Wk4- Opioids

Question 1

What is the definition of an opioid drug?

Answer 1

Opioid= ‘Any substance (endogenous or exogenous) that produces morphine-like effects that are blocked by antagonists such as naloxone’

Question 2

Where are opiates derived from?

Answer 2

Opiates are derived from opium, which is a milky extract from the poppy plant. This extract contains morphine and codeine

Question 3

All opioids are structurally similar, with a combination of ___ derived & ___ compounds

Answer 3

All opioids are structurally similar, with a combination of PLANT derived & SYNTHETIC compounds

Question 4

What is the solubility of opioids? & How does this impact opioids ability to enter the blood stream?

Answer 4

Opioids are highly lipid soluble (lipophilic). Therefore, they can cross biological barriers & enter blood stream

Question 5

What are 4 different routes of administration that can be used for Opioids?

Answer 5

Routes of administration for opioids-
1) IV
2) IM
3) IN
4) Transdermal (patch)

Question 6

Opioids are effective for treatment of severe acute pain, but can be problematic in the treatment of which type of pain?

Answer 6

Opioids are effective for treatment of severe acute pain, but can be problematic in treatment of CHRONIC (NON-CANCER) pain

Question 7

Why do different opioid drugs produce different physiological effects?

Answer 7

Different opioid drugs produce different physiological effects because ‘the pharmacological profile of the opioids drugs is related to the specific opioid receptors that they activate & the associated physiological effect of those receptors’

Question 8

What are the 3 main Opioid Receptors? [Just identify the names, don’t describe]

Answer 8

Opioid Receptor Types-
1) MOP Receptors
2) DOP Receptors
3) KOP Receptors

Question 9

There are 3 types of Opioid Receptors (MOP, DOP, & KOP). What are the pros & cons of MOP Receptors?

Answer 9

MOP Opioid Receptors-
a) Pros= Responsible for most of the analgesic effects of opioids
b) Cons= Produce many of the unwanted effects of opioids (resp depression, dependence, sedation)

Question 10

There are 3 types of Opioid Receptors (MOP, DOP, & KOP). What are the pros & cons of DOP Receptors?

Answer 10

DOP Opioid Receptors-
a) Pros= Produce analgesia
b) Cons= Can be proconvulsant (cause seizures)

Question 11

There are 3 types of Opioid Receptors (MOP, DOP, & KOP). What are the pros & cons of KOP Receptors?

Answer 11

KOP Opioid Receptors-
a) Pros= Contribute to spinal level analgesia
b) Cons= may elicit sedation, dysphoria, hallucinations

Question 12

What are the main pharmacological effects of Opioids like Morphine? [Theres 10- including the good & bad effects]

Answer 12

PHARMACOLOGICAL EFFECTS OF OPIOIDS (Morphine Specifically)-
1- Analgesia
2- Euphoria
3- Sedation
4- Respiratory Depression
5- Suppression of Cough/Gag Reflex
6- Nausea & Vomiting
7- Pupillary Constriction (Miosis)
8- Reduced GI Motility & Constipation
9- Hypotension
10- Bronchoconstriction

Question 13

The same mechanism causes Opioids to produce Hypotension & Bronchoconstriction. What is this mechanism?

Answer 13

The release of Histamine is what causes Hypotension & Bronchoconstriction following Opioid administration

Question 14

What is the name of the respiratory impairment/condition which Opioids can cause?

Answer 14

Opioids can cause ‘Opioid Induced Ventilatory Impairment’ (aka respiratory depression)

Question 15

What are the clinical features of ‘Opioid Induced Ventilatory Impairment’?

Answer 15

“Opioid Induced Ventilatory Impairment can lead to hypoxia and hypercapnia secondary to central nervous system depression, the loss of airway reflexes and respiratory failure”

Question 16

What are the clinical features of an ‘Opioid Overdose’?

Answer 16

Opioid Overdose- “A patient in an altered conscious state (drowsy) with respiratory depression (shallow leading to failure)and pinpoint pupils”

Question 17

There are 6 Severe Complications of Acute Opioid Overdoses/ Opioid Induced Ventilatory Impairment. List these complications?
[Just identify, don’t describe]

Answer 17

Severe Complications of Acute Opioid Overdoses/ Opioid Induced Ventilatory Impairment:
1) Airway Obstruction
2) Pulmonary Aspiration
3) Positional Asphyxia
4) Hypoxic Brain Injury
5) Rhabdomyolysis
6) Acute Renal Failure

Question 18

How do Acute Opioid Overdoses cause: Airway Obstructions?

Answer 18

Acute Opioid Overdoses-
Airway Obstruction occurs secondary to a loss of supraglottic airway muscle tone

Question 19

How do Acute Opioid Overdoses cause: Pulmonary Aspiration?

Answer 19

Acute Opioid Overdoses-
Pulmonary Aspiration occurs secondary to decreased consciousness/sedation & blunted reflexes

Question 20

How do Acute Opioid Overdoses cause: Positional Asphyxia?

Answer 20

Acute Opioid Overdoses-
Positional Asphyxia occurs secondary to sedation/decreased consciousness, thus inhibiting the ability to self correct airway obstruction

Question 21

How do Acute Opioid Overdoses cause: Hypoxic Brain Injury?

Answer 21

Acute Opioid Overdoses-
Hypoxic Brain Injury occurs secondary to hypoventilation & respiratory depression, thus reducing oxygen to the brain

Question 22

How do Acute Opioid Overdoses cause: Rhabdomyolysis?

Answer 22

Acute Opioid Overdoses-
Rhabdomyolysis occurs secondary to immobility from sedation, which can then lead to pressure areas & compartment syndromes

Question 23

How do Acute Opioid Overdoses cause: Acute Renal Failure?

Answer 23

Acute Opioid Overdoses-
Acute Renal Failure occurs secondary to Rhabdomyolysis (which is caused by immobility from sedation, which can then lead to pressure areas & compartment syndromes)

Question 24

What is an Opioid Antagonist?, and what is an example which is used prehospitally?

Answer 24

Opioid Agonists- Bind to opioid receptors and BLOCK their activation
Example- Naloxone

Question 25

Describe what Naloxone is?

Answer 25

Naloxone- ‘A non-selective and competitive reversible antagonist for opioid receptors’

Question 26

Describe Naloxone in terms of:
a) Affinity &
b) Efficacy

Answer 26

Naloxone has:
a) High Affinity for opioid receptors (high likelihood of receptor binding)
b) No Efficacy (no likelihood of receptor activation)