Ner 24: Opioid Analgesics

Front 1

Morpine (Admin, distrib, excretion)

Back 1

Admin - Parenternal 15 times more effective than oral. Has significant first pass metab.
Distrib - 33% protein bound, drug mainly in kidney, liver, lung, and spleen. Not much in CNS
Excretion - Conjugate by liver, glomerular filtration of metabolites and biliary excretion.

Front 2

Opiod overdose triad

Back 2

coma, pinpoint pupils, depressed respiration.

Front 3

Hormonal effects of Morphine

Back 3

Increased pituitary release of somatotropin, prolactin, and vasopressin.
Decresed pituitary release of lutenizing hormone causing decreased testosterone and sex drive in males.

Front 4

Opioid withdrawl response

Back 4

-lacrimation
-rhinorrhea
-perspiration
-goose flesh
-tremors to frank seizures
-anxiety/restless
-increased BP and temp
-vomiting
-pupilary dilation

Front 5

Locations of high opiate receptor concentrations

Back 5

-paleospinothalamic system
-limbic system
-substantia gelatinosa
-solitary, ambiguous, parabrachial nuclei (cough suppression)
-area postrema (nausea vomiting)
-PAG
-GUT

Front 6

Are opiates a better choice for acute or chronic pain?

Back 6

Acute

Front 7

5 indications for opiate prescription

Back 7

-analgesia
-anesthesia
-cough
-diarrhea
-detoxification

Front 8

How does morphine cause respiratory depression?

Back 8

By decreasing responsiveness to pCO2.

Front 9

6 symptoms which may counterindicate morphine

Back 9

1) hepatic disease
2) renal disease
3) poor respiratory function
4) head injuries
5) hypotension
6) biliary colic

Front 10

Morphine (Type/use, admin, excre)

Back 10

Opioid agonist. Analgesic, administered parenternal or oral, metabolized by hepatic conjugation.

Front 11

Codine (type/use, admin, abuse)

Back 11

Use - Opioid agonist. Used with aspirin as as analgesic
Admin - Oral 50% as effective than parenternal. 10% gets converted to morphine which is how it works.
Excre
Abuse - less risk than morphine

Front 12

Meperidine (type/use, pharm, SE)

Back 12

Type/use - Opioid agonist. Short duration analgesic, less constipating than morphine)
Pharm - metabolized by liver into convulsant
SE - OD causes stupor and convulsions. IV admin can increase HR

Front 13

Fentanyl (type/use, pharm, SE)

Back 13

Type - Opioid agoinst (80x morphine potency). Often used for anesthesia.
Pharm - administered IV or patch,
SE - accumulates with repeated doses

Front 14

Diphenoxylate (type/use, pharm, SE)

Back 14

Type - treats diarrhea. Very insoluable, therefore only works in gut. Given with atropine.
Pharm - No central effects at moderate doses.

Front 15

Methadone (type/use, pharm, SE)

Back 15

Type - used for addicts, similar to morphine but 85% protein bound.
Pham - given orally, widely spaced intervals

Front 16

Buprenophine (type/use, pharm, SE)

Back 16

Type - Used as analgesic, being tested for opiate/cocain addict treatment.
Pharm - 50 times more potent as analgesic, partial mu agonist, kappa antagonist

Front 17

Pentazocine (type/use, pharm, SE)

Back 17

Type - Used as analgesic. kappa-sigma agonist, mu antagonist.
Pharm - Given orally, made with naloxone to reduce parenternal abuse.
SE - High dose causes anxiety, nightmares, hallucinations, increases BP and HR. Can cause dependence.

Front 18

Butorphanol (type/use, pharm, SE)

Back 18

Same as pentazocine but only available parenternal, does not produce withdrawl syndromes when given to morphine users.

Front 19

Nalbupine (type/use, pharm, SE)

Back 19

Same as pentaxocine but without cardiovascular effects.

Front 20

Naloxone (type/use, pharm, SE)

Back 20

Type - Opioid mu antagonist. Used for saving life during opioid OD.
SE - none on healthy people, withdrawl on opioid dependent people.

Front 21

Dextromethorphan (type/use, pharm, SE)

Back 21

Type - Cough suppressant. Is d isomer of opioid levorphanol but has no other opioid characteristics other than cough suppressant.
SE - Counterindicated in peeps with MAO inhibitors b/c causes excitation and hyperpyrexia.