[PHARM] Opioids [Iszard] Flashcards by erin flaherty

What is the general MOA of Opioids?

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

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What is the onset of action of the following?

Oral Opioids (Immediate Release)

Oral –> 30 mins

IV –> 5-10 mins

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What is the intended duration of action for the following:

Immediate Release –>

Extended Release –>

Epidural/Intrathecal –>

Suppository –>

Immediate Release –> 3-5 hrs

Extended Release –> 8-24 hrs

Epidural/Intrathecal –> 24 hrs

Suppository –> 3-7 hrs

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What are some adverse effects of Opioids?

CNS Depression

Constipation

Hypotension

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What is the black box warning of Opioids?

Fatal Respiratory Depression

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

Oxycodone, Hydrocodone,Methadone, Fentanyl

LEAST: Hydrocodone

Oxycodone

Methadone

Fentanyl: GREATEST

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

Sickle Cell Crisis

Post OP

Trauma

Cancer

Kidney Stones

Back Pain

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What are the 3 Opioid Receptors?

What are their endogenous opioid peptide affinities?

Mu –> Endorphins > Enkephalins > Dynorphins

Delta –> Enkephalins > Endorphins > Dynorphins

Kappa –> Dynorphins >> Endorphins - Enkephalins

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

Kappa

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

Delta

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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?

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

Methadone

Buprenorphine

Naloxone

Methadone –> Full Agonist

Buprenorphine –> Parial Agonist

Naloxone –> Antagonist

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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?

Acute Adverse Effects

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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?

Opioid interactions with SEDATIVE-HYPNOTICS

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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?

Opioid interactions with Anti-Psychotic Agents

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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?

Opioid interactions with MAOI

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

Naloxone (Narcan)

–Pure opioid antagonist (releasing catecholamines)

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

(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

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

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

Also watch out for Acute Opioid Withdrawl

What are the 9 Opioid Agonists?

Morphine

Hydromorphine

Methadone

Meperidine

Fentanyl

Codeine

Oxycodone

Hydrocodone

Propoxyphene

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

Pentazocine

Nalbuphine

Buprenorphine

Butorphanol

What are the 2 Opioid Antagonists?

Naloxone

Naltrexone

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

Phenanthrenes

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

Phenylpiperidines

Pentazocine and Loperamide are what chemical class of Opioids?

Benzomorphans

Methadone and Propoxyphene are what chemical class of Opioids?

Diphenylheptanes

Morphine Sulfate is a what type of opioid? What are its contraindications? What warnings are involved? What are some adverese reactions?

**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**

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?

Tx of Opioid Dependence Can be abused like opioids, Resp Depression, **CYP3A4 inhibitors/inducers**

Fentanyl is what type of opioid? When is Fentanyl indicated?

- Full Opioid Agonist - Indicated for management of persistent, moderate to severe chronic pain

Methadone is what type of opiate? When is Methadone indicated?

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

Hydrocodone is what type of opioid? When is it indicated?

Hydrocodone is a semi-synthetic full opioid agonist for relief of moderate to moderately severe pain and for antitussive properties

Hydrocodone is often combined with what? What is important to keep in mind about this?

Hydrocodone is often combined with acetaminophen not to be used for a long time as this could lead to hepatotoxicity

Pentazocine is what type of opioid? When is it indicated?

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

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

prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome

Meperidine is what type of opioid? Drug interactions? Likely to be abused?

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

Codeine is what type of opioid? What is an important property about Codeine to remember?

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

What is the trade name for Loperamide? What is an off-label use of loperamide?

imodium A-D loperamide is used when you don't have morphine around