Pain Part 1 (Opioids) Flashcards by Shaquan Moore

Pure Opioid Agonists for Pain- Morphine Prototypes?
Morphine
Methadone
Loperamide, diphenoxylate-atropine
Codeine
Fentanyl
Buprenorphine
Naloxone
Methylnaltrexone
Butorphanol
Meperidine
Hydromorphone
Tramadol
Oxycodone
Nalbuphine
Hydrocodone
Pentazocine

Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone

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Pure Opioid Agonists for Pain- Non-morphine Prototypes?

Methadone, Fentanyl, Meperidine, Tramadol

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Anti-diarrheal Opioids?

Loperamide, diphenoxylate-atropine

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Mixed Opioid Agonists?

Buprenorphine, Butorphanol, Nalbuphine, Pentazocine

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Opioid Antagonist (Antidote)?

Naloxone

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Opioid Antagonist for Opioid Induced Constipation?

Methylnaltrexone

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Score of 4-6=

MODERATE TO SEVERE
MILD” pain
SEVERE pain
(Weak opioid- hydrocodone + acetaminophen
combo drug (Vicodin® or Norco®))
Non-opioids- like acetaminophen
Strong opioid- Morphine

MODERATE TO SEVERE
(Weak opioid- hydrocodone + acetaminophen
combo drug (Vicodin® or Norco®))

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Score of 7-10=

MODERATE TO SEVERE
MILD” pain
SEVERE pain
(Weak opioid- hydrocodone + acetaminophen
combo drug (Vicodin® or Norco®))
Non-opioids- like acetaminophen
Strong opioid- Morphine

SEVERE pain

Strong opioid- Morphine

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Which Assist primary drugs in relieving pain

Antidepressants 
Anticonvulsants 
Corticosteroids
Lidocaine patches
All
None

All

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NSAIDS/Corticosteroids can help suppress the ?

INFLAMMATORY SOUP or Spine

1) NSAIDS/Corticosteroids can help suppress the “INFLAMMATORY SOUP”

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Opioids can help suppress the Pain Pathway of the?

INFLAMMATORY SOUP or Spine

 2) Opioids can help suppress the Pain Pathway of the spine!

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Sudden onset
Usually subsides once treated

Acute pain or Chronic pain

Acute pain

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Persistent or recurring
Lasts 3 to 6 months 
Often difficult to treat 
Tolerance 
Physical dependence

Acute pain or Chronic pain

Chronic pain

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Mu Receptor

Analgesia
Decreased GI Motility
Euphoria
Miosis
Physical Dependence
Respiratory Depression
Sedation

Analgesia
Decreased GI Motility
Euphoria
Physical Dependence
Respiratory Depression
Sedation

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Kappa Receptor

Analgesia
Decreased GI Motility
Euphoria
Miosis
Physical Dependence
Respiratory Depression
Sedation

Analgesia
Decreased GI Motility
Miosis
Sedation

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USED TO TREAT:
 PRIMARY USE: Moderate to Severe Pain, Severe Pain

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)
b. (Methadone, Fentanyl, Meperidine, Tramadol)
c. (Loperamide, diphenoxylate-atropine)
d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)
e. Naloxone
f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

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USED TO TREAT:
Cough (anti-tussive)- weaker opioids such as ? in liquid form?

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)
codeine

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MECHANISM OF ACTION:
Agonists of opioid receptors in the
CNS and periphery (Mu + Kappa)

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

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ADVERSE EFFECTS PART 1:
Respiratory depression

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

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ADVERSE EFFECTS
 Excessive CNS sedation (CNS DEPRESSION)
 CNS depression- DROWSINESS/SLEEPY!

