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NRAD 201D Exam 5 > Pain - Opioids > Flashcards

Pain - Opioids Flashcards

1
Q

What are the characteristics of acute pain?

A
  • abrupt onset, short duration
  • subsides once healing is complete or pain stimulus ceases
  • most likely associated with injury or surgery
  • is self-limiting
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2
Q

What are the characteristics of chronic pain?

A
  • persists longer than 6 months
  • interferes with ADLs
  • may lead to depression, physical/psychological dependence
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3
Q

What is considered to be mild pain on a scale of 0-10?

A

Mild = 1 - 3/10

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4
Q

what is considered to be moderate pain on a scale of 0-10?

A

Moderate = 4 - 6/10

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5
Q

What is considered to be severe pain on a scale of 0 - 10?

A

Severe = 7 - 10/10

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6
Q

What are the characteristics of Mu agonists?

A
  • opioids bind to opiate receptors in the CNS
  • Mu & Kappa = major receptor sites of pain
  • activation of these sites alter perception of pain and cause respiratory distress and constipation
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7
Q

Where are Mu & Kappa receptor sites located?

A

in the brain, down the spine, and around the GI system

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8
Q

What type of pain is morphine used for?

A

acute and chronic pain management

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9
Q

what different routes does morphine come in?

A

ALL FORMS - oral, parenteral (IM, SubQ, IV), and PR (rectal)

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10
Q

What is morphine derived from?

A

comes from the poppy plant

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11
Q

What are the characteristics of morphine?

A
  • no upper end
  • tolerance can develop = ↑ dose of drug to produce the same effect
  • there is a short acting & a long acting
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12
Q

What is the peak & duration of oral normal morphine?

A

Peak: 60 min
Duration: 4 - 5 hr

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13
Q

What type of pain is morphine (ER) used for?

A

chronic pain management

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14
Q

What form is morphine ER in?

A

oral

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15
Q

T/F morphine ER is used for breakthrough pain.

A

FALSE. short acting is used for break through pain (which is severe pain in the background of managed pain)

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16
Q

What are the characteristics of morphine ER?

A
  • used for opioid tolerant patients
  • doses scheduled daily, BID, or TID
  • must be swallowedd whole
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17
Q

what type of pain is hydromorphone used for?

A

• severe acute and chronic pain

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18
Q

what routes/forms does hydromorphone come in?

A

ALL FORMS - PO, PO-ER, parenteral (IV, IM, SubQ), PR (rectal)

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19
Q

what are the characteristics of hydromorphone?

A
  • less nausea than morphine - less adverse effects
  • ↑ risk for orthostatic hypotension & urinary retention
  • ↑ risk for respiratory depression - keep close eye on them
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20
Q

how much stronger is hydromorphone than morphine?

A
  1. 7 times greater potency than morphine = stronger

* *be careful of overdose

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21
Q

what type of pain is codeine used for?

A

mild to moderate pain

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22
Q

what are the characteristics of codeine?

A
  • antitussive action (suppresses cough)
  • “ceiling effect”
  • ↑ dose → ↑ risk of adverse effects
  • combined with acetaminophen or aspirin
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23
Q

What are the forms of codeine?

A

Oral - Tab or Syrup

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24
Q

What schedule is codeine in?

A

schedule 5 drug

25
Q

What type of pain is hydrocodone used for?

A

moderate to severe pain

26
Q

what are the characteristics of normal hydrocodone?

A
  • semi-synthetic opioid
  • stronger than codeine
  • combined with acetaminophen, varied doses (vicadine, norco)
  • used to be a schedule III → 2013 - Schedule II drug
27
Q

Is there an extended release hydrocodone?

A

yes, extended release hydrocodone is called Zohydro ER. IT IS PURE HYDROCODONE

28
Q

what is extended release hydrocodone used for?

A

severe chronic pain

29
Q

what are the characteristics of extended release hydrocodone?

