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NMSP Exam III > [PHARM] Opioids [Iszard] > Flashcards

[PHARM] Opioids [Iszard] Flashcards

1
Q

What is the general MOA of Opioids?

A

Bind to Opioid Receptors in the CNS –> inhibits ascending pain pathways –> alters perception of pain –> CNS Depression

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2
Q

What is the onset of action of the following?

Oral Opioids (Immediate Release)

IV

A

Oral –> 30 mins

IV –> 5-10 mins

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3
Q

What is the intended duration of action for the following:

Immediate Release –>

Extended Release –>

Epidural/Intrathecal –>

Suppository –>

A

Immediate Release –> 3-5 hrs

Extended Release –> 8-24 hrs

Epidural/Intrathecal –> 24 hrs

Suppository –> 3-7 hrs

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4
Q

What are some adverse effects of Opioids?

A

CNS Depression

Constipation

Hypotension

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5
Q

What is the black box warning of Opioids?

A

Fatal Respiratory Depression

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6
Q

What is the correct order of Opioid Potency from least to greatest?

Oxycodone, Hydrocodone,Methadone, Fentanyl

A

LEAST: Hydrocodone

Oxycodone

Methadone

Fentanyl: GREATEST

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7
Q

What are some of the clinical uses of Opioid use in clinical settings to help reduce pain?

A

MI

Sickle Cell Crisis

Post OP

Trauma

Cancer

Kidney Stones

Back Pain

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8
Q

What are the 3 Opioid Receptors?

What are their endogenous opioid peptide affinities?

A

Mu –> Endorphins > Enkephalins > Dynorphins

Delta –> Enkephalins > Endorphins > Dynorphins

Kappa –> Dynorphins >> Endorphins - Enkephalins

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9
Q

Which of the opioid receptors functions as a supraspinal and spinal analgesia, psychotomimetic effects, and slow gastrointestinal transit?

A

Kappa

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10
Q

Which of the Opioid Receptors functions as a supraspinal and spinal analgesia, modulation of hormone and NT release?

A

Delta

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11
Q

Which of the opioid receptors functions as a supraspinal and spinal analgesia, sedation, inhibition of respiration, slowed GI transit, modulation of hormone and NT release?

A

Mu

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12
Q

List what type of functional class each of the drugs are:

Methadone

Buprenorphine

Naloxone

A

Methadone –> Full Agonist

Buprenorphine –> Parial Agonist

Naloxone –> Antagonist

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13
Q

If you have a patient that comes in while taking Opioids who complains of Respiratory Depression, Pruritis, N/V, Delirium, Sedation, Constipation, or Seizures – what sort of adverse effects to opioids are these?

A

Acute Adverse Effects

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14
Q

If a patient comes in while taking an opioid and they have increased CNS depression, and respiratory depression – what sort of drug interaction must you be worried about?

A

Opioid interactions with SEDATIVE-HYPNOTICS

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15
Q

If a patient comes in while taking an Opioid and complains of Increased Sedation, and accentuation of cardiovascular effects, and some variable respiratory depression – what sort of drug interaction are you thinking of?

A

Opioid interactions with Anti-Psychotic Agents

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16
Q

If you have a patient come in while taking an Opioid and they have hyperpyrexic coma and HTN – what sort of Opioid drug interactions should you think about?

A

Opioid interactions with MAOI

17
Q

If someone comes in with an Opioid Overdose what drug should you give them?

A

Naloxone (Narcan)

–Pure opioid antagonist (releasing catecholamines)

18
Q

What is the indicated use of Naltrexone (an Opioid Antagonist)?

A

(Works on Mu Receptors)

acts as a competitive antagonist at opioid receptor sites

Tx of Alcohol use disorder***

blocks effects of exogenously administered opioids

***he basically said this would be a test question

19
Q

If a patient was recently given Naltrexone, what warning or precaution should you let them know about?

A

They may respond to lower opioid doses than previously used – watch out for opioid intoxication

Also watch out for Acute Opioid Withdrawl

20
Q

What are the 9 Opioid Agonists?

A

Morphine

Hydromorphine

Methadone

Meperidine

Fentanyl

Codeine

Oxycodone

Hydrocodone

Propoxyphene

21
Q

What are the 4 mixed agonist/antagonist (partial agonist) Opioids?

A

Pentazocine

Nalbuphine

Buprenorphine

Butorphanol

22
Q

What are the 2 Opioid Antagonists?

A

Naloxone

Naltrexone

23
Q

Morphine, Hydromorphone, Hydrocodone, Oxycodone are what type of chemical class of Opioids?

A

Phenanthrenes

24
Q

Fentanyl, Meperidine are what type of chemical class of Opioids?

A

Phenylpiperidines

25
Q

Pentazocine and Loperamide are what chemical class of Opioids?

A

Benzomorphans

26
Q

Methadone and Propoxyphene are what chemical class of Opioids?

A

Diphenylheptanes

27
Q

Morphine Sulfate is a what type of opioid?

What are its contraindications?

What warnings are involved?

What are some adverese reactions?

A

Opioid Agonist – tx pain not responsive to non-narcotic analgesics

Hypersensitivity to morphine, Asthma

Dosing Errors, Resp Depression, CNS Toxicitiy, CNS Depressants

Sedation, N/V/Lightheadedness, Constipation

28
Q

What is the drug Buprenorphine used for?

What is a warning for using this drug?

It has the same adverse effects as regular opioids.

What drug interactions does it have?

A

Tx of Opioid Dependence

Can be abused like opioids, Resp Depression,

CYP3A4 inhibitors/inducers

29
Q

Fentanyl is what type of opioid?

When is Fentanyl indicated?

A
  • Full Opioid Agonist
  • Indicated for management of persistent, moderate to severe chronic pain
30
Q

Methadone is what type of opiate?

When is Methadone indicated?

A

Methadone is a synthetic full agonist opioid

-most appropriate drug to manage abstinence symptoms and treat opioid use disorder in an outpatient rehabilitation setting ***

***he basically said this was going to be a test question

31
Q

Hydrocodone is what type of opioid?

When is it indicated?

A

Hydrocodone is a semi-synthetic full opioid agonist

for relief of moderate to moderately severe pain and for antitussive properties

32
Q

Hydrocodone is often combined with what?

What is important to keep in mind about this?

A

Hydrocodone is often combined with acetaminophen

not to be used for a long time as this could lead to hepatotoxicity

33
Q

Pentazocine is what type of opioid?

When is it indicated?

A

Pentazocine is a mixed opioid agonist/antagonist

used in the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate

does not work well for treating addiction

34
Q

What is an adverse effect observed in pregnant patients using pentazocine?

A

prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome

35
Q

Meperidine is what type of opioid?

Drug interactions?

Likely to be abused?

A

Full opioid agonist

Avoid mixed agonist/antagonist analgesics use with meperidine because the analgesic effect may be reduced or may precipitate withdrawal symptoms

the anesthesiologist is the key abuser for meperidine bc they have direct access***

***he basically said this would be a test question

36
Q

Codeine is what type of opioid?

What is an important property about Codeine to remember?

A

Codeine is classified as a moderate full opioid agonist

Compared to fentanyl, hydromorphone, meperidine, and morphine, codeine contains the least opioid analgesic activity***

***He basically said this would be a test question

37
Q

What is the trade name for Loperamide?

What is an off-label use of loperamide?

A

imodium A-D

loperamide is used when you don’t have morphine around

NMSP Exam III (5 decks)

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