[PHARM] Opioids [Iszard] Flashcards
What is the general MOA of Opioids?
Bind to Opioid Receptors in the CNS –> inhibits ascending pain pathways –> alters perception of pain –> CNS Depression
What is the onset of action of the following?
Oral Opioids (Immediate Release)
IV
Oral –> 30 mins
IV –> 5-10 mins
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
What are some adverse effects of Opioids?
CNS Depression
Constipation
Hypotension
What is the black box warning of Opioids?
Fatal Respiratory Depression
What is the correct order of Opioid Potency from least to greatest?
Oxycodone, Hydrocodone,Methadone, Fentanyl
LEAST: Hydrocodone
Oxycodone
Methadone
Fentanyl: GREATEST
What are some of the clinical uses of Opioid use in clinical settings to help reduce pain?
MI
Sickle Cell Crisis
Post OP
Trauma
Cancer
Kidney Stones
Back Pain
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
Which of the opioid receptors fxns as a supraspinal and spinal analgesia, psychotomimetic effects, and slow gastrointestinal transit?
Kappa
Which of the Opioid Receptors fxns as a supraspinal and spinal analgesia, modulation of hormone and NT release?
Delta
Which of the opioid receptors fxns as a supraspinal and spinal analgesia, sedation, inhibition of respiration, slowed GI transit, modulation of hormone and NT release?
Mu
List what type of fxnal class each of the drugs are:
Methadone
Buprenorphine
Naloxone
Methadone –> Full Agonist
Buprenorphine –> Parial Agonist
Naloxone –> Antagonist
In general what are some of the effects of opioids that garner a HIGH degree of tolerance from long lasting use of Opioids?
Analgesia
Euphoria
Mental Clouding
Sedation
Respiratory Depression
Antidiuresis
N/V
Cough Suppression
In general what are some of the effects of opioids you dont see patients developing a tolerance for with long lasting use of opioids?
Miosis
Constipation
Convulsions
(Bradycardia – moderate amount)
What are some of the Chronic Adverse effects of Opioid Use?
Hypogonadism
Immunsuppression
Increased Feeding
Increased GH sec
Withdrawl
Tolerance
Abuse
Hyperalgesia
Impairment while driving
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
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
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
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)
Tx of Alcohol use disorder
blocks effects of exogenously administered opioids
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 whay 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, UAO
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