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

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ADVERSE EFFECTS
Nausea / vomiting

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

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ADVERSE EFFECTS
Miosis (pinpoint pupils)

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

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ADVERSE EFFECTS
Diaphoresis/Flushing
Urinary Retention
Constipation/gastroparesis

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

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ADVERSE EFFECTS
Do Not Use in Head Injury

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

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ADVERSE EFFECTS Tolerance / dependence / EUPHORIA/ addiction a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

ADVERSE EFFECTS  Do NOT GIVE IN BILIARY COLIC, do NOT give in Paralytic Ileus a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

ADVERSE EFFECTS  Itching (histamine release)- NOT ALLERGIC REACTION a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

ADVERSE EFFECTS  ALLERGIC REACTIONS- Anaphylaixs- IgE Mediated a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

ADVERSE EFFECTS hypotension/bradycardia a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

ADVERSE EFFECTS Dizziness/Lightheadedness Counsel your patients NOT TO OPERATE MACHINERY Change positions slowly a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

Miosis (constriction of the pupil) Out of it (sedated) Respiratory depression Pruritus (common) Hypotension (dizzy) & Head injury(avoid!) Infrequency (referring to urinary retention or constipation) Nausea Emesis a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

``` (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) M? Out of it ? R? P? H? (?) & H? (?!) I? (? or ? N? E? ```

``` Miosis (constriction of the pupil) Out of it (sedated) Respiratory depression Pruritus (common) Hypotension (dizzy) & Head injury(avoid!) Infrequency (referring to urinary retention or constipation) Nausea Emesis ```

Which cause RESPIRATORY DEPRESSION with opiods? ``` Alcohol Antihistamines Barbiturates Benzodiazepines Monoamine oxidase inhibitors (MAO-Is) None All ```

Alcohol Antihistamines Barbiturates Benzodiazepines

``` Which causes SEROTONIN SYNDROME with opiods? Alcohol Antihistamines Barbiturates Benzodiazepines Monoamine oxidase inhibitors (MAO-Is) None All ```

Monoamine oxidase inhibitors (MAO-Is)

Which is true for Opiods -Known drug allergy (or allergy in same Drug Class) -Giving with other CNS Depressant Drugs (Drug-Drug Issue) -Use with extreme caution in patients with: -Severe Asthma/COPD -Respiratory insufficiency -Decreased intracranial pressure -Elevated intracranial pressure -Morbid obesity or sleep apnea -Paralytic ileus -Pregnancy and Breastfeeding (Codeine, Tramadol can cross! -All None

- Known drug allergy (or allergy in same Drug Class) - Giving with other CNS Depressant Drugs (Drug-Drug Issue) - Use with extreme caution in patients with: - Severe Asthma/COPD - Respiratory insufficiency - Elevated intracranial pressure - Morbid obesity or sleep apnea - Paralytic ileus - Pregnancy and Breastfeeding (Codeine, Tramadol can cross!

Geriatrics May need lower doses of Tramadol, Codeine No Codeine No Codeine or Tramadol

May need lower doses of Tramadol, Codeine

Pediatrics May need lower doses of Tramadol, Codeine No Codeine No Codeine or Tramadol

No Codeine

Breastfeeding and Pregnancy May need lower doses of Tramadol, Codeine No Codeine No Codeine or Tramadol

No Codeine or Tramadol

Which has CROSS SENSITIVITY a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone

What is a true IgE mediated reaction (Type I)? - Throat Itching General Itching Tongue/Lip/Eyelid Swelling (Angioedema) Flushing Throat Swelling Nausea/Vomiting Difficulty Breathing Hallucinations Hives Rash* a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)

Which is TRUE ALLERGY CONCERN? ``` Throat Itching General Itching Tongue/Lip/Eyelid Swelling (Angioedema) Flushing Throat Swelling Nausea/Vomiting Difficulty Breathing Hallucinations Hives Rash* ```

``` Throat Itching Tongue/Lip/Eyelid Swelling (Angioedema) Throat Swelling Difficulty Breathing Hives ```