A
  • only used when alternative treatment attempted.
  • opioid tolerant people only
  • no acetaminophen - PURE hydrocodone
  • not a PRN medication b/c of ER
  • swallow whole
30
Q

what type of pain is fentanyl used for?

A

chronic persistent pain & management of breakthrough cancer pain

31
Q

what are the different route/forms of fentanyl?

A

PO, buccal, sublingual, transmucosal, and transdermal

32
Q

what are the characteristics of fentanyl?

A
  • IV anesthetic for perioperative anesthesia

* used for opioid tolerant pts

33
Q

how much stronger is fentanyl than morphine?

A

100 times more potent than morphine

34
Q

what is special about transmucosal fentanyl?

A

mixed first pass/not first pass

• rapid absorption 25% into bloodstream, then medicated saliva is swallowed and goes through GI (first pass)`

35
Q

what type of pain is transdermal fentanyl used for?

A

moderate to severe chronic pain

36
Q

what are the characteristics of transdermal fentanyl?

A
  • opioid tolerant patients
  • long-term chronic analgesic therapy
  • 6 - 12 hr to reach steady state
  • duration of action 72 hours - changed every 72 hrs
37
Q

T/F this patch is transparent.

A

TRUE. make sure to document where it is placed. If lost, we have to look for it.

38
Q

What type of pain is oxycodone used for?

A

moderate to severe pain

39
Q

Is oxycodone short or long acting?

A

SHORT ACTING.

40
Q

What is long acting oxycodone called?

A

oxyCONTIN - controlled release

• around the clock analgesia for extended period of time

41
Q

What form/route is oxycodone and oxycontin available in?

A

PO

42
Q

what is the onset, peak, and duration of oxycodone?

A

onset: 10-15 min
peak: 60-90 min
duration 3-6hr

43
Q

what is the onset, peak, and duration of oxycontin?

A

onset: 10-15 min
peak: 3 hrs
duration: 12 hr

44
Q

what specific type of pain is short acting good for?

A

breakthrough pain

45
Q

what is the combo drugs of Percocet?

A

oxycodone & acetaminophen

46
Q

what is the combo drugs of Percodan?

A

oxycodone & aspirin

47
Q

what are the 6 adverse effect of opioid on the CNS?

A

• sedation, confusion, drowsiness, dizziness, floating feeling, and possible euphoria

48
Q

what is the adverse effect of opioid on the respiratory system?

A

respiratory depression

49
Q

what are the 2 adverse effects on the ♥ system?

A

hypotension, and bradycardia (peripheral vasodilation)

50
Q

what are the 3 adverse effects on the GI system?

A

constipation (slows peristalsis), nausea & vomiting

51
Q

what is the adverse effect of opioids on the GU system?

A

urinary retention

52
Q

what are 2 miscellaneous adverse effects of opioids?

A

tolerance (when taking frequent doses)

physical/psychological dependence

53
Q

T/F Adverse effects ↑ with ↑ doses.

A

TRUE

54
Q

what type of pain is methadone used for?

A

moderate or severe chronic pain

55
Q

what are the characteristics of methadone?

A
  • opioid tolerant pts
  • schedule II drug
  • less severe euphoria s/sx
  • not first choice drug for mod/severe pain
  • methadone maintenance - detoxification & maintenance of opiate or heroin dependency
  • DOES NOT CURE DEPENDENCE
56
Q

what should you do to monitor for oversedation?

A 
• assess RR and level of sedation
• consider holding opiates if RR < 12 breaths/min 
• respiratory depression if RR < 10/min
- unresponsive to verbal cue
- require painful stimuli (sternal rub)
57
Q

what is the opioid antagonist called?

A

naloxone (Narcan)

58
Q

what are the characteristics of narcan?

A
  • reverses opioid inducer CNS & respiratory depression
  • reverses analgesia effects
  • home use available - subcutaneous & intranasal
  • onset: 1-2 min

NRAD 201D Exam 5 (4 decks)

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