Opioids: Special Considerations

Question 1

dextromethorphan

Answer 1

anti-tussive only

no analgesic property, low abuse potential

Question 2

naloxone

Answer 2

reverses acute opioid OD

Question 3

buprenorphine

Answer 3

25-50x MORE potent than morphine

produces morphine-like analgesia with little euphoria

suboxone: buprenorphine + naloxone
^ used to tx opioid addiction and prevents illicit IV use

Question 4

pentazocine

Answer 4

KOR&raquo_space;> MOR

lower abuse potential since MOR in reward pathway not activated

can precipitate opioid withdrawal response

Question 5

hydrocodone and oxycodone

Answer 5

analgesia: oxycodone > hydrocodone > codeine

unclear if CYP2D6 polymorphism plays a role in analgesic efficacy

Question 6

codeine

Answer 6

CYP2D6 polymorphism –> poor metabolizers AND ultra metabolizers exist

if poor or ultra metabolizer: use an opioid that doesn’t require metabolism (ex. morphine, hydromorphone, buprenorphine)

can also be used as antitussive and antidiarrheal

Question 7

meperidine

Answer 7

toxic metabolite normeperidine can cause seizures

causes mydriasis and tachycardia instead of miosis d/t antimuscarinic property

Question 8

fentanyl

Answer 8

more potent than morphine

mult routes of admin

short acting

ideal primary general anesthetic d/t low cardiac depression profile

Question 9

methadone

Answer 9

long halflife

frequently used for CA pt and opioid abuse pt

inactivated by CYP2D6 –> polymorphism in poor metabolizers can cause OD

Question 10

hydromorphone

Answer 10

more potent than morphine

Question 11

morphine

Answer 11

high potential for abuse – controlled release oral preps available

mult routes of admin

highly effective anesthesia – can be used for intrathecal/epidural