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Maddy - NMSP Exam I - psych pharm > Pharm - Opioids > Flashcards

Pharm - Opioids Flashcards

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1
Q

name the benzomorphans

A
  • pentazocine
  • diphenoxylate
  • loperamide
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2
Q

name the phenylpiperidines

A
  • meperidine
  • fentanyl
  • sufentanil
  • ramifentanil
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3
Q

name the diphenylheptanes

A
  • methadone

- propoxyphene

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4
Q

name the opioid agonists

A
  • morphine
  • hydromorphine
  • methadone
  • meperidine
  • fentanyl
  • codeine
  • oxycodone
  • hydrocodone
  • propoxyphene
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5
Q

name the mixed opioid agonist/antagonist (partial agonists)

A
  • pentazocine
  • nalbuphine
  • buprenorphine
  • butorphanol
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6
Q

name the opioid antagonists

A
  • naloxone

- naltrexone

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7
Q

MOA opioids

A

bind to opioid receptors in the CNS causing inhibition of ascending nerve pathway, altering the perception of and response to pain and producing generalized CNS depression

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8
Q

compare onset of action between oral and IV opioids

A

oral: 30 mins
IV: 5-10 mins

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9
Q

compare duration between:

  • immediate release
  • extended release
  • epidural/intrathecal
  • suppository
A
  • immediate release: 3-5 hours
  • extended release: 8-24 hours
  • epidural/intrathecal: up to 24 hours
  • suppository: 3-7 hours
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10
Q

3 main adverse effects of opioids

A
  • CNS depression
  • constipation
  • hypotension
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11
Q

constipation (as an adverse effect of opioid use) is particularly problematic in what patients

what preventative measures can be taken to reduce potential for constipation

A

patients with unstable angina and patients post-MI

stool softeners, increased fiber

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12
Q

hypotension (as an adverse effect of opioid use) is particularly concerning in what patients

A

hypovolemic patients, CV disease, circulatory shock, or pts on other drugs that exaggerate hypotensive effects (phenothiazines, general anesthetics)

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13
Q

what is the black box warning for opioids

A

serious, life-threatening, or fatal respiratory depression may occur

carbon dioxide retension

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14
Q

compare potency of opioids

A 
least:
- hydrocodone
- oxycodone
- methadone
- oxymorphone
- hydromorphone
- butorphanol
- buprenorphine
- fentanyl
most:
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15
Q

other than pain relief indications for opioids, what are some additional indications

A
  • adjunct to general anesthesia
  • epidural anesthesia
  • palliative care
  • antitussive
  • antidiarrheal
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16
Q

compare affinities to endogenous opioids peptides for the mu receptor

A

endorphins > enkaphalins > dynorphins

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17
Q

compare affinities to endogenous opioids peptides for the delta receptor

A

enkephalins > endorphins and dynorphins

18
Q

compare affinities to endogenous opioids peptides for the kappa receptor

A

dynorphins&raquo_space; endorphins and enkaphalins

19
Q

what receptors does methadone work on

A

full agonist on mu receptor

20
Q

what receptors does buprenorphine work on

A

partial agonist to all receptors

21
Q

what receptors does naltrexone work on

A
  • antagonist to mu

- partial agonist to kappa

22
Q

what receptors does nalmefene work on

A
  • agonist to mu

- partial agonist to kappa

23
Q

what is the only listed drug to work on delta receptors

A

buprenorphine

24
Q

describe the stimulant effects of opioids

A

analgesic: stimulates vagal centers, chemoreceptors, antinociceptive system
antidiarrheal: spastic constipation, works on ureter, bladder

25
Q

describe the dampening effects of opioids

A

analgesic: decreased pain sensation and mood alertness
antitussive: decreases respiratory center, cough center, emetic center

26
Q

list the acute adverse effects of opioid use

A
  • respiratory depression
  • N/V
  • pruritis
  • urticaria
  • constipation
  • urinary retention
  • delirium
  • sedation
  • myoclonus
  • seizures
27
Q

list the chronic adverse effects of opioid use

A
  • hypogonadism
  • immunosuppression
  • increased feeding
  • increased GH secretion
  • withdrawal effects
  • tolerance, dependence
  • abuse, addiction
  • hyperalgesia
  • impairment while driving
28
Q

specific side effects to oxycodone

A

CNS: hallucinations, confusion, fainting, dizziness

Eyes: swelling, redness

MSK: seizures

Skin: hives, rash

Respiratory: difficulty breathing

29
Q

what drug-drug interactions can occur with opioids

A

1) w/ sedatives/hypnotics –> increased CNS depression, particularly respiratory
2) antipsychotics –> increased sedation
3) MOAIs –> hyperpyrexic coma, hTN

30
Q

indications for morphine sulfate

A

opioid agonist indicated for management of pain not responsive to non-narcotic analgesics

31
Q

contraindications to morphine sulfate

A

bronchial asthma or upper airway obstruction

32
Q

AEs of morphine sulfate

A
  • respiratory depression
  • CNS toxicity
  • CNS depression
  • sedation
  • light-headedness
  • dizziness
  • N/V
  • constipation
33
Q

indications for buprenorphine

A

treatment of opioid dependence and is preferred for induction

34
Q

AEs buprenorphine

A
  • headache
  • N/V
  • hyperhidrosis
  • constipation
  • withdrawal
  • insomnia
  • pain
35
Q

drug interactions buprenorphine

A

monitor pts starting or ending CYP3A4 inhibitors or inducers for potential over or under dosing

36
Q

MOA naloxone

A

pure opioid antagonist that competes and displaces opioids at opioid receptor site

37
Q

indications naloxone

A

for the complete or partial reversal of opioid depression induced by natural and synthetic opioids

also for diagnosis of suspected or known acute opioid overdosage

38
Q

warnings/precautions naloxone

A

acute opioid withdrawal: naloxone causes release of catecholamines which may precipitate acute withdrawal or unmask pain

39
Q

MOA naltrexone

A

pure opioid antagonist; cyclopropyl derivative of oxymorphone; competitive antagonist at opioid receptor sites with high affinity for mu receptors

40
Q

indications naltrexone

A

treatment of alcohol use disorder

blocks effects of exogenously administered opioids

41
Q

warnings/precautions naltrexone

A
  • accidental opioid OD (pts on naltrexone may respond to lower opioid doses than previously used, so using opioids again could cause OD)
  • acute opioid withdrawal
42
Q

indications loperamide other than pain relief

A

used to treat diarrhea

Maddy - NMSP Exam I - psych pharm (23 decks)

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