T41c Opioids

Question 1

alfentanyl

Answer 1

opiod used in anesthesiology

Question 2

buprenorphine

Answer 2

opiod -partial mu agonist (duality of precipitating withdrawl causing in the presence of full agonist)

TX. IV mild moderate pain.

buccal ceiling effect due to being a partial agonist (safe)

Question 2

alvimopan

Answer 2

opiod- antagonist peripheral opiod receptors canbe used to combat contipation of systmic opiods

Question 3

codeine

Answer 3

opiod weak agonitst

metabolized to morphine very weak

TX. anti-tussive

(used in combo with NSAIDs as analgesic)

Question 3

dextrometorphane

Answer 3

opiod- related anti-tussive (robitussum)

(not addictive but at super high dose ketaminergic-_hallucingens_ causing status epilepticus)

Question 4

Fentanyl

Answer 4

opiod

DoA 30min. Distribution of action with 9hr terminal half life transdermal patch for chronic long term patients with subcutaneous depot ~17hr half life 1:100 dose vs oral morphine

TX: Energency use.

Question 4

heroin

Answer 4

opiod of abuse illegal in USA

Question 6

hydrocodone

Answer 6

opiods

Question 7

levopropoxyphene

Answer 7

opiod- anti-tussive (not addictive)

Question 8

loperamide

Answer 8

opiod-related anti-diarrheal (tinctura opii). imodium

Question 9

Meperidine

Answer 9

Opiod (with anti-muscarinic effects) [demorol - pethidine]

DoA 2-3 hrs (better than morphine delivery - shorter acting) 100% oral bioavail -

ADV NO miosis, NO GI/GU/gallbladder spasm -metabolized by P450 to SSRI as normeperidine (may cause serotonin syndrom and seizures), tachycardia (torsade),

Question 10

methadone

Answer 10

opiod used in heroin addiction (25 hr half life)

slow kinetic action (less adictive) DOA long with taper (but also takes time to come to steady state which risks OD of heroin fro the street)

Question 11

methylnaltrexone

Answer 11

opiod antagonist

TX reverse opiod induced constipation (NO BBB CNS)

Question 12

Morphine

Answer 12

Opiod (mu receptor agonist)

DoA 3-5 hrs (caution delivery) dose range 15mg to 15g (oral 33% bioavai) metabolized M-6-glucuronidate more active than the drug itself (caution in renal dysfunction and OD by metabolity)

TX.

ADV: sedative, respiratory depression (inhibit hypoxic drive pCO2 centers of the CNS not the periphery therefor do not administer O2 - give naloxone), histamine release leads to vasodilation and permeability, colicky GI crampsdue to longitudinal contract/ spincters constrict (contraindicated in obstructive GI, stones etc i.e. use anti-muscarinic), Miosis due to decreased NE secretion, antitussive (not mu mediated), nausea/vomitting (chemoreceptor trigger zone D2),

Question 13

nalbuphine

Answer 13

opiod -mixed agonist

• kappa agonist (spinal analgesic, dysphoria - non addictive)
• mu antagonist (precipitation of withdrawl)

Question 14

naloxone

Answer 14

opiod- antagonist

DOA 60-100 min half life

TX. (IV) use for respiratory depression

*caution withdrawl syndrom in ‘junkies’*

Question 15

naltrexone

Answer 15

opiod- antagonist

DOA ~48hr half life, oral

TX. decreases craving for alcohol used in opiate addiction

Question 18

oxycodone

Answer 18

opiods

Question 19

pentazocine

Answer 19

opiod -mixed agonist

* *kappa agonist (**spinal analgesic, _**dysphoria -** non addictive_)
 * *mu antagonist** (_precipitation of withdrawl)_

Question 20

remifentanyl

Answer 20

opiod used in anesthesiology

Question 21

sufentanyl

Answer 21

opiod used in anesthesiology

Question 22

tramadol

Answer 22

opiod -partial agonist ceiling effect