yes

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14
Q

What patients should be given opioids with caution?

A

-Immunocompromised (immunosuppresion)
-Asthmatics (bronchoconstriction - histamine release)
-Recent head injury (increase CSF)
-Seizure prone (lower seizure threshold)

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15
Q

Drug interactions with morphine?

A

1) CNS depressants (additive effect)
2) MAO inhibitors (coma/hyperpyrexia)
3) Speedball

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16
Q

Triad symptoms for opioid overdose?

A

1) pinpoint pupil
2) depressed rate of respiration
3) CNS depression

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17
Q

Treating opioid OD?

A
  • Ventilation (admin O2-but may remove hypoxic drive)
  • Narcotic antagonist (Narcan)
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18
Q

True or False: Opioids can be used to treat moderate to severe pain, as adjunct to anesthesia, as anti-tussives, or dyspnea of left heart failure

A

True

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19
Q

How does morphine compare to codeine?

A

Codeine is effective when administered orally (morphine is not)
Codeine is less potent - it is a weak opioid agonist

20
Q

Morphine dosage?

A

30-60 mg PO
10 mg SC/IM

21
Q

In most patients, codeine is metabolized to ___

A

morphine

22
Q

Uses of morphine?

A

1) Anti-tussive
2_analgesic

23
Q

People with CYP2D6 are more likely to overdose on _____

A

codeine

24
Q

Why is meperidine not an appropriate treatment for chronic pain?

A

Build up of normepedrine can lead to seizures

25
Q

When heroin enters the brain, what does it become?

A

Morphine + 2 acetyl groups

26
Q

How does duration of action vary when methadone is used as analgesic vs. for opioid addiction?

A

-Analgesic: 4-6 hrs
-Opioid addiction: 12-24 hrs

27
Q

____ can be used to treat breakthrough pain, supplement in surgical anesthesia, and transdermally for chronic pain

A

Fentanyl

28
Q

How can opioid combination preparations cause liver damage?

A

-At high doses, may have toxic doses of acetaminophen, aspirin, or ibuprofen

29
Q

What drug class has less abuse potential, compared to opioids?

A

Mixed agonist-antagonists

30
Q

How does pentazocine act?

A

High doses: mu-antagonist

Normally:
-mu receptor (partial agonist)
-kappa receptor (agonist)

31
Q

Although pentazocine is less effective for severe pain, it is also less likely to do what two thing? What is it more apt to caues?

A

1) respiratory depression
2) potential for dependence

more likely to cause CNS stimulation

32
Q

Why does the Talwin NX include both pentazocine and naloxone?

A

Naloxone decreases chance of IV abuse (stops person from getting high)

33
Q

Buprenorphine is a ___ agonist that acts at __ receptors

A

partial; mu

34
Q

Main use of buprenorphine?

A

Reduce drug cravings in addicts

35
Q

What two partial agonists have abuse deterrent formulations?

A

-Buprenorphine
-Talwin NX

36
Q

What is the primary agent of office based treatment of opioid addiction?

A

Buprenorphine

37
Q

___ is a weak agonist that inhibits synaptic re-uptake of NE and serotonin, can be used to treat mild to moderate pain

A

Tramadol

38
Q

While Tapentadol is similar to Tramadol, how is it unalike? Alike?

A

Tapentadol has stronger mu activity and more effective than tramadol at treating pain (also more abuse potential)

-Both inhibit uptake of 5-HT and NE

39
Q

Naltrexone is a long-acting ____ that treats primary ______

A

antagonist
etoh abuse

40
Q

Two drawbacks of naltrexone?

A

1) Hepatotoxicity risk
2) Supppppper long acting (like 3-4 weeks long!)

41
Q

What two drugs can be given to treat/prevent constipation from opioid use?

A

-Naloxegol (opioid antagonist - chronic; outpatient setting; less sytemic effects)
-Methylnaltrexone (for serious constipation resulting from higher doses)

42
Q

True or False:
Features of acute withdraw include: dilation of pupils, HTN, tachy, goose flesh, yawning, sweating

A

True

43
Q

Why does one feel bad when they withdraw?

A

Person becomes depleted of endorphins and enkephalins

44
Q

Which is fatal: opioid or alcohol withdraw?

A

ETOH

45
Q

Before beginning naltrexone, an opioid addict must first ___

A

be detoxified

46
Q

Is Naloxone

A

Pharmacology (53 decks)

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