Pain Part 1 (Opioids) Supplemental.ppt Flashcards
Which are Pure Opioid Agonists for Pain?
a. Morphine Prototypes
b. Non-morphine Prototypes
c. Anti-diarrheal Opioids
d. Mixed/Partial Agonist
a. Morphine Prototypes
b. Non-morphine Prototypes
Morphine Prototypes
a. Loperamide,
b. Morphine
c. Fentanyl
d. Hydromorphone
e. Methadone
f. Codeine
g. Meperidine
h. Tramadol
i. Oxycodone
j. diphenoxylate-atropine
k. Hydrocodone
b. Morphine
d. Hydromorphone
f. Codeine
i. Oxycodone
k. Hydrocodone
Non-morphine Prototypes
a. Loperamide,
b. Morphine
c. Fentanyl
d. Hydromorphone
e. Methadone
f. Codeine
g. Meperidine
h. Tramadol
i. Oxycodone
j. diphenoxylate-atropine
k. Hydrocodone
c. Fentanyl
e. Methadone
g. Meperidine
h. Tramadol
Anti-diarrheal Opioids
a. Loperamide,
b. Morphine
c. Fentanyl
d. Hydromorphone
e. Methadone
f. Codeine
g. Meperidine
h. Tramadol
i. Oxycodone
j. diphenoxylate-atropine
k. Hydrocodone
a. Loperamide,
j. diphenoxylate-atropine
Mixed Opioid Agonists
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
f. Pentazocine
b. Buprenorphine
c. Nalbuphine,
e. Butorphanol
f. Pentazocine
Opioid Antagonist (Antidote)
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
f. Pentazocine
a. Naloxone
Opioid Antagonist for Opioid Induced Constipation
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
f. Pentazocine
d. Methylnaltrexone
Pain is ?
Subjective or Objective?
Subjective
Pain is the “ ? Vital Sign”
Fourth or Fifth
Fifth
Numeric rating scale of 0-10
ADULTS or PEDIATRICS
ADULTS
Faces of Pain Scale
ADULTS or PEDIATRICS
PEDIATRICS
Medications that relieve pain without causing loss of consciousness
Anesthesia or Analgesic
Analgesic
Which can be Opioid or Non-opioids/Adjuvant drugs
Anesthesia or Analgesic
Analgesic
MILD pain
a. Weak opioid- hydrocodone + acetaminophen combo drug (Vicodin® or Norco®)
b. Non-opioids- like acetaminophen
c. Strong opioid- Morphine
d. Score of 4-6
e. Score of 1-3
f. Score of 7-10
b. Non-opioids- like acetaminophen
e. Score of 1-3
MODERATE TO SEVERE
a. Weak opioid- hydrocodone + acetaminophen combo drug (Vicodin® or Norco®)
b. Non-opioids- like acetaminophen
c. Strong opioid- Morphine
d. Score of 4-6
e. Score of 1-3
f. Score of 7-10
a. Weak opioid- hydrocodone + acetaminophen combo drug (Vicodin® or Norco®)
d. Score of 4-6
SEVERE pain
a. Weak opioid- hydrocodone + acetaminophen combo drug (Vicodin® or Norco®)
b. Non-opioids- like acetaminophen
c. Strong opioid- Morphine
d. Score of 4-6
e. Score of 1-3
f. Score of 7-10
c. Strong opioid- Morphine
f. Score of 7-10
Which of the following are adjuvants for relieving pain?
a. Antidepressants
b. Anticonvulsants
c. Corticosteroids
d. Lidocaine patches
All
? can help suppress the “INFLAMMATORY SOUP?
Opioids or NSAIDS/Corticosteroids
NSAIDS/Corticosteroids
? can help suppress the Pain Pathway of the spine?
Opioids or NSAIDS/Corticosteroids
Opioids
Which helps you forget you pain?