Which is QUESTIONABLE ALLERGY CONCERN ``` hroat Itching General Itching Tongue/Lip/Eyelid Swelling (Angioedema) Flushing Throat Swelling Nausea/Vomiting Difficulty Breathing Hallucinations Hives Rash* ```

``` General Itching Flushing Nausea/Vomiting Hallucinations Rash ```

Opioids how to treat constipation? which -Opioids lock up GI Motility- Peristalsis -Patients NEVER develop a tolerance to this -Minimally effective: Instruct patients to increase fiber/fluid + exercise -BEST way to treat constipation: Remember “all mush, no push”, -recommend a drug BEFORE they get constipated (prophylaxis!) All None

all

Opioids cause diarrhea or constipation

constipation

BEST way to treat ?: Remember “all mush, no push”, diarrhea or constipation

constipation

recommend a drug ? they get constipated (prophylaxis!) Before or After

BEFORE

Which Nursing Consideration applies to all Opioids ``` Urinary Retention CNS Sedation Nausea and Vomiting Dizziness/Orthostatic hypotension All None ```

All

PRIOR TO ADMINISTRATION of opioids which is true? Assess pain level – treat according to pain scale! Take vital signs -> Respiratory Rate, what is normal range? Both None

Both

What other medications should you assess that can worsen Respiratory Depression?

Alcohol  Antihistamines  Barbiturates  Benzodiazepines

Ability to provide equivalent pain relief by calculating dosages of different drugs or routes of administration that provide comparable analgesia. ``` Equianalgesia EFFICACY POTENCY Opioid Tolerance Physical Dependence Psychologic Dependence ```

Equianalgesia

Both drugs are equally ``` Equianalgesia EFFICACY POTENCY Opioid Tolerance Physical Dependence Psychologic Dependence ```

EFFICACY

They are different ``` Equianalgesia EFFICACY POTENCY Opioid Tolerance Physical Dependence Psychologic Dependence ```

POTENCY

A common physiologic result of chronic opioid treatment ``` Equianalgesia EFFICACY POTENCY Opioid Tolerance Physical Dependence Psychologic Dependence ```

Opioid Tolerance

Physiologic adaptation of the body to the presence of an opioid ``` Equianalgesia EFFICACY POTENCY Opioid Tolerance Physical Dependence Psychologic Dependence ```

Physical Dependence

A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief ``` Equianalgesia EFFICACY POTENCY Opioid Tolerance Physical Dependence Psychologic Dependence ```

Psychologic Dependence

Frequently given with Non-Opioids as a multi-modal pain approach a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

b. (Methadone, Fentanyl, Meperidine, Tramadol)

Binds to opioid receptors increases Serotonin and Norepinephrine in the nociceptive pathway a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Tramadol

Different from other opioids because it increases Serotonin a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Tramadol

UNIQUE ADVERSE EFFECTS:  This medication can lower the seizure threshold (SEIZURE RISK!) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Tramadol

UNIQUE ADVERSE EFFECTS:  Increases Serotonin- watch out for SEROTONIN SYNDROME a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Tramadol

SPECIAL USE: SUBSTANCE USE DISORDERS a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Methadone

 Binds to opioid receptors + inhibits NMDA receptors a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Methadone

UNIQUE ADVERSE EFFECTS:  This medication can prolong the QT interval (dysrhythmia risk). Patients require periodic EKGs a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Methadone

MECHANISM:  Binds to opioid receptors a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Fentanyl | Meperidine

MOST POTENT OPIOID a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Fentanyl

``` FENTANYL: Comes in several forms ? - IV pushes- critical care only (ICU,ED, OR) - Lozenge/Lollipops- oral mucosa- acute cancer pain - Patch- Transdermal- CHRONIC PAIN ONLY - IM- SQ All None ```

- IV pushes- critical care only (ICU,ED, OR) - Lozenge/Lollipops- oral mucosa- acute cancer pain - Patch- Transdermal- CHRONIC PAIN ONLY

Patch- Transdermal- CHRONIC PAIN ONLY a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Fentanyl

