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SUMPHARM > PAIN-OPIOIDs > Flashcards

PAIN-OPIOIDs Flashcards

1
Q

What if Pt is intolerant to one opioid?

A

Can try another class.

  1. Phenanthrenes- PHINES
  2. Phenylpiperdine- ANIL/YL/DINE
  3. Diphenlyheptan- ADONE/PHENE
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2
Q

What is difference btwn opioid and opiates?

A

Opiates -natural opium morphine.

Opioids- synthetic- methadone and semisynthetic- derived from morphine (heroin)

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3
Q

What is active metabolite of most Opioids, thus ideal to just give this?

A

Codeine to MORPHINE/ Via liver metab.

Excreted via Kidney.

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4
Q

What are pharmacokinetic importance of opioids?

A

Some have HIGH 1st pass metabolism.

Codeine reduced-thus n/v instead of morphine

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5
Q

What is important with morphine as far as doses?

A

Use less due to HIGH renal clearance

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6
Q

What is route of opioid administration?

A

ALL- PCA- self administered button if IV not poss.

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7
Q

What are benefits of Short vs Long acting opioids?

A

SA- LESS SE. Always start 1st to determine pt tolerance. LA- less peaks, steady, less end of dose failure, inc adherence.

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8
Q

What inhibit the release of excitatory transmitters from the
primary afferents & directly inhibit the dorsal horn pain
transmission neuron

A

Opioids

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9
Q

Why do Full agonist have high potency and addictive?

A
  1. Reinforcing.
  2. No ceiling effect
  3. They don’t knock each other off, 2x effect if taking 2
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10
Q

What is MC drug effect of full agonist opioids?

A

PSNS and anticholingeric- euphoria, vomit, dec pain sensation, alter consciousness.
LARGE- bradycardia, hypotension, non responsive, pinpoint pupils, flaccid, cyanotic, pulmonary edema

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11
Q

What is reason for large doses to produce same effects?

A

Tolerance

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12
Q

What is the normal physiological response with opioids?

A

Withdrawal. NOT always abuse. ex. Cancer PT.
Both reversible.
Titrate down slowly

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13
Q

What SE do people not develop a tolerance?

A
  1. Miosis- constriction of pupil
  2. Constipation
  3. Seizure Convulsions-
    always have these, the rest need high dose
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14
Q

What are the 5 C of addiction?

A 
Chronic use. 
Loss of Control, 
Compulsive use, 
Craving, 
Continued despite harm
50% who take opioids for 3m, wil cont. for 5y
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15
Q

In order to choose a diff drug or dose, what is used?

A

Morphine equivalent.
But never start at that max dose.
10-50% morphine and titrate up

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16
Q

If treat pain is it ok to give less of another type of opiod?

A

Caution. BUT can give less or more of opiod. No potency myth

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17
Q

What is the peak of effect of morphine?

A 
90min after bolus. Accumulation = less pain
Strongest to weak opioid
Fentanyl
Methadone- Dolphine
Hydromorphone- Dialuid
Oxymorphone
Meperidine-Demrol
Oxycodone- Percocet+APap
Morphine
Codeine
Hydrocodone-Vicodin
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18
Q

What is scary about Hydrocodone/Vicodin?

A

Often combo with APAP.

  1. Pt can OD on APAP if pain not changing
  2. INC sedation then codeine
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19
Q

Is Tramadol addictive?

A

yes it is a synthetic partial agonist.

Still abuse potential. AVOID: ELDERLY**

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20
Q

Who should not take Tramadol?

A
  • *1. Elderly
    2. Psych- weak inhib of NE and serotonin
    3. MAOI
    4. UNLIKELY LESS EFFECTIVE than NSAIDs- use NSAID
    5. Higher DI, SE
21
Q

What is absolute reason why people with PMH of seizures should avoid TramadoL?

A

**LOWERS THRESHOLD OF SEIZURES

22
Q

What is the main reason to know Brand name for Codeine?

A
  1. DANA least favorite 2/2 N/V- never give to pt w/ GI upset
  2. Tylenol 2-4 means diff Codeine dosage/APAP.
  3. not a strong MU agonist, thus why we use RX d/t least risk of OD
23
Q

What is Tylenol # 2?

A

Codeine/APAP 15mg/300mg,

24
Q

What is Tylenol # 3?

A

Codeine/APAP 30mg/300mg,

25
Q

What is Tylenol # 4?