Opioids or NSAIDS/Corticosteroids
Opioids
Which of the options are Acute Pain
a. Sudden onset
b. Often difficult to treat
b. Usually subsides once treated
c. Persistent or recurring
d. Lasts 3 to 6 months
e. Usually subsides once treated
f. Tolerance
g. Physical dependence
a. Sudden onset
e. Usually subsides once treated
Which of the options are Chronic Pain
a. Sudden onset
b. Often difficult to treat
c. Persistent or recurring
d. Lasts 3 to 6 months
e. Usually subsides once treated
f. Tolerance
g. Physical dependence
b. Often difficult to treat
c. Persistent or recurring
d. Lasts 3 to 6 months
f. Tolerance
g. Physical dependence
What the Two main opioid receptors
a. Delta
b. Mu
c. Beta
d. Kappa
b. Mu
d. Kappa
Match Locations of Receptors Respiratory Center- slow or stop breathing a. Brain Stem b. Brain c. Peripheral Neurons d. Spinal Cord e. GI Tract
a. Brain Stem
Locations of Receptors Reward Pathway- Euphoria, Addiction a. Brain Stem b. Brain c. Peripheral Neurons d. Spinal Cord e. GI Tract
b. Brain
Locations of Receptors side effects like constipation/urinary retention) a. Brain Stem b. Brain c. Peripheral Neurons d. Spinal Cord e. GI Tract
e. GI Tract
Locations of Receptors (pain relief) a. Brain Stem b. Brain c. Peripheral Neurons d. Spinal Cord e. GI Tract
c. Peripheral Neurons
d. Spinal Cord
the inability to feel pain?
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
g. analgesia
When nerves or muscles in any portion of the digestive tract do not function with their normal strength and coordination?
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
f. Decreased gi motility
excessive constriction of the pupil of the eye.
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
e. Miosis
? is the experience (or affect) of pleasure or excitement and intense feelings of well-being and happiness?
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
d. Euphoria
A condition in which a person takes a drug over time, and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses.
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
c. physical dependence
? is a breathing disorder characterized by slow and ineffective breathing? - hypoventilation
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
b. Respiratory depression
?the administering of a sedative drug to produce a state of calm or sleep?
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
a. Sedation
Mu receptors have
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
f. Decreased gi motility
g. analgesia
Kappa receptors have
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
a. Sedation
e. Miosis
f. Decreased gi motility
g. analgesia
Kappa and Mu both have?
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
a. Sedation
f. Decreased gi motility
g. analgesia
Which does Kappa have vs Mu
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
e. Miosis
Which does Mu not have vs Kappa
a. Sedation
b. Respiratory depression
c. physical dependence
d. Euphoria
e. Miosis
f. Decreased gi motility
g. analgesia
b. Respiratory depression
c. physical dependence
d. Euphoria
Moderate to Severe Pain, Severe Pain
a. Loperamide,
b. Morphine
c. Fentanyl
d. Hydromorphone
e. Methadone
f. Codeine
g. Meperidine
h. Tramadol
i. Oxycodone
j. diphenoxylate-atropine
k. Hydrocodone
b. Morphine
d. Hydromorphone
f. Codeine
i. Oxycodone
k. Hydrocodone
Pure Opiods agonist are ? Morphine , Codiene
a. Mu
b. Kappa
c. Neither
d. Both
d. Both
Mixed Opiods agonist are ? - Butorphanol pentazocine a. Mu b. Kappa c. Neither d. Both
b. Kappa
Mixed Opiods agonist are? -Buprenorphine
a. Mu
b. Kappa
c. Neither
d. Both
a. Mu
Pure opiods antagonist ? Naloxone
a. Mu
b. Kappa
c. Neither
d. Both
c. Neither
Which means an itch is defined as an unpleasant sensation of the skin that provokes the urge to scratch.?
a. Miosis
b. Pruritus
c. Emesis
b. Pruritus
Which of the following mean vomitting?
a. Miosis
b. Pruritus
c. Emesis
c. Emesis
What are MORPHINE Prototypes adverse side effects? M- O- R- P- H- I- N- E-
Do not give with head
M- Miosis O- Sedation R- Respiratory depression P- Pruritus H- Hypotension (Dizzy) and Do not give with head injuries I- Constipation & Urine retention N- Nasua E- Emesis
No
Can you can give Morphine Prototypes with Head injuries?
T/F if not why?
False b/c you can not.