SLOW TO KICK IN- NEVER FOR ACUTE PAIN! (can take 12 hours) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Fentanyl

Which is - EDUCATE ABOUT PROPER DISPOSAL! Why?  AVOID HEATING PADS! Why?  SLOW TO KICK IN- NEVER FOR ACUTE PAIN! (can take 12 hours)  NEVER FOR OPIOID NAÏVE!- a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Fentanyl

Can be used for shivering in the OR a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Meperidine

CANNOT be given with MAO-I drugs a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Meperidine

Can only be given short term a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Meperidine

Has a CNS toxic metabolite called Normeperidine that can cause seizures a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Meperidine

USED TO TREAT:  These are used to treat diarrhea a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

c. (Loperamide, diphenoxylate-atropine)

MECHANISM OF ACTION:  These function as opioid agonists only in the periphery (GI tract) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

c. (Loperamide, diphenoxylate-atropine)

ADVERSE EFFECTS:  Constipation!  Extreme usage/abuse- bowel obstruction a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

c. (Loperamide, diphenoxylate-atropine)

Which uses atropine a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

c. (Loperamide, diphenoxylate-atropine)

Which causes C.Diff- can cause toxic megacolon? a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

c. (Loperamide, diphenoxylate-atropine)

- Addiction management (Substance Use Disorders) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Buprenorphine

1. Less abuse potential (not as strong- less risk for euphoria) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

2. Less Respiratory Depression (Ceiling effect) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

3. Less Analgesic Effect (Ceiling effect) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

4. Partial agonists usually have higher affinity than other opioids a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

ADVERSE EFFECTS:  Same as our other opioids (MORPHINE)  Nausea, Respiratory Depression, Miosis, Constipation, etc a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

Partial Mu agonist, Kappa antagonist a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Buprenorphine

Mu antagonist , partial Kappa agonist a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

Butorphanol, Pentazocine

Which are opioid withdrawal symptoms? - Findings include agitation, anxiety, insomnia, flu-like manifestations, opioid cravings - Physical- rhinorrhea, yawning, sweating (diaphoresis), pilo-erection (goose bumps), abdominal cramping, and diarrhea. - May see autonomic dysfunction (hypertension, tachycardia) - Manifestations are non-life-threatening, although suicidal ideation can occur - All - Nome

All

Which Three main Symptoms (TRIAD) Opioid overdose? - Respiratory Depression - Dilated pupils (Mydriasis) - Pinpoint pupils (miosis) - Coma - Cancer

Respiratory Depression Pinpoint pupils (miosis) (not always!) Coma

USED TO TREAT: Primarily as an antidote for opioids a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

e. Naloxone

Competitive antagonist at opioid receptors (has an extremely high affinity) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

e. Naloxone

ADVERSE EFFECTS: Fast acting, can reverse pain relief! (meant to reverse respiratory sedation) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

e. Naloxone

Short half life- patients may need a continuous IV drip a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

e. Naloxone

Assess and monitor Respiratory Rate Assess vitals- Blood pressure increase and heart rhythm irregularities may occur What happens if you give the maximum dose and patients respiratory depression has not reversed? a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

e. Naloxone

USED TO TREAT: Opioid Induced Constipation (OIC) a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

f. methylnaltrexone

MECHANISM OF ACTION: Competitive antagonist at opioid receptors (has an extremely high affinity) only for the GI TRACT a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

f. methylnaltrexone

“An Antidote for Opioid Induced Constipation” a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

f. methylnaltrexone

ADVERSE EFFECTS: Abdominal bloating, cramping because GI tract starts back up a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

f. methylnaltrexone

NURSING CONSIDERATIONS: Do NOT use if someone has a bowel obstruction a. (Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone) b. (Methadone, Fentanyl, Meperidine, Tramadol) c. (Loperamide, diphenoxylate-atropine) d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) e. Naloxone f. methylnaltrexone

f. methylnaltrexone