Neuro - Carrier - Opioids I And Ii

Front 1

Define Nociceptive pain

Back 1

Stim. of peripheral nerve

Front 2

Are All of the following are considered nociceptive pain?

Cold, Burn, Alc. on wound
Herptetic neuralgia, Phantom limb pain

Back 2

Cold, burn, alc. on wound are nociceptive pain

Front 3

MOA of Opioids?

Back 3

G-protein coupled receptors in CNS and spinal cord regions involved in modulation of pain

Close voltage-gated Ca2+ channels on presynaptic nerve terminals --> reducing transmitter release

Hyperpolarize = inhibit post-synaptic neurons by opening K+ channels

Front 4

What receptors do opiods have actions at?

Back 4

Mu, Kappa and delta

They can be agonists at one and antagonists at another

Front 5

What are the actions of the mu receptor acted on by opiods?

Back 5

Supraspinal and spinal analgesia, inhibition of respiration, slowed GI transit, modulation of hormone and NT release, euphoria

Front 6

What are the actions of the delta receptor acted on my opioids?

Back 6

suprespinal and spinal analgesia, modulation of hormone and NT release

Front 7

What are the actions of the kappa receptor acted on by opioids?

Back 7

Supraspinal and spinal analgesia, psychomotor effects, slowed GI transit, dysphoria

Front 8

T/F: If you give exogenous Opioids, you can spur release of endogenous opioids

Back 8

TRUE

Front 9

What are the sites of opioid action in the ascending pathway?

Back 9

Periphery, Dorsal Horn, ventral caudal thalamus

Front 10

What is the role of the descending pathway in opioid drugs?

Back 10

Lesser understood - thought to inhibit pain transmission neurons

Front 11

What are the sites of opioid action in the descending pathway?

Back 11

Periaquaductal gray
Rostral ventral medulla
Dorsal Horn

Front 12

Frequent repeated doses of a drug produce a gradual loss of effectiveness. What does this describe?

Back 12

Tolerance

Front 13

When a drug is stopped or antagonist administered and the pt. experiences withdrawal syndrome, what does this define?

Back 13

Dependence

(The Symptoms themselves are the withdrawal)

Front 14

What are the possible hypotheses for tolerance?

Back 14

cAMP upregulation
NMDA
Receptor recycling
Receptor uncoupling


Note - persistent administration of opioids increases the sensation of pain

Front 15

A pt comes in after stopping an opioid, describing the sensation of euphoria and analgesia, mental clouding b/c they can't do their taxes, sedation, respiratory depression, Anti-diuresis, N, V, and cough suppression. What level of Tolerance does this describe?

Back 15

HIGH

Front 16

A pt stops their opioid med and you note bradycardia on PE. What level of tolerance are they experiencing?

Back 16

Modertate

Front 17

What are the symptoms of LOW tolerance?

Back 17

Miosis, Constipation, Convulsions

Front 18

T/F: Opioids are well absorbed through most routes, but undergo significant first pass effect

Back 18

TRUE - Subcu, IM, Oral

Codeine + Ocycodone do NOT undergo significant first pass effects

Front 19

do Opioids localize rapidly or slowly to highly perfused tissue sites?

Back 19

Rapidly to places like brain, kidney, lung, liver, spleen

= what makes them fun to abuse

Front 20

Whats the main reservoir of opioids?

Back 20

Skeletal muscle

Front 21

A pt is elderly an thus their metabolism has slowed substantially. After giving them codeine, would you expect to see more codeine or morphine in their system?

Back 21

Codeine

Codeine --> Morphine via CYP2D6

Slow metabolizers can't covert it fast, thus we'll see build up of Codeine

Note: Oxycodone and Hydrocodone are also metabolized by CYP2D6

Front 22

What are the CNS affects of Opioids?

Back 22

Euphoria, Dysphoria, Sedation, Respiratory Depression, Cough suppression, miosis, truncal rigidity, N, V, Temp (u agonists = hyperthermia, kappa agonist = hypothermia)

Front 23

What are the effects of opioids on CV?

Back 23

MOST cause bradycardia,

Meperidine causes Tachycardia

Front 24

What do opioids do to GI tract, Biliary tract, and Renal system?

Back 24

GI = constipation b/c they dec. motility
Biliary = contract biliary sm. m = biliary colic, Inc. amylase and lipase
Renal = depressed due to dec. renal plasma flow

Front 25

A Preggo Pt on an opioid wants to know what SE's she can exect in terms of her uterus. (and neuroendocrine, pruritis, immune system). what do you tell her?

