Pharm Pain, Martin I

Question 1

What are the full agonists for opioid R

Answer 1

morphine
fentanyl
heroin
methadone

Question 2

what are the partial agonists for opioid R

Answer 2

codeine, hydrocondone, oxycodone

Question 3

what are the mixed agonists/antagonists

Answer 3

buprenorphine

Question 4

opioid antagonists

Answer 4

naloxone

Question 5

what are the weak opioid antonists or reuptake inhibitors

Answer 5

tramadol

tapentadol

Question 6

what are the non opioid analgesics

Answer 6

acetaminphen, aspirin, other NSAIDs and selective COX2 inhibitors

Question 7

what is analgesia

Answer 7

attenuation of pain perception without loss of consciousness

Question 8

how is analgeisa accomplised

Answer 8

raising pain threshold at level of spinal cord and altering brains perception of pain

Question 9

sensory component of pain

Answer 9

perceived as result of direct stimulatino of pain R

Question 10

reactive component of pain

Answer 10

intensity of pain dramatically altered by lvel of anxiety and stress response related to original insult

Question 11

narcotic

Answer 11

substance producing stupor associated with analgesia

Question 12

opiates

Answer 12

natural products and dervatives obtained from opium poppy

opium, morphine, heroin, codeine

Question 13

opioids

Answer 13

bind to opioid R

includes agonists, antagonists, partial agonists and mixed agonists/antagonists

Question 14

endogenous opioid agonists

Answer 14

endorphin enkephalin, dynorphin and others

Question 15

where are endogenous opioid peptides made

Answer 15

in nucleus and transported down

Question 16

endogenous opioid peptide precursoe

Answer 16

pro-opiomelanocortin POMC

Question 17

opioid effect in peraqueductal gray

Answer 17

inhibit GABA release which increase inhibitory nerve activity regulating projections to medulla that alter dorsal horn excitability

Question 18

how do opiates work on spinal cord

Answer 18

presynaptically to block Ca influx and NT release
or
postsynaptically to open K Ch causing hyeprpolarization

Question 19

mu opiod R

Answer 19

endorphins>enkephalins>dynorphins
supraspinal and spinal analgesia
sedation
inhibition respiration
slowed GI
modulation hormone and NT release

Question 20

kappa opioid R

Answer 20

enkephalins>endorphins=dynorphins
supraspinal and spinal analgesia
modulation hormone and NT release

Question 21

delta opioid R

Answer 21

dynorphins>endorphins>enkephalins
supraspinal and spinal analgesia
psychomimetic effects and slowed GI transit

Question 22

principle signal mech of opioid R

Answer 22

GPCR

• inhbiit cAMP
• open K Channels allowing efflux and hyperpolarization
• reduce presynaptic Ca influx inhibiting NT release

Question 23

brainstem opiod R influence

Answer 23

respiration, cough, nausea, vomiting, BP, pupillary diameter, stomach secretions

Question 24

medial thalamus opioid R mediate

Answer 24

deep pain that is poorly localized

Question 25

spinal cord opioid R mediate

Answer 25

reciept and integration of incoming sensory | change painful afferent stimuli

Question 26

hypothalamic opioid R

Answer 26

effect neuroendocrine secretion

Question 27

limbic system opioid R

Answer 27

high density of opioid R in amygdala

Question 28

periphery opioid R

Answer 28

inhibit Ca influx and release of excitatory glutamate and pro inflammatory substanc eP

Question 29

immune cell opioid R

Answer 29

function unknown

Question 30

which opioid R is responsible for majoirty classical effects of opiods

Answer 30

mu R | analgesia, euphoria, miosis, resp depression, physio dependence, reduced GI motility (constipation)

Question 31

main action of stimulation kappa R

Answer 31

dysphoria analgesia psychotomimetic responses

Question 32

what occurs with respiratory depression from opioids

Answer 32

decreased response to CO2

Question 33

what drugs are used to suppress cough

Answer 33

dextromethophan and codeine

Question 34

why do opiates cause miosis

Answer 34

indirect parasympathetic actions | no tolerance develops in abusers

Question 35

when does opiate overdose cause mydriasis

Answer 35

when asphyxia develops

Question 36

opioids CI in what patients

Answer 36

with severe brain injury since increase the CSF from respiratory depression and CO2 retention

Question 37

GI complication opioid therapy

Answer 37

constipation

Question 38

why should asthmatics not be on opioids

Answer 38

can cause histamine induced bronchoconstriction | causes urticaria, sweating and vasodilation

Question 39

what do you consider when giving morphine orally

Answer 39

high first pass metabolism so oral higher dose than IV | usually 4X higher dose

Question 40

teratogenicity of opioids

Answer 40

do not use during labor

Question 41

PK fentanyl

Answer 41

highly lipophilic cross BBB quick but redistributes to fat super fast

Question 42

affinity of morphin

Answer 42

mu > delta or kappa

Question 43

warning of morphine

Answer 43

high addiction potential

Question 44

clinical uses morphine

Answer 44

``` analgesia acute pulmonary edema AcuteMI cough suppression diarrhea ```

Question 45

type of pain to attempt analgesia with morphine

Answer 45

severe | constant

Question 46

morphine and acute pulmonary edema

Answer 46

relief from dyspnea with L ventricular failure reduced perception SOB dec anxiety reduce cardiac preload and afterload

Question 47

what opioids are used for diarrhea

Answer 47

loperamide (imodium OTC) diphenoxylate + atropine (lomotil) difenoxin and atropine (motofen)

Question 48

administration fentanyl

Answer 48

IV epidural intrathecal

Question 49

fentanyl is used for what

Answer 49

analgesia labor | oral transucosal for cancer patients

Question 50

which opioid has longer duration action than morphine but less euphoria

Answer 50

methadone

Question 51

methadone used for

Answer 51

controlled withdrawal of dependent heroin and morphine abusers

Question 52

what is the synthetic opioid used for acute pain

Answer 52

meperidine | "demerol"

Question 53

reaction of pupils from meperidine

Answer 53

mydriasis | dilates

Question 54

which opioid can be used in obstetrics

Answer 54

meperidine

Question 55

meperidine time use limit

Answer 55

<48 hours since toxic metabolite accumulates and can cause seizures