Week 5: Amnesics and Hypnotics Flashcards
What are the 5 important Opioid Analgesics and Sedative (Sleep) Hypnotic Prototype Drugs
morphine sulfate
naloxone (Narcan)
nalbuphine (Nubain)
codeine
zolpidem (Ambien)
Narcotics means __
opioids
What is the prototype for the Narcotic class
Morphine
What schedule is morphine
schedule II
___ is the standard by which new analgesics are measured
morphine (it either is weaker or stronger than morphine)
What are the main 3 opioid receptors
Mu (major one)
Delta
Kappa
Opioids are what
naturally occurring substance
What is the main action of morphine (and narcotics)
central action on PAIN PERCEPTION (we want to decrease it)
So it impacts the sensory cortex
Other than act on pain perception what other effects do narcotics like morphine have
Alter attitudes by psychological, sedative, and hypnotic effects
Morphine is a narcotic ____
agonist
What does it mean that morphine is an opioid/narcotic agonist
It interacts with receptors in BRAIN AND OTHER TISSUES - it causes opioid effects to happen
What sort of CNS effects does morphine and opioids/narcotics cause
Analgesia, Drowsiness, Changes in Mood, Mental Clouding - the main reasons we use it
- CONSTRICTED PUPILS
- DECREASES CO2 RESPONSE - BREATHING DECREASE / RESP
- STIMULATES NV - may need to give anti emetic
What other systems and effects can opioids and narcotics and morphine cause besides CNS
- CV - Doesnt impact heart rate but provokes histamine release and can cause hypotension — It dilates resistance vessels and can cause DIZZINESS AND ORTHOSTATIC HYPOTENSION
- GI - decreases motility and biliary tract ==> CONSTIPATION OCCURS
- Smooth Muscle - Increases bladder and sphincter tone leading to URGENCY AND RETENTION; and LARGE DOSES CAUSE BRONCHOCONSTRICTION
- Skin - Dilation leads to FLUSHING, WARM SKIN, AND SOMETIMES ITCHING (histamines)
Why is morphine never given orally usually
morphine has HIGH FIRST PASS when given PO - so we give it IV/Injection usually
ADRs from Morphine (Opioids/Narcotics)
Allergic Rxns
ABUSE POTENTIAL
Orthostatic Hypotension, Itchiness, Warm Skin, Dizziness, Flushing, Constipation, Urinary Retention, Constricted Pupils, NV, Depressed Breahting
Examples of other Narcotics/Opioids
- meperidine (Demerol) - less GI effects but doesnt last as long - additive effects - synthetic opioid - rigors - normoparadeine metabolite causes seizures
- Percocet (Oxycodone and Acetaminophen) & Percodan (Oxycodone and ASA)
- Vicodin and Norco
- Dilaudid (v. potent)
- Fentanyl
naloxone (Narcan)
Narcotic Antagonist - blocks and prevents action of opioids and narcotics
gigiven IV or nasally
used to reverse narcotic effects of anesthesia or in case of overdose
Why is naloxone givne nasally or by IV
because it has a very extensive first pass
naloxone is a pure antagonist, what does that mean
it has no agonist or respiratory depressant effects
it only blocks the opioid receptor and wont cause harm from taking aside from preventing opioids from working
If one is addicted to an opioid like morphine and takes naloxone what is an ADR that can occur
if they are addicted the naloxone will cause withdrawl symptoms
What is an example of a narcotic agonist antagonist
Nalbuphine (Nubain)