A

Codeine/APAP 60mg/300mg,

26
Q

Why is important to believe pt when they say they don’t want codeine?

A

BBW
1. Could be UM-ultrametablizer CHILD death w/ breastfeeding.
2. NON metabolizer- if pain not working. CYP metab.
In general DON’T PRESCRIBE bc difficult to tell for either

27
Q

What is important with Oxycodone and Elderly?

A
  1. CrCL <60 means serum level will INC by 50%-Toxic AVOID.

2. 20mg PO oxy- 30mg morphine. Could start 5-10mg morphine

28
Q

How can you prescribe Percocet?

A

ONLY Combo of Oxy+ APAP- Monitor strengths. (5/325)

29
Q

What is the cleanest synthetic opioid?

A

Fentanyl-POTENT Use for post op shivering instead of meperidine/Demerol

30
Q

If using the Fentanyl patch what are the mainstay recc?

A
  1. CHRONIC pain only- NEVER post op or dental or FX
  2. DO NOT dose adjust before 3 days- drug takes awhile to get to MAX
  3. 17hr req b4 50% dec in fentanyl levels
  4. Start lowest dose on path, titrate
31
Q

What are BBW for Fentanyl patch?

A
  1. DO NOT CUT
  2. Flush in toilet
  3. NO kids
  4. MUST NOT be OPIOID naive
  5. Abuse chewed if cute
  6. Temperature Dependent
32
Q

In order to get Fentanyl patch, what is process?

A

Must start OPIOID for one week, every day or longer AT LEAST.
TITRate up with opioid which takes longer.

33
Q

Which opioid has longest half life and what are effects?

A

Methadone- WILL accumulate to reach steady state…thus effective after multiple titrating. TID

34
Q

WHat are reasons why pain specialist should prescribe methadone?

A

Racemic mixture

  1. AVOID malnourished
  2. AVOID CVD pt or arrhythmia
  3. Biphasic elimination 1: analgesia effect 2. sub analgesia but prevent W/D
35
Q

What is the Morphine equivalent to methadone?

A

<200mg/day for 5mg q8hrs. Take very long to convert.

1-2wks

36
Q

Which drugs are you NOT using on Opioid naive pts?

A

Fentanyl patch, Methadone, ER

37
Q

What is 8x more potent than morphine, with no active metabolite and not for LTC?

A

Hydromorphone- Start low dose POST op 0.25-0.5mg

38
Q

WHat has very little role in pain management, used of post op shivering, AVOID Elderly but Dana hates?

A

Meperidine/Demerol- Toxic metabolite long 1/2 life cleared renal, but leads to accumulation.

39
Q

What is only benefit of meperidine?

A

Difficult pain control in Sickle cell pts

40
Q

What med is ideal for antitussive?

A

Opioid analgesics- low doses

1. Dextrometrophan. 2 Codeine/quaifensesin

41
Q

What med are opioid like compounds for diarrheal?

A

Opioids slow GI-

Diphenoxylate atropine, Loperamid (Imodium).

42
Q

Which two antidiarrheal drugs is important to KNOW the BRAND name d/t miss up resulting in death?

A

Opium tincture VS camphorated tincture of opium -25 fold overdose

43
Q

How do Opioids affect Cardiovascular system?

A

Peripheral and Cerebral vasodilation.

Orthostatic hypotension

44
Q

Beside risk of OD, who are at risk with ADR?

A
  1. Head trauma
  2. Pregnancy
  3. Pulmonary COPD, OSA-INC respiratory depression
  4. Hepatic/Renal
  5. Endocrine dz- prolong effects of opioids
45
Q

WHat are top 3 opioids to avoid in renal dysfunction?

A
  1. Morphine
  2. Hydromorphone
  3. Codeine
  4. MAYBE oxycodone
    SAFE- Fentanyl and Methadone
46
Q

How is Naloxone diagnostic and a treatment for OD of opioids?

A
  1. Will throw person into WD
  2. Knock drug off receptor
  3. Will know if they are LOC d/t opioid or not.
47
Q

WHat are some Opioid medication error?

A 
1. Hydromorphone is not generic morphine. NO equivalent. HYRO way potent. 
2 Decimal, Abbreviations 
3. IV Vs epidural dose 
4. Elderly-seizure w/ meperidine 
5. Fentanyl patch removal too early
48
Q

What drugs should be avoid with opioids?

A
  1. Sedative CNS or Respiratory depression drugs

2. Antipsychotic and MAOI

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