Therapeutic Considerations Flashcards
What are the therapeutic considerations of morphine?
metabolized in the liver, active metabolite M6G is excreted in the kidney, dose adjustment for patients with kidney disease
controlled-release oral preparations reduce # of daily doses, but associated with abuse
IV or subcutaneous morphine is commonly used in patient-controlled analgesia devices
epidural or intrathecal morphine can produce highly effective analgesia by achieving locally high concentrations in the dorsal horn of the spinal cord
What are the therapeutic considerations of codeine?
less effective than morphine in pain treatment
used for antitussive and antidiarrheal effects
quinidine reduces analgesic effects of codeine by inhibiting bioactivation of codeine to morphine
What are the therapeutic considerations of oxycodone and hydrocodone?
more effective than codeine
hydrocodone is more effective than morphine
What are the therapeutic considerations of tramadol?
limited abuse potential
administration with acetaminophen improves analgesic efficacy
What are the therapeutic considerations of methadone?
due to long duration of action, it is used to achieve pain relief in cancer patients
What are the therapeutic considerations of fentanyl?
more potent than morphine and is bioavailable through several routes
transmucosal administration (lozenge) is useful in pediatric patients
transdermal (patch) formulation releases the drug slowly
alfentanil and sufentanil?
alfentanil is less potent than fentanyl
sufentanil is more potent than fentanyl
What are the therapeutic considerations of remifentanil?
rapid metabolism and elimination
has precise matching of the drug dose to the clinical response
requires coadministration with a longer-acting drug to maintain analgesia postoperatively
What are the therapeutic considerations of meperidine?
toxic metabolites can increase CNS excitability and seizures
excreted renally, problem for patients with kidney disease
causes mydriasis, rather than miosis
risk of life-threatening serotonin syndrome when coadministered with MAOI
What are the therapeutic considerations of levorphanol?
exerts analgesic effects through receptors in periventricular and periaqueductal gray matter in the brain and spinal cord, altering pain perception and transmission
IV and oral forms
What are the therapeutic considerations of propoxyphene?
structurally related to morphine
mild centrally acting analgesia
increases serum levels of carbamezepine
What are the therapeutic considerations of butorphenol and burenorphine?
produce morphine-like analgesia, but with milder euphoric symptoms
available in intranasal and IV forms
What are the therapeutic considerations of nalbuphine?
may precipitate withdrawal in patients who have received opioids chronically
What are the therapeutic considerations of naloxone?
combination with yohimbine results in greater anxiety, tremors, palpitations, hot and cold flashes, and elevated plasma cortisol levels
What are the therapeutic considerations of alvimopan and methlnaltrexone?
they are antagonists of peripheral u-opioid receptors, prevent morphine-induced constipation, but have no effect on morphine analgesia
