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Phamacology Summer > Pain Part 1 (Opioids) > Flashcards

Pain Part 1 (Opioids) Flashcards

1
Q 
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
A

Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone

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2
Q

Pure Opioid Agonists for Pain- Non-morphine Prototypes?

A

Methadone, Fentanyl, Meperidine, Tramadol

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3
Q

Anti-diarrheal Opioids?

A

Loperamide, diphenoxylate-atropine

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4
Q

Mixed Opioid Agonists?

A

Buprenorphine, Butorphanol, Nalbuphine, Pentazocine

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5
Q

Opioid Antagonist (Antidote)?

A

Naloxone

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6
Q

Opioid Antagonist for Opioid Induced Constipation?

A

Methylnaltrexone

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7
Q

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
A 
MODERATE TO SEVERE
(Weak opioid- hydrocodone + acetaminophen
combo drug (Vicodin® or Norco®))
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8
Q

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
A

SEVERE pain

Strong opioid- Morphine

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9
Q

Which Assist primary drugs in relieving pain

Antidepressants 
Anticonvulsants 
Corticosteroids
Lidocaine patches
All
None
A

All

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10
Q

NSAIDS/Corticosteroids can help suppress the ?

INFLAMMATORY SOUP or Spine

A

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

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11
Q

Opioids can help suppress the Pain Pathway of the?

INFLAMMATORY SOUP or Spine

A

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

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12
Q

Sudden onset
Usually subsides once treated

Acute pain or Chronic pain

A

Acute pain

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13
Q 
Persistent or recurring
Lasts 3 to 6 months 
Often difficult to treat 
Tolerance 
Physical dependence

Acute pain or Chronic pain

A

Chronic pain

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14
Q

Mu Receptor

Analgesia
Decreased GI Motility
Euphoria
Miosis
Physical Dependence
Respiratory Depression
Sedation
A 
Analgesia
Decreased GI Motility
Euphoria
Physical Dependence
Respiratory Depression
Sedation
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15
Q

Kappa Receptor

Analgesia
Decreased GI Motility
Euphoria
Miosis
Physical Dependence
Respiratory Depression
Sedation
A

Analgesia
Decreased GI Motility
Miosis
Sedation

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16
Q

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

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

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17
Q

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

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

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

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18
Q

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

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

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

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19
Q

ADVERSE EFFECTS PART 1:
Respiratory depression

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

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

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20
Q

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

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

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

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21
Q

ADVERSE EFFECTS
Nausea / vomiting

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

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

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22
Q

ADVERSE EFFECTS
Miosis (pinpoint pupils)

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

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

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23
Q

ADVERSE EFFECTS
Diaphoresis/Flushing
Urinary Retention
Constipation/gastroparesis

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

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

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24
Q

ADVERSE EFFECTS
Do Not Use in Head Injury

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

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

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25
Q

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

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

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26
Q

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

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

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27
Q

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

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

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28
Q

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

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

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29
Q

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

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

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30
Q

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

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

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31
Q

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

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

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32
Q

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

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

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33
Q 
(Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone)
M?
Out of it ?
R?
P?
H? (?) & H? (?!)
I? (? or ?
N?
E?
A 
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
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34
Q

Which cause RESPIRATORY DEPRESSION with opiods?

Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Monoamine oxidase inhibitors (MAO-Is)
None
All
A

Alcohol
Antihistamines
Barbiturates
Benzodiazepines

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35
Q 
Which causes SEROTONIN SYNDROME with opiods?
Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Monoamine oxidase inhibitors (MAO-Is)
None
All
A

Monoamine oxidase inhibitors (MAO-Is)

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36
Q

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

A
  • 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!
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37
Q

Geriatrics

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

A

May need lower doses of Tramadol, Codeine

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38
Q

Pediatrics

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

A

No Codeine

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39
Q

Breastfeeding and Pregnancy

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

A

No Codeine or Tramadol

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40
Q

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

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

41
Q

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

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

42
Q

Which is TRUE ALLERGY CONCERN?

