Psych: Opiates

Question 1

Which receptor produces all: analgesia, respiratory depression, sedation, euphoria, dependence, and constipation?

Answer 1

Mu

Kappa only causes analgesia, sedation, and constipation

Question 2

MOA of morphine, codeine, hydrocodone, and meperidine?

Answer 2

Mu and kappa pure agonists

Question 3

MOA of pentazocine

Answer 3

Mu antagonist

kappa agonist

Question 4

MOA of butorphanol?

Answer 4

Mu partial agonist

Kappa agonist

Question 5

MOA of buprenorphine

Answer 5

Mu partial agonist

Kappa antagonist

Question 6

MOA of nalaxone and naltrexone?

Answer 6

Mu and Kappa antagonists

Question 7

Why are larger oral doses needed compared parenteral doses needed for the same effect?

Answer 7

Larger oral doses due to first pass metabolism

-conjugation

Question 8

With prolonged use of opioids what do you develop?

Answer 8

Tolerance
-only to analgesia, euphoria, and sedation and resp depression

Physical dependence

Question 9

What does not develop tolerance when using opiods?

Answer 9

Constipation and miosis

Question 10

What drugs/other meds should you avoid when on opiods?

Answer 10

Alc and other CNS depressants

Also avoid anticholinergic drugs
-exacerbate adverse effects

Question 11

What is the triad of opioid overdose?

Answer 11

Coma, respiratory depression, and PINPOINT pupils

Question 12

How much stronger is fentanyl than morphine?

Answer 12

100x more potent

Question 13

ROI of fentanyl?

Answer 13

IM, IV, transdermal, transmucosal, nasal spray, lozenge, buccal tablets

LOTS

Question 14

Clinical use of alfentanil/remifentanil/sufentanil?

Answer 14

Induction and maintenance of anesthesia

Question 15

Is remifentanil quick or slow onset?

Answer 15

Rapid onset with brief duration

Question 16

Why is meperidine use declining?

Answer 16

Short half life
Adverse interactions with other drugs
Toxic metabolite

Question 17

Does meperidine cause the pinpoint pupils seen in other opioids?

Answer 17

Nope

Question 18

Besides mu opoids agonist, what other receptor does methadone work at?

Answer 18

NMDA antagonist

Question 19

Does methadone have long or short duration of action?

Answer 19

Long

Question 20

Which opioid causes QT prolongation?

Answer 20

Methadone

Question 21

How is hydromorphine different than plain old morphine?

Answer 21

More water soluble

-so can be diluted for injection

Question 22

10% of codiene is broken down into morphine by which CYP?

Answer 22

CYP2D6

-required for analgesic effects

Question 23

Which two opioids are used as cough suppressants?

Answer 23

Codeine and dextromethorphan (does not bind Mu)

Question 24

Which CYP metabolizes oxycodone?

Answer 24

CYP3A4

Question 25

What is the treatment for opioid overdose?

Answer 25

Naloxone

-can cause immediate withdrawal effects

Question 26

How is naltrexone useful in opioid addiction?

Answer 26

Prevents euphoria seen

Question 27

How is naltrexone useful in alcohol addiction?

Answer 27

Reduces craving and heavy drinking

Question 28

MOA of methylnaltrexone?

Answer 28

mu opioid antagonist

-doesnt cross BBB

Question 29

Clinical use of methylnaltrexone?

Answer 29

Opioid induced constipation

Question 30

MOA of loperamide?

Answer 30

Mu opioid agonist

-does not cross BBB

Question 31

Clinical use of loperamide?

Answer 31

Acute and chronic diarrhea

Question 32

What happens if you ingest loperamide in large quantities?

Answer 32

Can cuase torsades de pointes

Question 33

Which drugs should you not use with renal insufficiency?

Answer 33

Meperidine and codeine

Question 34

Which drugs should you not use with hepatic insufficiency?

Answer 34

Meperidine, codeine, and methadone

Question 35

What adverse effects can happen if you combine opioids with anticholinergic?

Answer 35

Increased constipation and urinary retention

Question 36

What adverse effects can happen if you combine opioids with MAOIs?

Answer 36

Hyperpyrexic coma