Pharm Pain, Martin II Flashcards
codeine affects what R
mu at low dose
at high dose starts to work on kappa
hydrocodone works on what R
mu
oxycodone works on what R
mu
what are the most widely prescribed outpatient analgesics
tylenol with codeine codeine/aspirin hydrocodone/acetaminophen oxycodone/acetaminophen oxycodone/aspirin
what is a common mixed opioid agonist-antagonist
buprenorphine
what occurs when partial agonist given with full agonist
act as antagonist!!
important concept
buprenorphine action on mu R
partial agonist
major use beuprenorphine
opioid detoxification
what R activated by high dose codeine cause psychotomimetic effects
kappa
what occurs with the antagonist side of opioid agonist/antagonist drugs
precipitate withdrawal Sx in physically dependent individuals since block effects of full agonists
what are the opioid antagonist
naloxone(narcan)
short acting, injected
what is naloxone used for
treat opioid overdose
what occurs if give naloxone to patient dependent on opioids
precipitate withdrawal syndrome
reward pathway
reduce excitability and transmitter release
inhibits VTA on GABA interneurons and increase ventral pallidum outflow which correlates to positive reinforcing state
which way does dose response curve shift in tolerance
to the right
what occurs in tolerance
R down regulated and signal transduction pathways desensitized
what effects of opioids develop tolerance
analgesia
respiratory depression
euphoria
sedation
what effects of opioids do not develop tolerance
miosis
constipation
tolerance can be how high
35x fold
opioid withdrawal Sx
rhinorrhea lacrimation yawning chills piloerection hyperventilation hyperthermia mydriasis vomiting diarrhea anxiety
firs 8 hours withdrawal Sx
anxiety and drug craving
8-24 hours withdrawal Sx
anxiety insomnia GI disturbance rhinorrhea mydriasis diaphoresis
up to 3 days Sx withdrawal
tachycardia nausea vomiting HTN diarrhea fever chills tremors seizure muscle spasm
Tx opioid withdrawal
monitor
if need– clonidine a2 agonist
