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Pharmacology > Opoids/ On > Flashcards

Opoids/ On Flashcards

1
Q

What are Opioids?

A

-Drugs that bind to receptors in CNS

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2
Q

3 main opiate receptors

A

Mu, kappa, Delta

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3
Q

Mu receptor

A
  • most important

- analgesia, resp. depression, euphoria, sedation, physical dependence

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4
Q

Kappa receptor

A

-Analgesic, sedation, psychotomimetic effects (psychotic)

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5
Q

Delta receptor

A

opioids don’t interact with delta

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6
Q

Agonists

A
  • Drugs that occupy receptors and activate them
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7
Q

Agonist + antagonist

A
  • Offer less activation of receptor
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8
Q

Antagonist

A
  • Drugs that occupy receptors but do not activate them. Antagonists block receptor activation by agonists.
  • No analgesia, precipitate withdrawal
  • used for overdose
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9
Q

Morphine is the __________

A

Gold standard

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10
Q

Opioids Effect

A
  • No analgesic ceiling

- You can keep going up and up

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11
Q

Opioids SE

A
  • Resp depression
  • Sedation
  • Constipation
  • Nausea
  • Itching
  • Postural Hypotension
  • urinary retention
  • All of these SE are limited except Constipation
  • Also has anti-tussive and anti-diarrheal properties
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12
Q

Other Side Effects Opioids (less common)

A
  • Neurotoxicity
  • Miosis (always despite tolerance)
  • Euphoria/Dysphoria: Anxiety/ sense of unease
  • increased ICP- not used head injury patients
  • Biliary colic- not used in cholecystitis patients
  • Prolonged use -> immune depression
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13
Q

Management of Resp depression/ sedation

A
  • If RR below 12 bpm.. do something
  • Arousal, oxygen, HOB elevated, naloxone
  • IM: 30 mins
  • IV: 7 mins
  • SQ: 90 mins
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14
Q

Management of constipation

A

Prevention: fluid/ fiber/ prune juice
Stool Softener: (docusate = Colace)/ stimulant laxative (senna= Senokot)
-Drugs for long term constipation form opiods

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15
Q

Nausea/ Emesis Management

A
  • Recumbent position helps

- Premediate with antiemetics

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16
Q

Itching

A

Premedicate with antipruritic agent (diphenhydramine)

- Change to a different opioid

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17
Q

Hypotension/ Post Hypotension

A
  • don’t give if BP is too low
  • Move positions slowly
  • Only up with assistance
18
Q

Urinary retention

A
  • Monitor, prevent with voiding q 4

- May need I&O catheter

19
Q

Morphine Sulfate

A

-DOC fro MI pain, and air hunger

20
Q

Dilaudid (hydromorphone)

A
  • 2nd DOC more potent than morphine

- Normal dose 0.3 mg

21
Q

Fetanyl (Duragesic)

A
  • dosed in mcg
  • 80x stronger than Morphine
  • used with chronic pain and anesthesia
  • comes in patch and intranasal
  • IV not common
22
Q

Methadone (Dolophine)

A
  • Used for opiod addiction (low dose)
    -For pain: long half life but harder to titrate
  • ## don’t use in elderly lots of deaths related to its use
23
Q

Demerol ( Meperidine)

A
  • Synthetic opiod
  • great pain relieving
  • half- life : 2-4 hours
  • toxic metabolite normeperidine half life of 24-48 hours can cause seizures
  • Should only be used for short period (2 days)
  • Assess for toxicity: nervousness, tremors, seizures
24
Q

Opioids that treat moderate pain

A

Codeine and tylenol (tylenol #3)
Hydrocodone and tylenol ( Vicodin, Loratab)
Oxycodone and Tylenol ( Percocet, Tylox)
Oxycontin: Extended Release
combos due to synergistic effect

25
Q

Hydrocodone and tylenol

A
  • most prescribed can be used with aspirin and ibuprofen
26
Q

Non- opioid Centrally acting analgesics

A

MOA: analog of codeine: weak action of mu receptors and blocks norepinephrine and serotonin
Prototype: tramadol (ultram)
Mod to severe pain: onset within 1 hour, works for 6 hours
SE: sedation, dizziness, headache, dry mouth, constipation
-Serious risk of suicide

