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Phar 507 > Therapeutic use of opioids > Flashcards

Therapeutic use of opioids Flashcards

1
Q

How do opiods provide analgeisa

A

Activation of the descending inhibitory pathway from brain to spinal causing a reduction in pain signal from the periphery, inhibition of the ascending pain signals coming from dorsal horn to brain

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2
Q

What is the indications of opiods

A

Moderate-severe pain unrelieved by non-opiods alone OR non-opiods are not appropiate

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3
Q

T/F: The most caution for using opiods is use to treat acute pain, cancer pain, pain near or at the end of life

A

False: The most caution for using opiods is use to treat chronic pain

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4
Q

Which pain is time limited (up to 7 days), 6-12 weeks following a severe inhury

A

Acute, subacute/post acute

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5
Q

What are the most common opiods

A

Codeine, hydrocodone, oxycodone, morphine, hydromorphone, fentanyl

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6
Q

What is the weakest opiod and most effected by genetic variability

A

Codeine

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7
Q

T/F: Codeine is NOT more effective than just an NSAID alone

A

True

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8
Q

Why is there caution when codeine is administered with a SSRI

A

SSRIs are potent CYP2D6 inhibitors, preventing conversion of codeine to morphine

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9
Q

Which opiod is more potent than codein with better CNS penetration and greater mu-receptor binding than codeine

A

Hydrocodone

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10
Q

Which drugs does hypdrocodone work synergistically with

A

Acetaminophen and ibuprofen

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11
Q

What is the efficacy dosing between morphine, hydrocodone, and oxycodone

A

10 mg oral morphine = 10 mg oral hydrocodone =7 mg oral oxycodone

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12
Q

Which liver enzyme keeps hydrocodone active, inactive

A

CYP2D6 (hydromorphone), CYP3A4 (norhydrocodone)

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13
Q

Which opiod is more potent than morphine due to better oral bioavailability, what is the efficacy dosing

A

Oxycodone, 15 mg oral morphine = 10 mg oxycodone

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14
Q

How should morphine dosing be changed from oral to IV/ IV to oral

A

Increase by 3X the amount, reduce by 1/3

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15
Q

What are the two metabolites of morphine

A

Morphine-3glycuronide: non acitve metabolite, morphine-6-glucuronide: active metabolite that contributes to morphine’s analgesic AND adverse effects

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16
Q

What patients should avoid morphine

A

Renally impaired patients

17
Q

What opiod is 5-7 more potent to morphine, what is the efficacy dosing

A

Hydromorphone, 1 mg IV hydromorphone = 0.4 mg IV hydromorphone

18
Q

T/F: There is extensive first pass metabolism of hydromorphone so switching from IV to PO needs to be increased by 5 Fold

A

True

19
Q

What opiod is 100 times more potent than morphine and is not given orally, how is it given or dosed

A

Fentanyl/ buccal and transmucosal

20
Q

What does it mean opiod-naive

A

Person who has NOT recently taken enough opiod on a regular enough basis to become tolerant to effects

21
Q

What is a patient who is opioid-tolerant, how much would a patient take to be put in this category

A

Person who HAS taken opiods long enough at doses high enough to develop tolerance to analgesia and sedation, Greater than 60 mg oral morphine (or its quivalent) per day for at least 7 days

22
Q

What and how are the starting doses chosen

A

Usual starting dose, opiod-naive adult: 5 mg
Usual starting dose, elderly or high risk adult: 2.5 mg or 5 mg
Usual starting dose, opiod-tolerant adult: 10 mg

23
Q

What are the dosing intervals and how are they selected

A

Immediate release morphine/hydromorphone or oxycodone: 4 hours
Acetaminophen plus codeine OR acetaminophen plus hydrocodone: 4-6 hours
Sustained/controlled realse morphine or oxycodone: 12 or 24 hours
IV morphine or IV hydromorphone: 2-4 hours

24
Q

How does lipophilicity effect IV opiods, rank the strongest opiods from most lipophillic to least

A

Onset, peak, and duration is related to lipophilicity (fast onset, short duration)/ fentayl -> hydromophone -> morphine

25
Q

How should the dose of opiods be adjusted if PAIN is NOT RESOLVED and side effects are NOT PROBLEMATIC

A

Increase dose by 25-50% once at steady state

26
Q

How should the dose of opiods be adjusted if pain is RESOLVED BUT SIDE EFFECTS ARE PRESENT

A

Decrease dose by 25%

27
Q

T/F: Opiods have a S curve meaning doses should be adjusted tightly

A

True

28
Q

What is incomplete cross-tolerance, how does this effect opiod conversions

A

For opiod tolerant patients since they are used to the side effects of the current opiod switching to another opiod can cause side effects/ 25%-50%

29
Q

What are the adverse effects

A

nausea and vomiting, constipation, sedation, concentration and memory deficits, dizziness, puritus

30
Q

What causes nausea and vomiting when using opiods

A

Direct stimulation fo chemoreceptor trigger zone, enhanced vistublar sensitivity, reduced gastrointestinal motility

31
Q

How is nausea/ vomiting treated

A

Antiemetic, reduced dose, patience/tolerance, switch to another opiod

32
Q

What is the one opiod side effect that tolearance dose not develop for, how is it prevented, treated

A

Constipation, Stool softener AND mild stimulant laxative (Docusate with Senna), lactulose and PEG

33
Q

T/F: Opiod-induced respiratory depression happens abruptly with no signs and symptoms

A

False: Increased sedation is a precursor of OIRD and a good early warning sign of OIRD (monitor sedation level AND respiratory quality)

34
Q

What type of sedation must lead to a decrease in opiod dose, how much

A

Frequently drowsy,arousable, drifts off to sleep during conversatoin/ Decrease by 25-50%

35
Q

What are risk factors for OIOPD

A

Pulmonary disease, obstructive sleep apnea, obesity, cardiac didease, renal or hepatic disease, concurrent CNS depressants

36
Q

T/F: For pain following surgery the longer duration, not dose, is more strongly associated with opiod misuse

A

True

Phar 507 (33 decks)

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