Back 25

Uterus = prolong labor
Neuroendocrine = stimulate release of ADH, prolactin, somatropin, inhibit LH
Pruritis = flushing and warming of skin
Immune function = inhibit or augments it

Front 26

What do we need to monitor in a pt who has been on opioids for a long time?

Back 26

Their immune function

Front 27

What are the clinical uses of opioids?

Back 27

Analgesia, Acute pulm edema, cough, D, Shiverring

Front 28

A pt suffers from the shivers every time he sees a cup of sugar. What do you give him to tx?

Back 28

Meperidine = anti-shiver via alpha-2 receptor subtype

Front 29

Pt going in for Sx gets opioids for what reason?

Back 29

Pre-Sx = sedative, analgesic
During -Sx = they can minimize CV depression

Front 30

What are the Strong Agonist Opioid agents to know?

Back 30

Morphine, Hydromorphone, Heroin, Methadone, Meperidine, Fentanyl

Front 31

What are the Mild-moderate opioid agents to know?

Back 31

Codeine, Hydrocodone, oxycodone, diphenoxylate, Loperamide, Buprenorphine, Naloxone, Naltrexone, Tramadol, Dextromethrophan

Front 32

How do all the opioids we learned about work?

Back 32

Agonists of the Mu receptor

Front 33

What is methadone used for?

Back 33

Heroine addicts = suppresses opioid withdrawal symptoms, analgesia

Tolerance and physical dependence develop slowly and withdrawal symptoms are more mild, but more prolonged than morphine

Front 34

Whats one of the major side effects of Methadone?

Back 34

Prolonged QT = why its black boxed

Front 35

Whats the primary use of codeine?

Back 35

Antitussive (anti-cough), pain relief

Front 36

Between Fentanyl and Meperidine, which one is more widely used?

Back 36

Fentanyl

(DON'T USE meperidine with tachycardia b/c it can cause QT prolongation)

Front 37

T/F: Hydrocodone and Oxycodone are less efficacious than morphine

Back 37

TRUE

Front 38

How do we get a fatal overdose of Hydrocodone or oxycodone?

Back 38

Drugs that have been modified to release all of the drug at once --> fatal

Front 39

What are Loperamide and Diphenoxylate used for?

Back 39

Diarrhea

Front 40

What do we combine Loperamide and Diphenoxylate with to reduce abuse?

Back 40

Atropine

Front 41

What receptor do Naloxone and Naltrexone work through?

Back 41

Mu

Front 42

T/F: Naloxone and Naltrexone have little action in the absence of agonist

Back 42

TRUE

Front 43

T/F: in the presence of agonist for ex. morphine, the opioids effects are reversed in 3 minutes with Naloxone and Naltrexone

Back 43

TRUE

= normalizes repiration, level of consciousness, pupils, bowel activity, awareness of pain

Front 44

Whats one of the main problems associated with administering Naloxone?

Back 44

Within 3 minutes, you can see withdrawal symptoms

Front 45

A pt comes in having overdosed on opioids, and is now in a coma. What do you use to tx?

Back 45

Naloxone

Front 46

Why does Buprenorphine have a long DOA?

Back 46

Slow dissociation from the receptor

Front 47

T/F: Buprenorphine is as effective as Methadaone for tx of opioid dependence

Back 47

TRUE

Front 48

What is Tramadol used for? SE's?

Back 48

Use = Pain

SE = Lowers seizure threshold, serotonin uptake syndrome

Front 49

Dextromethorphan use?

Back 49

Anti-tussive

Front 50

What do the withdrawal symptoms from opioids depend on?

Back 50

Strength of opioid

Front 51

When does tolerance from an opioid begin?

Back 51

After the first dose

Minimize tolerance by giving smaller doses with longer intervals between dosing

Front 52

T/F: Physical dependence develops as tolerance develops

Back 52

TRUE

Front 53

What are the withdrawal symptoms seen with opioids?

Back 53

Rhinorrhea, lacrimation, yawning, chill, goosebumps, hyperventilation, hyperthermia, mydriasis, muscular aches, V/D, Anxiety, hostility

# and severity depend on degree of dependence

Front 54

T/F: The longer the half life of the drug, the longer time it takes to reach withdrawal symptoms

Back 54

TRUE

Front 55

How do we prevent dependence on opioids?

Back 55

Establish therapeutic goal before starting therapy, once effective dose is established, limit dose to this level, Look at other options, Evaluate frequently

Front 56

In what pt. populations should we need to watch use of opioids?

Back 56

Preggos, impaired hepatic function, endocrine disease, head injuries, impaired pulmonary function