Which you Do NOT GIVE IN BILIARY COLIC, do NOT give in Paralytic Ileus.
a. morphine
b. codeine
c. hydromorphone
d. oxycodone
e. hydrocodone)
All because they are Morphine protypes
Which is the following: a medicinal drug taken to reduce tension or anxiety? a. Alcohol b. Antihistamines c. Tranquilizers d. Barbiturates e. Benzodiazepines
c. Tranquilizers
Which of the following: are a type of medication known as tranquilizers? a. Alcohol b. Antihistamines c. Tranquilizers d. Barbiturates e. Benzodiazepines
e. Benzodiazepines
Which of the following: any of a class of sedative and sleep-inducing drugs? a. Alcohol b. Antihistamines c. Tranquilizers d. Barbiturates e. Benzodiazepines
d. Barbiturates
Which of the following: are drugs which treat allergic rhinitis and other allergies.> a. Alcohol b. Antihistamines c. Tranquilizers d. Barbiturates e. Benzodiazepines
b. Antihistamines
Which of the following can not be giving during respiratory depression with Morphine Prototypes?
a. Alcohol
b. Antihistamines
c. Tranquilizers
d. Barbiturates
e. Benzodiazepines
All
Which of the following you need to look out for with opiods?
a. Drug allergy
b. CNS Depressant Drugs
c. Severe Asthma/COPD
d. Respiratory insufficiency
e. Elevated intracranial pressure
f. Morbid obesity or sleep apnea
g. Paralytic ileus
h. Pregnancy and Breastfeeding
All
With opiod what are the drug that cause problems with pregnant woman b/c it can cross to her baby?
a. Antihistamines
b. Codeine
c. Tranquilizers
d. Barbiturates
e. Tramadol
f. Benzodiazepines
b. Codeine
e. Tramadol
Which mean the following: It works by changing how your brain senses pain and is similar to opiods? a. Antihistamines b. Codeine c. Tranquilizers d. Barbiturates e. Tramadol f. Benzodiazepines
e. Tramadol
Which mean the following: a sleep-inducing and analgesic drug derived from morphine. a. Antihistamines b. Codeine c. Tranquilizers d. Barbiturates e. Tramadol f. Benzodiazepines
b. Codeine
Which can not be given to pediatrics:
a. Antihistamines
b. Codeine
c. Tranquilizers
d. Barbiturates
e. Tramadol
f. Benzodiazepines
b. Codeine
Which cannot be given during Breastfeeding and Pregnancy?
a. Antihistamines
b. Codeine
c. Tranquilizers
d. Barbiturates
e. Tramadol
f. Benzodiazepines
b. Codeine
e. Tramadol
Do you (increase or decrease) the dosages of opiods you give to a Geriatrict patient?
decrease
With opiods can there be an histamine release that is not a allergic reaction?
Yes
Which means , temporary reddening of the skin, usually of the face?
a. Flushing
b. Throat Itching
c. Tongue/Lip/EyelidSwelling (Angioedema)
d. Throat Swelling
e. Difficulty Breathing
f. Hallucinations
g. Hives
h. Rash*
i. Nausea/Vomiting
a. Flushing
Which of the following are true allergy concerns? General Itching a. Flushing b. Throat Itching c. Tongue/Lip/EyelidSwelling (Angioedema) d. Throat Swelling e. Difficulty Breathing f. Hallucinations g. Hives h. Rash* i. Nausea/Vomiting
b. Throat Itching
c. Tongue/Lip/EyelidSwelling (Angioedema)
d. Throat Swelling
e. Difficulty Breathing
g. Hives
Opiods (do or do not) cause GI imobility?
Do
Since opiods cause GI imobility should you give a patient a ? for constipation ? in opiod treatment
a. should not receive a stimulant
b. should receive a stimulant
c. Early
d. Late
b.
c.
ll mush, no push”, recommend a drug BEFORE they get constipated (prophylaxis!)