27
Q

Opioid agonist/antagonist

A
  • bind as agonist on kappa receptors and weak antagonist on mu receptors
  • Less analgesia, less resp depression
  • Lower potential for abuse
  • Psychotomimetic effects: anxiety, strange thoughts, nightmares, hallucinations, delirium
  • IF given to patient physically dependent on opiods-> withdrawal
  • Ex: Butaphanol (stadol) and pentazocaine (Talwin)
28
Q

Opioid Antagonist

A
  • Bind to mu and kappa receptors but do not cause analgesia
  • Naloxone (Narcan)
  • Used for overdose, over sedation due to opiods
  • Last 1 hour. Redosing is usually necessary
  • Given IV, IM, SQ
  • only effective on pure opioid agonists or opiod agonist- antagonist
29
Q

Alvimopan (Entereg)

A
  • Selective peripheral mu antagonist
  • Blocks adverse effects on bowel action does not affect analgesia
  • Short term use to prevent ileus in bowel resection surgery and accelerate bowel recovery
  • Risk of heart attack only in hospitalized patients
30
Q

Non- opioids - NSAIDS & acetaminophen

A
  • NSAIDs work by inhibiting cyclooxygenase (COX)

- 1st and 2nd generations

31
Q

COX -1

A

Good Cox- considered the good one since it proves GI protection and hemostasis

32
Q

Cox- 2

A

Bad cox - because it mediates inflammation and sensitizes tissues to pain

33
Q

1st generation NSAIDS

A
  • Blocks both COX-1 and 2
  • Decrease pain, inflammation, fever
  • Gastric ulceration, bleeding risk, renal impairment
34
Q

1st gen NSAIDS Aspirin

A
  • Irreversible inhibition of COX longer acting effect
  • chem family: Salicylate
  • Analgesic
  • antipyretic
  • Anti- inflammatory
  • Antiplatelet agent 81 mg dose: one dose lasts a week for platelet aggregation
  • Colon cancer prevention, stroke, heart attack
  • stop a week before surgery
35
Q

Aspirin SE:

A
  • Most common: Gastric distress, heartburn, nausea
    Long term ASA SE: Gastric ulceration, perforation and bleeding
    -Prevent GI bleeding: adminster with food or milk. Prophalyxis with proton pump inhibitor for high risk population
  • Salicylate Toxicity: high dose ASA -> tinnitus, sweating, headache, dizziness
  • Contraindicated: bleeding disorders, anticoagulant drugs, renal impairment, children with viral infection, alcoholic use disorder, allergic reaction (hx of asthma, rhinitis, nasal polyps)
36
Q

1st gen NSAID NON- ASA

A
  • Analgesic
  • Anti-inflammatory
    -Anti-pyretic
    Se: gastric ulceration, bleeding, renal impariment, risk of MI/ Stroke (lower than COX-2)
    EX: Ibuprofen, naproxen, diclofenac
  • Comes in an IV formulation: ketorolac (Toradol)
37
Q

Prostaglandins keep what dilated

A

Afferent arteriole

38
Q

IF NSAIDS block dilation?

A

reduces renal perfusion preventing filtration

39
Q

2nd gen NSAIDs

A 
- Only inhibit COX- 2 
Analgesic 
- Anti-inflammatory 
-SE: GI erosion and ulcers, MI/ Stroke risk, renal impairment 
-Ex: celecoxib (Celebrex)
40
Q

Acetaminophen (tylenol)

A
  • selective inhibition of prostaglandins
  • Analgesic
  • Anti- pyretic
  • No anti- inflammatory action
  • Leading cause of liver injury
  • Max dose- 4 grams
  • Chronic alcohol use - 2 grams
41
Q

Acetaminophen Toxicity antidote

A

Antidote is Acetylcysteine (Mucomyst) is used to minimize liver damage.
- Best given 8-10 hours (100% recovery) of ingestion.
24 hours still significant effect

42
Q

Multi Modal Therapy

A

Using flexiril and gabapentin

- Tens machine

Pharmacology (14 decks)

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