Opioids - Iszard

Question 1

morphine
codeine
hydrocodone
hydromorphone
levorphanol
oxycodone
oxymorphone
buprenorphine
nalbuphine
butorphanol
naloxone
heroin

Answer 1

phenanthrenes

Question 2

pentazocine
diphenoxylate
loperamide

Answer 2

benzomorphans

Question 3

meperidine
fentanyl
sufentanil
ramifentanil

Answer 3

phenylpiperidines

Question 4

methodone

propoxyphene

Answer 4

diphenylheptanes

Question 5

what are the opioid agonists? (9)

Answer 5

morphine
hydromorphine
meperidine
fentanyl
codeine
oxcodone
hydrocodone
propoxyphene

Question 6

what are the mixed agonist/antagonists? (4)

Answer 6

pentazocine
nalbuphine
buprenorphine
butorphanol

Question 7

what are the opioid antagonists? (2)

Answer 7

naloxone

naltrexone

Question 8

what are the concerns related to opioid adverse effects?

Answer 8

• CNS depression
• constipation
• hypotension -> use caution in pt w/hypovolemia*

Question 9

what is the black box warning of opioids?

Answer 9

serious, life-threatening respiratory depression may occur

Question 10

what are the indications of opioid therapy?

Answer 10

• MI
• sickle cell crisis
• post-op
• trauma
• cancer
• kidney stones
• back pain
• epidural anesthesia
• antitussive
• antidiarrheal (loperamide)

Question 11

which opioid receptor subtype shows this affinity:

- endorphins > enkephalins > dynomorphins

Answer 11

mu

Question 12

which opioid receptor subtype shows this affinity:

- enkephalins > endorphins and dynomorphins

Answer 12

delta

Question 13

which opioid receptor subtype shows this affinity:

- dynomorphins&raquo_space; endorphins and enkephalins

Answer 13

kappa

Question 14

methadone is a full agonist for which receptor?

Answer 14

mu

Question 15

naltrexone and nalmefene inhibit which receptor?

Answer 15

mu

Question 16

buprenorphine is a partial agonist for which receptors?

Answer 16

kappa and delta

Question 17

naltrexone is a partial agonist for which receptor?

Answer 17

kappa

Question 18

nalmefene is a partial agonist for which receptor?

Answer 18

kappa

Question 19

what are the dampening effects of opioids?

Answer 19

• depresses pain sensation (analgesic)

- depresses respiratory and cough centers (antitussive)

Question 20

what are the stimulant effects of opioids?

Answer 20

• antinociceptive system (analgesic)
• smooth musculature of stomach and bowel (antidiarrheal)
• ureter, bladder, sphincter

Question 21

• respiratory depression
• nausea/vomiting
• pruritus
• urticaria
• constipation
• urinary retention
• delirium
• sedation
• myoclonus
• seizures

Answer 21

acute adverse effects of opioid use

Question 22

• hypogonadism
• immunosuppression
• increased feeding
• increased GH secretion
• withdrawal effects
• tolerance/dependence
• abuse/addiction
• hyperalgesia
• impairment while driving

Answer 22

chronic effects of opioid use

Question 23

what are the minimal effects of opioid use?

Answer 23

• miosis
• constipation
• convulsion

Question 24

what is the one moderate effect of opioid use?

Answer 24

bradycardia

Question 25

what are the serious effects of opioid use?

Answer 25

• analgesia
• euphoria
• mental clouding
• sedation
• respiratory depression
• antidiuresis
• nausea/vomiting
• cough suppression

Question 26

what are the effects of opioid use with sedative-hypnotics?

Answer 26

increased CNS depression, especially respiratory depression

Question 27

what are the effects of opioid use with antipsychotic agents?

Answer 27

increased sedation

• variable effects on respiratory depression
• accentuation of cardiovascular effects (antimuscarinic and a-blocking actions)

Question 28

what are the effects of opioids with monoamine oxidase inhibitors?

Answer 28

relative contraindication to all opioid analgesics d/t high incidence of hyper-pyrexic coma
- HTN has also been reported

Question 29

this drug is an opioid agonist indicated for the management of pain not responsive to non-narcotic analgesics
- contraindicated in pts with bronchial asthma or upper airway obstruction, or respiratory depression

Answer 29

morphine sulfate

warnings: respiratory depression, CNS toxicity, don’t use with CNS depressants (alcohol)
adverse rxns: sedation, lightheadedness, dizziness, nausea, vomiting, constipation

Question 30

this drug is indicated for treatment of opioid dependence and is preferred for induction

• can be abused in a similar manner to other opioids
• significant respiratory depression and death have occurred, especially when given intravenously in combination with benzodiazepines and other CNS depressants

Answer 30

buprenorphine

Question 31

what are the drug interactions of buprenorphine?

Answer 31

monitor patients starting or ending CYP34 inhibitors for potential over/under-dosing
- use caution with benzos or other CNS depressants

Question 32

pure opioid antagonist that competes and displaces opioids at opioid receptor
- used for complete or patial reversal of opioid overdose or opioid depression (respiratory depression)

Answer 32

nalozone

NOTE: causes the release of catecholamines, which may precipitate acute withdrawal or unmask pain in those who regularly take opioids

Question 33

pure opioid antagonist

• cyclopropyl dervative of oxymorphone similar to naloxone and nalorphine
• acts as competitive antagonist at opioid receptor, showing highest affinity for mu receptors

Answer 33

naltrexone

NOTE: pts who have been treated with naltrexone may respond to lower opioid doses than previously used -> could result in potentially life-threatening opioid intoxication
- may also precipitate symptoms of acute withdrawal in opioid-dependent patients