Which is true for all opiod groups?
a. You do not need to asses I/O for urine retention
b. Instruct that it is okay for patients use highly machinery
c. Can be taken with food to help with nausea and emesis
d. Orthostatic hypotension can occur, so change
positions slowly, be aware of fall risk
c. Can be taken with food to help with nausea and emesis
d. Orthostatic hypotension can occur, so change
positions slowly, be aware of fall risk
With opiods the following: assess pain level – treat according to pain scale! Take vital signs -> Respiratory Rate a. Before opiod treatment b. After opiod treatment
a. Before opiod treatment
What is the respiration rate number that means you should had opiod meditations?
12 and lower
Due to Opiod Epidemic (REM ) opiod drugs are written
given in ? dose possible for outpatients?
a. Highest
b. Lowest
b. Lowest
What means the strength of a drug?
a. Equianalgesia
b. Potency
c. Physical Dependence
d. Efficacy
e. Opioid Tolerance
f. Psychological Dependence
b. Potency
Which means the effectiveness of a drug?
a. Equianalgesia
b. Potency
c. Physical Dependence
d. Efficacy
e. Opioid Tolerance
f. Psychological Dependence
d. Efficacy
Which means A dose of one form of analgesic drug equivalent in pain-relieving effect to another analgesic
a. Equianalgesia
b. Potency
c. Physical Dependence
d. Efficacy
e. Opioid Tolerance
f. Psychological Dependence
a. Equianalgesia
? is characterized by a reduced responsiveness to an opioid agonist such as morphine and is usually manifest by the need to use increasing doses to achieve the desired effect.
a. Equianalgesia
b. Potency
c. Physical Dependence
d. Efficacy
e. Opioid Tolerance
f. Psychological Dependence
e. Opioid Tolerance
? is a state that involves emotional–motivational withdrawal symptoms?
a. Equianalgesia
b. Potency
c. Physical Dependence
d. Efficacy
e. Opioid Tolerance
f. Psychological Dependence
f. Psychological Dependence
? A condition in which a person takes a drug over time, and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses.
a. Equianalgesia
b. Potency
c. Physical Dependence
d. Efficacy
e. Opioid Tolerance
f. Psychological Dependence
c. Physical Dependence
7mg of Morphine = 1 mg or Hydromorphone What example is this? a. Equianalgesia b. Potency c. Physical Dependence d. Efficacy e. Opioid Tolerance f. Psychological Dependence
a. Equianalgesia
Non Morphine opiods This medication can lower the seizure threshold (SEIZURE RISK!) a. Methadone b. Tramadol c. meperidine d. Fentanyl
b. Tramadol
Increases Serotonin- watch out for SEROTONIN SYNDROME
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
b. Tramadol
Do NOT use in breastfeeding (similar concern to Codeine)
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
b. Tramadol
SPECIAL USE: SUBSTANCE USE DISORDERS
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
a. Methadone
Which prolong the QT interval (dysrhythmia risk)
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
a. Methadone
Is EKG needed for patients taking methadone?
Yes or No
Yes
Which is the MOST POTENT OPIOID ?
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
d. Fentanyl
Which comes as an IV pushes?
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
d. Fentanyl
Which comes as a Lozenge/Lollipops?
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
d. Fentanyl
Which comes as Transdermal Patch?
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
d. Fentanyl
Does Fentanyl Transdermal Patch treat ? pain
a. Chronic
B. Acute
a. Chronic
Select all that apply for Fentanyl
a. PROPER DISPOSAL is important!
b. AVOID HEATING PADS!
c. SLOW TO KICK IN- NEVER FOR ACUTE PAIN! (can take 12 hours)
d. FAST TO KICK IN- NEVER FOR CHRONIC PAIN! (can take 1 hours)
e. NEVER FOR OPIOID NAÏVE!-
f. USE FOR OPIOID NAÏVE!-
a. PROPER DISPOSAL is important!
b. AVOID HEATING PADS!
c. SLOW TO KICK IN- NEVER FOR ACUTE PAIN! (can take 12 hours)
e. NEVER FOR OPIOID NAÏVE!-
Which Can be used for SHIVERING in the OR ?
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
c. meperidine
Which drug you should never use first as a treatment?
