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36 Cards in this Set
- Front
- Back
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neuroexcitatory
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morphine 3- glucoronide
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has genetic polymorphism
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codine, hydroxycodeine and oxycodone
metabolized by CYP2D6 to morphine |
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Meperidine AEs
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metabolized to normeperidine
causes seizures |
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Remifentanil is metabolized by
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plasma and tissue esterases NOT liver
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3 naturally occuring opiod
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enkephalins
endorphins dynorphins |
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mu receptors
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respiratory depression
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kappa receptors
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sedation actions
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delta
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tolerance
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identify opiod ionic mechanism of action
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G protein
activate PLC or inhibit AC open K+ channels close Ca2+ channels inhibits neurotransmitters inhibits Ach, NE, serotonin |
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identify the acute effects of opiods
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analgesia
sedation and euphoria decrease respiration and response to CO2 antitussive decrease GI movements Biliary colic increase baldder tone decrease uterine tone miosis |
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what opiod DOESNT cause biliary colic or miosis
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meperidine
bc it has anticholinergic effects |
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how do u block miosis
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naloxone and atropine
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describe the other acute effects:
histamine release endocrine addisons |
histamine --> rash and flushing
endocrine: increased ADH and prolactin, decrease LH exaggerated response in adrenal insuffiency and HYPO thyroidism |
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Chronic effects of Opiods
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tolerance
physical dependance |
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sx exceptions to tolerance
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miosis and constipation blocked by ketamine
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physical dependance sx
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6-8 hours after last dose
lacrimation, midriasis, diarrhea, rhinorrhea, goosebumps, muscle aches, anxiety and hostility |
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AE of dextromethorphan
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hallucinations, confusion, excitation, miosis. mydriasis, nystagmus, decrease breathing , seizures and coma
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drugs used for opiod dependancy treatment
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methadone:
manage withdrawl symptoms less euphroric sx Buprenorphine |
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overdose AE
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miosis
respiratory depression comatose |
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confirm opiod overdose using
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IV naloxone- short acting opiod antagonist
* very quick recovery, needs ventilatory support naltrexone (long acting) |
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additive effects of opiod drug interaction:
AE with MAOI |
hyperpyrexia, seizure and coma
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AE with SSRI
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serotonin syndrome
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agonist antagonist drugs
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pentazocine
buprenorphine butorphanol nulbuphrine |
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amitriptyline
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antidepressant
CI in elderly with heart problems because of anti-cholinergic effects |
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desipramine
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antidepressant
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duloxetine
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antidepressant
better tolerated than TCA |
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clonidine
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central alpha 2 agonist
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tizanidine
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central alpha 2 agonist
less likely to cause hypotension than clonidine |
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dexamethasone
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corticosterioid
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prednisone
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corticosteriod
** only use with pain with inflammation |
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dextromethophan
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NMDA receptor antagonist
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memantin
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NMDA receptor antagonist
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mexiletine
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oral Na channel blocker
used ONLY for neuropathic pain for pt with heart dx. |
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capsaicin
lidocaine |
oral Na channel blockers
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baclofen
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GABA receptor
used in trigeminal neuralgia and neuropathic pain |
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pamidronate
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regional pain syndrome
treatment for osteoperosis, Multiple myloma and pagets |
