Pharm: Opioids

Question 1

4 classes of opioids and examples?

Answer 1

1. Phenanthrenes = most of them. Morphine, Codeine, Hydrocodone, Oxy, Heroin
2. Benzomorphans = Diphenoxylate, Loperamide
3. Phenylpiperidines = Fentanyl, Sufentanil
4. Diphenylheptanes = Methadone

Question 2

3 fxntl classes of opioids?

Answer 2

1. Agonist = Morphine, Oxy, Methadone, etc
2. Mixed = Pentazocine, Buprenorphine, Butorphanol, Nalbuphine
3. Antagonist = Naloxone, Naltrexone

Question 3

Concerns related to AE of opioids (3)

BBW?

Answer 3

1. CNS depression
2. Constipation = may cause issue in those w unstable angina
3. Hypotension = syncope. Caution in ppl with hypovolemia and CV disease

BBW = fatal resp depression may occur

Question 4

Peptide affinity of opioid receptors (3)

Answer 4

• mu = endorphins > enkephalin > dynorphins
• delta = enkephalins > endorphons/dynorphins
• kappa = dynorphins >> endorphins/enkephalins

Methadone is full agonist at mu receptor. Partial agonists (buprenorphine) affect all 3 receptors. Antagonists (naltrexone) block mu only.

Question 5

What degrees of tolerance develop for opioid addicts?

Answer 5

Question 6

What drugs will cause CNS/resp depression when added to opioids?

Sedation and CV effects?

Hyperpyrexic coma and HTN?

Answer 6

1. Sedative hypnotics = inc CNS/resp depression
2. Antipsychotics = inc sedation and CV effects
3. MAOIs = hyperpyrexic coma and HTN

Question 7

Naloxone

Answer 7

Question 8

Naltrexone

Answer 8