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
d. Fentanyl
Which CANNOT be given with MAO-I drugs
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
c. meperidine
Which CAN be given short term
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
c. meperidine
Which Has a CNS toxic metabolite called NORMEPERIDINE that can cause seizures
a. Methadone
b. Tramadol
c. meperidine
d. Fentanyl
c. meperidine
These are used to treat diarrhea
a. Pentazocine
b. Loperamide
c. Methylnaltrexone
d. Diphenoxylate
e. Naloxone
g. Atropine
b. Loperamide
d. Diphenoxylate
Bowel obstruction & Constipation!
a. Pentazocine
b. Loperamide
c. Methylnaltrexone
d. Diphenoxylate
e. Naloxone
g. Atropine
b. Loperamide
d. Diphenoxylate
Which is added to Loperamide & Diphenoxylate to help aide or prevent bowel obstruction?
a. Pentazocine
b. Loperamide
c. Methylnaltrexone
d. Diphenoxylate
e. Naloxone
g. Atropine
g. Atropine
Which you need to Limit use of anti-diarrheals
a. Pentazocine
b. Loperamide
c. Methylnaltrexone
d. Diphenoxylate
e. Naloxone
g. Atropine
b. Loperamide
d. Diphenoxylate
Which you need to culture poop for infections such as C.Diff- can cause toxic megacolon
a. Pentazocine
b. Loperamide
c. Methylnaltrexone
d. Diphenoxylate
e. Naloxone
g. Atropine
b. Loperamide
d. Diphenoxylate
Can Loperamide & Diphenoxylate be used short term or Long term/
Short term
Which of the following Mixed/Partial Agonists: are Addiction management (Substance Use Disorders) ?
a. Buprenorphine
b. Butorphanol
c. Nalbuphine
d. Pentazocine
a. Buprenorphine
Less abuse potential (not as strong- less risk for euphoria)
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
f. Pentazocine
b. Buprenorphine
c. Nalbuphine,
e. Butorphanol
f. Pentazocine
Less Respiratory Depression (Ceiling effect)
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
f. Pentazocine
b. Buprenorphine
c. Nalbuphine,
e. Butorphanol
f. Pentazocine
Less Analgesic Effect (Ceiling effect)
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
f. Pentazocine
b. Buprenorphine
c. Nalbuphine,
e. Butorphanol
f. Pentazocine
Which have higher affinity than of all?
a. Morphine Prototypes
b. Non-morphine Prototypes
c. Anti-diarrheal Opioids
d. Mixed/Partial Agonist
d. Mixed/Partial Agonist
Which are symptoms of overdose rather than withdrawal from opioids? a. Agitation, b. Anxiety, c. insomnia, d. Respiratory Depression e. Flu‑like opioid cravings f. Rhinorrhea, g. Pinpoint pupils (miosis) h. Yawning, I. Sweating (diaphoresis), k. Pilo-erection (goose bumps), m. Abdominal cramping, and diarrhea. n. Hypertension, tachycardia l. Suicidal ideation o. Coma
d. Respiratory Depression
g. Pinpoint pupils (miosis)
o. Coma
What is the primary antidote for opioids?
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
f. Pentazocine
a. Naloxone
Which is opioid antagonist?
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
f. Pentazocine
a. Naloxone
Which Fast acting, can reverse pain relief!
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
a. Naloxone
If you have given Naloxone and the pain hasn’t reversed what does this means?
The pateint isn’t having an opioid overdose
Which of the following is true about Naloxone
a. Assess and monitor Respiratory Rate
b. Does not have short half life, so patients will not need need a continuous IV drip
c. Does have short half life-, so patients may need a continuous IV drip
d. Patients pain will reverse
e. Patients pain will not be reversed
a. Assess and monitor Respiratory Rate
c. Does have short half life-, so patients may need a continuous IV drip
d. Patients pain will reverse
Which treats opioid Induced Constipation (OIC)
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
d. Methylnaltrexone
Competitive antagonist at opioid receptors (has an extremely high affinity) only for the GI TRACT
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
d. Methylnaltrexone
Bowel obstruction, but treats Constipation!
a. Naloxone
b. Buprenorphine
c. Nalbuphine,
d. Methylnaltrexone
e. Butorphanol
d. Methylnaltrexone