Throat Itching General Itching
Tongue/Lip/Eyelid
Swelling (Angioedema)
Flushing
Throat Swelling Nausea/Vomiting
Difficulty Breathing Hallucinations
Hives Rash*
A 
Throat Itching 
Tongue/Lip/Eyelid
Swelling (Angioedema)
Throat Swelling
Difficulty Breathing 
Hives
43
Q

Which is QUESTIONABLE ALLERGY CONCERN

hroat Itching General Itching
Tongue/Lip/Eyelid
Swelling (Angioedema)
Flushing
Throat Swelling Nausea/Vomiting
Difficulty Breathing Hallucinations
Hives Rash*
A 
General Itching
Flushing
Nausea/Vomiting
Hallucinations
Rash
44
Q

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

A

all

45
Q

Opioids cause diarrhea or constipation

A

constipation

46
Q

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

diarrhea or constipation

A

constipation

47
Q

recommend a drug ? they get constipated (prophylaxis!)

Before or After

A

BEFORE

48
Q

Which Nursing Consideration applies to all Opioids

Urinary Retention
CNS Sedation
Nausea and Vomiting
Dizziness/Orthostatic hypotension
All
None
A

All

49
Q

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

A

Both

50
Q

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

A

Alcohol
 Antihistamines
 Barbiturates
 Benzodiazepines

51
Q

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
A

Equianalgesia

52
Q

Both drugs are equally

Equianalgesia
EFFICACY
POTENCY
Opioid Tolerance
Physical Dependence
Psychologic Dependence
A

EFFICACY

53
Q

They are different

Equianalgesia
EFFICACY
POTENCY
Opioid Tolerance
Physical Dependence
Psychologic Dependence
A

POTENCY

54
Q

A common physiologic result of chronic opioid
treatment

Equianalgesia
EFFICACY
POTENCY
Opioid Tolerance
Physical Dependence
Psychologic Dependence
A

Opioid Tolerance

55
Q

Physiologic adaptation of the body to the
presence of an opioid

Equianalgesia
EFFICACY
POTENCY
Opioid Tolerance
Physical Dependence
Psychologic Dependence
A

Physical Dependence

56
Q

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
A

Psychologic Dependence

57
Q

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

A

b. (Methadone, Fentanyl, Meperidine, Tramadol)

58
Q

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

A

Tramadol

59
Q

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

A

Tramadol

60
Q

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

A

Tramadol

61
Q

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

A

Tramadol

62
Q

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

A

Methadone

63
Q

 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

A

Methadone

64
Q

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

A

Methadone

65
Q

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

A

Fentanyl

Meperidine

66
Q

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

A

Fentanyl

67
Q 
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
A
  • IV pushes- critical care only (ICU,ED, OR)
  • Lozenge/Lollipops- oral mucosa- acute cancer pain
  • Patch- Transdermal- CHRONIC PAIN ONLY
68
Q

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

A

Fentanyl

69
Q

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

A

Fentanyl

70
Q

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

A

Fentanyl

71
Q

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

A

Meperidine

72
Q

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

A

Meperidine

73
Q

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

A

Meperidine

74
Q

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

A

Meperidine

75
Q

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

A

c. (Loperamide, diphenoxylate-atropine)

76
Q

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

A

c. (Loperamide, diphenoxylate-atropine)

77
Q

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

A

c. (Loperamide, diphenoxylate-atropine)

78
Q

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

A

c. (Loperamide, diphenoxylate-atropine)

79
Q

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

A

c. (Loperamide, diphenoxylate-atropine)

80
Q
  • 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
A

Buprenorphine

81
Q
  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
A

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

82
Q
  1. 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
A

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

83
Q
  1. 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
A

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

84
Q
  1. 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
A

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

85
Q

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

A

d. (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine)

86
Q

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

A

Buprenorphine

87
Q

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

A

Butorphanol, Pentazocine

88
Q

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
A

All

89
Q

Which Three main Symptoms (TRIAD) Opioid overdose?

  • Respiratory Depression
  • Dilated pupils (Mydriasis)
  • Pinpoint pupils (miosis)
  • Coma
  • Cancer
A

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

90
Q

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

A

e. Naloxone

91
Q

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

A

e. Naloxone

92
Q

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

A

e. Naloxone

93
Q

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

A

e. Naloxone

94
Q

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

A

e. Naloxone

95
Q

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

A

f. methylnaltrexone

96
Q

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

A

f. methylnaltrexone

97
Q

“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

A

f. methylnaltrexone

98
Q

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

A

f. methylnaltrexone

99
Q

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

A

f. methylnaltrexone

Phamacology Summer (48 decks)

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