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Pharm test 3 > Opioids/Narcotics > Flashcards

Opioids/Narcotics Flashcards

1
Q

What is opium?

A

Dried juice from the seed-head of the opium poppy

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2
Q

What are 3 indications for opium?

A

analgesia, antitussive (codeine), constipating

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3
Q

What year was morphine derived? Who was responsible?

A

1801 by Morpheus – the greek of dreams!

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4
Q

What is an opioid?

A

Generic term for natural and synthetic substances that bind opioid receptors

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5
Q

What are the 3 subtypes of opioid receptors?

A

Delta, Mu, Kappa

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6
Q

How do opioids relieve pain?

A

receptor agonism by reducing the pain NT

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7
Q

what are 7 AEs of opioids?

A
  1. sedation
  2. Reduced peristalsis
  3. Pruritis (histamine release)
  4. Respiratory depression
  5. N/V
  6. Miosis
  7. Peripheral vasodilation (decrease in BP)
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8
Q

Why do opioids worsen pancreatic pain? What drug may cause less pain in these patients?

A

contract sphincter of oddi (increased biliary tree pressure)

Meperidine!

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9
Q

What is the anti-dote of opioids? what will you see in patients after giving it?

A

Naloxone (Narcan)

withdrawal symptoms

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10
Q

What is a longer acting form of naloxone that can be used for detox/addiction therapy? How long do you take it? How does it work?

A

Naltrexone (Vivitrol) - 1-3 days

Reduces euphoria in stable addicts

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11
Q

What can Ky EMTs use for opioid ODs in the field?

A

injection/inhalation of naloxone

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12
Q

Are all opioids long or short acting?

A

They have a broad range -
Remifentanil - short half life with plasma esterase
Methadone - large Vd, half life (take 1x/wk)

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13
Q

opioids = ______ inter-pt variability

A

wide

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14
Q

opioids dosage forms?

A

IV, SQ, TD, Intrathecal, PCA (pump)

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15
Q

Morphine is the ____- ______ opioid. How is different from the others?

A

Gold standard

Water-soluble (hydrophilic)

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16
Q

Morphine is used most often in pts with what pain? why?

A

Chest pain - it reduces sympathetic tone (decrease HR, BP) with little reflex tachycardia

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17
Q

How is morphine metabolized?

A

first-pass effect - after it passes thru the liver, there is very little concentration of the drug left in the blood to enter the systemic circuit.

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18
Q

which drug is the most resistant to naloxone?

A

methadone

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19
Q

What does it mean that morphine as an IV:PO ratio of 1:6?

A

You need to give MORE morphine PO because only some of it will end up in the systemic blood stream. When giving it IV, it does not have the first pass effect, thus needing smaller dose.

20
Q

Meperidine (Demerol) is structurally ________ to MS. It is _____potent than MS.

A

Dissimilar, less potent

21
Q

How is demerol metabolized? What patients should not take it?

A

Hepatically – normeperidine

patients with renal failure.. normeperidine will accumulate and cause seizures.

22
Q

meperidine can also increase ____ levels, when combined with antidepressants can lead to a life threatening condition called ________________.

A

5-ht

Serotonin Syndrome - tremors, sz, hallucinations, death.

23
Q

What is the official name of heroin? How do you imagine heroin? Why does it elicit such potent effects?

A

Diamorphine
chain of morphines
its highly lipophilic and goes straight to the brain.
highly addictive

24
Q

Why should you avoid meperidine in chest pain alerts?

A

can cause reflex tachycardia

25
Q

Meperidine is a weak ____________ and has __________ properties.

A

weak antitussive

antiACh properties

26
Q

Codeine is used more for _______ than pain relief.

For pain above or below the shoulders? What is an example?

A

cough suppression
Above the shoulders - dental pain:
Codeine #3 (30 mg Codeine + 300mg APAP)

27
Q

T or F. Most analgesic effects of codeine are from the metabolism to morphine.

A

T.

28
Q

Oxycodone is a ______-_______ opioid. And is __x more potent that MS. It is highly ________.

A

semi-synthetic
2x as potent as MS
addictive

29
Q

Oxycodone has ____ systemic bioavailability even following oral administration. Meaning, it has ___ first pass.

A

high

low first pass

30
Q

Oxycodone causes more/less pruritis and mental status change than MS.

A

less

31
Q 
Hydrocodone is coformulated with APAP in what 2 drugs? Below or above the shoulder pain?
What class is hydrocodone?
A

Vicodin, Lortab
Below the shoulders - back pain
C2

32
Q

T or F. Hydocodon + APAP is Percocet.

A

F. Oxycodone + APA = Percocet

Percodan = ASA+Oxy

33
Q

Hydromorphine (Dilaudid) has ___x the potency of MS via PO and ___x the potency via IV.

A

5x as potent with PO

8x as potent with IV

34
Q

How is Methadone useful in withdrawl/maintenance of opioid addiction?

A

It reduces cravings and the euphoric effect of other opioids

35
Q

How long is methadone’s duration of action? What does this mean for its reversibility? It is hydro/lipophilic?

A

15h following a PO dose –large Vd
It is hard to reverse!
Lipophilic

36
Q

What is a medical AE of methadone?

A

QT prolongation – Torsades

37
Q

Fentanyl is long/short acting. What is the relationship with dose and half life?

A

short

half life increases with dose

38
Q

How potent is fentanyl compared to MS?

A

100x as potent as MS

39
Q

Why is fentanyl a good transdermal agent? how long does the patch last?

A

it is highly lipophilic.

replace patch after 72h ($$$)

40
Q

Alfentanil, Remifentanil, Sufentanil have different _______ than fentanyl. Which one has the most rapid on/off? Which one is more potent than F?

A

onset/duration/potency
Remifantanil
Sufentanil

41
Q

Tramadol has weak/strong opioid activity? How does it work? Which opioid AE does tramadol cause less of?

A

weak opioid activity
Inhibits reuptake of NE and enhances 5-HT release.
resp depression

42
Q

AE of Tramadol? Is it less addictive? What narcotic class is it?

A

Seizure
Equally addictive
C4 (moved from C5)

43
Q

Bupenorphine (Butrans patch, Bupenex, Subutex) is used for what? What does it mean that it is paradoxical?

A

opioid dependence and moderate-severe pain

it acts as a opioid agonist/antagonist – wean off narcotics

44
Q

What narcotic class is the Butrans patch? How often should you change it?

A

C3

change every 7 days

45
Q

Dextromethorphan is used for what?

A

cough

Pharm test 3 (9 decks)

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