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Pharm 323 - Royce > Opioids / Non-Opioids > Flashcards

Opioids / Non-Opioids Flashcards

1
Q

3 opioid receptors and which are used/most important

A

Mu, Kappa, Delta

Mu is most important, Kappa also used

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2
Q

Mu receptors produce which effects? (6 things)

A 
respiratory depression
physical dependence
decreased GI motility
analgesia 
sedation
euphoria
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3
Q

Kappa receptors produce which effects? (4 things)

A

analgesia, sedation, psychotic effects, decreased GI motility

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4
Q

most opioid analgesics activate which receptors?

A

Mu

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5
Q

what do pure opioid agonists do to the receptors?

A

activate Mu + Kappa receptors

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6
Q

what do agonist-antagonist opioids do to the receptors?

A

activate Kappa + block Mu

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7
Q

what do pure opioid antagonists do to the receptors?

A

BLOCK all receptors

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8
Q

what’s an example of an opioid antagonist? and what is it used to treat?

A

naloxone

opioid overdose, reversal of post-op effects

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9
Q

example of pure opioid agonist

A

morphine

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10
Q

if a person has been on a pure opioid agonist, and is then given an agonist-antagonist, what are you concerned about?

A

the Mu receptor is now being blocked and this person will experience withdrawal symptoms

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11
Q

name some “strong opioid agonists”

A

“fentanyl + the m’s”

fentanyl, morphine, meperidine, methadone, hydromorphone

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12
Q

name some “moderate to strong opioid agonists”

A

“co”

codeine, hydrocodone, oxycodone

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13
Q

name some “agonist-antagonist opioids”

A

“bu”

butorphanol, pentazocine, buprenorphine, nalbuphine

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14
Q

major SE of opioids (7)

  • which one is most serious?
  • which one will not go away, even with tolerance?
A
  1. respiratory depression - most serious
  2. sedation
  3. nausea
  4. itching
  5. constipation - doesn’t resolve
  6. postural hypotension
  7. urinary retention
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15
Q

re: administration of opioids, if RR is <12, what would you do? and which nursing interventions could you try?

A

DON’T GIVE MED.

elevate HOB, O2 therapy, naloxone

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16
Q

what is prevention and treatment for constipation with opioid use?

A

prevention: fluid + fiber + activity
treatment: enema, stool softener (colace), stimulant laxative (senokot)

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17
Q

prevention and treatment for nausea/emesis with opioid use?

A

prevention: antiemetic
tx: lay flat + avoid movement

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18
Q

teaching/safety points for hypotension r/t opioid use

A

dangle, switch positions slowly, ask for assistance

FALL RISK

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19
Q

tx for urinary retention r/t opioid use

A

void q4, closely monitor I+O

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20
Q

strong opioids should be given with pain rating of what?

A

7-10

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21
Q

which drug would we use to tx opioid addiction w/low doses?

A

methadone

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22
Q

meperidine brand name

A

demerol

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23
Q

what is the special concern with using meperidine for chronic pain control?

A

it creates a toxic metabolite (normeperidine) that can cause seizures. this drug should only be used for 2 days max and patients should be assessed for nervousness, tremors + seizures

24
Q

moderate to strong opioids should be given with pain rating of what?

A

4-7

25
Q

what is the prototype for non opioid centrally acting analgesics

A

tramadol

26
Q

what is the MOA with tramadol?

A

weak action at Mu receptors and blocks norepinephrine + serotonin

27
Q

what is the onset with tramadol? max? duration?

A

onset: 1 hour
max: 2 hour
duration: 6 hr

28
Q

with tramadol, there’s a serious risk of ______ + should be AVOIDED with these patients

A

suicide

29
Q

with an opioid agonist-antagonist, what happens with the receptors? what different effects would you see?

A

activates kappa, blocks mu receptors –> less respiratory depression and physical dependence, but have psychotomimetic effects

30
Q

do opioid antagonists cause analgesia?

A

NO! they block both Mu + Kappa receptors

31
Q

re: dosing, what is important to know with naloxone?

A

effects only last for 1 hour, need repeated dosing and to be taken for medical care

32
Q

why is alvimopan (Entereg) used?

A

this drug blocks the Mu receptors in the gut, which blocks adverse effects on the bowel but still produces analgesia.

-preferred use to prevent ileus in bowel resection surgery and accelerate bowel recovery

33
Q

mneumonic for entereg

A

entereg = enteral feeding = selective peripheral inactivation of mu (in gut)

34
Q

entereg serious AE, and what is important to look for re: cessation of this med?

A

can cause MI - only use in hospital and STOP AS SOON AS CLIENT HAS BM!!!

35
Q

NSAIDs work by inhibiting what?

A

Cyclooxygenase (COX)

36
Q

COX 1 does what?

A

:)

prevents gastric ulceration + prevents bleeding and + prevents renal impairment

37
Q

COX 2 does what?

A

:(

promotes MI, strokes, pain, fever, inflammation

38
Q

1st generation NSAIDs do what?

A

block COX 1 + COX 2

39
Q

re: 1st generation NSAIDs and the COX that are blocked, what effects would you see?

A

GI ulceration, bleeding risk, renal impairment, decreased stroke/MI, decreased pain, fever, inflammation

40
Q

which drug has an IRREVERSIBLE inhibition of COX?

A

aspirin

41
Q

5 therapeutic effects of aspirin

A
  1. analgesic
  2. anti-inflammatory
  3. anti-pyretic
  4. anti-platelet
  5. colon cx prevention
42
Q

long term ASA side effects?

A

gastric ulceration, bleeding, perforation (esp. risky in elderly!!)

43
Q

how do we prevent GI bleeding with ASA use?

A

take with food/milk

use proton pump inhibitors

44
Q

what s+s would you see with salicylate toxicity? (ASA)

A

tinnitus, HA, dizziness, diaphoresis

45
Q

what are 3 examples of 1st gen NSAIDs (non-ASA)

A

ibuprofen, naproxen, diclofenac

46
Q

1st gen NSAIDs (non-ASA) major AE

A

gastric ulceration, MI/stroke

47
Q

ibuprofen greatly impacts which organs?

A

kidneys

48
Q

acetaminophen greatly impacts which organ?

A

liver

49
Q

hi

A

you’re doing great :)

50
Q

2nd gen NSAIDs do what? what’s an example?

A

inhibit COX 2

Celebrex

51
Q

how does acetaminophen work?

A

blocks prostaglandins

52
Q

does acetaminophen have anti-inflammatory action?

A

NO!!!

53
Q

what drug is the leading cause of liver injury?

A

acetaminophen

54
Q

what is the max dose of acetaminophen?

A

4g/day (healthy + no organ impiarment)

55
Q

what is max dose of acetaminophen with person w/AUD?

A

2g/day

56
Q

what drug can we administer for acetaminophen toxicity? and when should we give it?

A

acetylcystine (Mucomyst)

8-10 hours after ingestion is BEST (can be up to 24 hours)

rotten egg smell

Pharm 323 - Royce (28 decks)

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