Pm Ch 28 Opioid (Narcotic) Analgesics, Opioid Antagonists, And Nonopioid Centrally Acting Analgesics

Front 1

What is the difference between an opiod and a narcotic?

Back 1

• Opioid is a general term defined as any drug, natural or synthetic, that has actions similar to those of morphine.
• Narcotic has been used to mean an analgesic, a central nervous system (CNS) depressant, and any drug capable of causing physical dependence.

Narcotic has also been employed in a legal context to designate not only the opioids but also other diverse drugs that do not have true pharmacologic properties.

Opioid is the better term.

Front 2

What is an analgesic?

Back 2

Analgesics are drugs that relieve pain without causing loss of consciousness.

Front 3

At each type of receptor, a drug can act in one of three ways:

Back 3

as an agonist, partial agonist, or antagonist.

Drugs that bind opioid receptors fall into three major groups: (1) pure opioid agonists, (2) agonist-antagonist opioids, and (3) pure opioid antagonists.

Front 4

_______ are the most effective analgesics available.

Back 4

opioids

Front 5

_______ and other pure opiod agonists relieve pain by mimicking the actions of endogenous opioid peptides.

Back 5

Morphine

Front 6

Why are opiods contraindicated in patients with intracranial pressure?

Back 6

due to their ability to suppress respirations which increases the CO2 content of the blood which in turn results in increased intracranial pressure; as well as their increased sedative effects which can mask relevant changes in intracranial pressure.

Front 7

Concurrent use of benzodiazepines and morphine puts a patient at risk for _________ _________.

Back 7

Respiratory depression

Front 8

Because of first-pass metabolism, _____ doses of morphine must be larger than _______ doses to produce equivalent analgesic effects.

Back 8

oral (enteral)

parenteral

Front 9

With prolonged opioid use, tolerance develops to analgesia, euphoria, sedation, and respiratory depression but not to _________ and _______.

Back 9

constipation and miosis.

Front 10

What is tolerance?

Back 10

a state in which larger doses are required to produce the same response formerly produced by a lesser dose.

Front 11

What is physical dependence?

Back 11

Physical dependence is a state in which an abstinence syndrome occurs if the drug is discontinued abruptly. Drug abuse is a state in which an individual will seek and use the drug despite physical, psychological, or social harm.

Front 12

Cross-tolerance exists among the various _________ but not between opioid agonists and general CNS depressants.

Back 12

opioid agonists

Front 13

With prolonged opioid use, ________ ______ develops. An _______ _______ will occur if the opioid is abruptly withdrawn

Back 13

Physical dependence

Abstinence syndrome

Front 14

In comparison to abstinence syndrome which requres physical dependence how does withdrawal syndrome differ?

Back 14

withdrawal syndrome associated with general CNS depressants, the withdrawal syndrome associated with opioids, although unpleasant, is not dangerous

Front 15

What should be done to minimize the symptoms of abstinence syndrome with opioid use?

Back 15

opioids should be withdrawn gradually, they cannot be stopped randomly

Front 16

What should be done to prevent withdrawal syndrome symptoms with opioid use?

Back 16

To prevent withdrawal symptoms, the patient should taper the drugs over a 7-to-day period. Switching to another opiate will not help taper the first drug.

Front 17

Precautions to opioid use include .... (4)

Back 17

pregnancy, labor and delivery, head injury, and decreased respiratory reserve

Front 18

Why should patients taking opioids not take anticholinergic drugs?

Back 18

• Patients taking opioids should avoid anticholinergic drugs (eg, antihistamines, tricyclic antidepressants, atropine-like drugs)—because these drugs can exacerbate opioid-induced constipation and urinary retention.

Front 19

Opioid overdose produces a classic triad of signs:

Back 19

coma, respiratory depression, and pinpoint pupils.

Front 20

Fentanyl (Duragesic) is available in five formulations for administration by three routes:

The advantage of fentanyl as non morphine opiate is that it can be administered through so many routes.

Back 20

parenteral, transdermal, and transmucosal

Front 21

T/F
Fentanyl is more potent than morphine

Back 21

True

• Fentanyl is much more potent than morphine, as evidenced by its dosing in micrograms rather than milligrams. (Potency is defined as providing a stronger response at a smaller dosage).

Front 22

Why is Fentanyl an appropriate drug for use in tx of chronic pain?

Back 22

Fentanyl’s half-life is very long. With transdermal application, its levels remain steady for 24 to 48 hours.

Front 23

Use of meperidine (Demerol) (a non morphine opiate) should not exceed ___ hours to avoid accumulation of normeperidine, a toxic metabolite. Demerol is not a long-acting drug because of its short half-life and would not be a good drug for chronic pain.

Back 23

48

Front 24

Why would Demerol not be use to treat chronic pain?

Back 24

it has short half life

Front 25

Like morphine, codeine and other moderate to strong opioid agonists produce analgesia, sedation, euphoria, respiratory depression, constipation, urinary retention, cough suppression, and miosis. But how do these drugs differ from Morphine?

Back 25

These drugs differ from morphine in that they produce less analgesia and respiratory depression and have a lower potential for abuse.

Front 26

T/F
The combination of codeine with a nonopioid analgesic (eg, aspirin, acetaminophen) produces greater pain relief than can be achieved with either agent alone

Back 26

True

Front 27

Pentazocine and other agonist-antagonist (partial agonist) opioids produce ____ analgesia than morphine and have a ____ potential for abuse.

Back 27

less

lower

Front 28

Naloxone and other pure opioid antagonists can reverse respiratory depression, coma, analgesia, and most other effects of pure opioid agonists. The only exception is __________, which does not cross the blood-brain barrier.

Back 28

methylnaltrexone (which is used for opiod induced constipation not overdose)

Front 29

If the pure opioid antagonist Naloxone is given to an individual is dependent upon opioid agonists what will happen?

Back 29

immediate withdrawal reaction

Front 30

T/F
Opiod dosage must be individualized?

Back 30

True

Patients with a low tolerance to pain or with extremely painful conditions need high doses. Patients with sharp, stabbing pain need higher doses than patients with dull pain. Elderly adults generally require lower doses than younger adults. Neonates require relatively low doses.

Front 31

Use of parenteral opioids during delivery can _____uterine contractions and cause _______ _______ in the neonate.

Back 31

suppress

respiratory depression

Front 32

Physical dependence and addiction are not the same.

how are they different?

Back 32

Addiction is a behavior pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm.


Physical dependence is a state in which an abstinence syndrome occurs if the drug is discontinued abruptly.

Front 33

Abuse

Back 33

is defined as drug use that is inconsistent with medical or social norms.

Front 34

• An adverse effect of Methadone used to overcome opioid addiction is prolongation of the ___ _______, seen on the ECG (electrocardiograph).

Back 34

QT interval