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63 Cards in this Set
- Front
- Back
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what are some opiod analgesics that are Strong (Full) Agonists
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Morphine (prototype)
Fentanyl Heroin Methadone Meperidine |
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what are opioid analgesics that are weak agonists
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Codeine
Hydrocodone Oxycodone (OxyContin, sustained release) Propoxyphene (caution) |
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what are opioid analgesics that are mixes agonist and antagonists
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Buprenorphine
Butorphanol Nalbuphine Pentazocine |
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what are antitussitives
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Codeine
Dextromethorphan |
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what are non opioid analgesics
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Acetaminophen, NSAIDs, & Selective COX-2 Inhibitors
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what are some opioid antagonists
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Naloxone
Naltrexone Nalmafene |
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what are some weak agonist. reuptake inhibitors
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Tramadol -(5-HT uptake blockade, NE uptake blockade, weak mu-receptor agonist) and Tapentadol -mu receptor agonist (?) & NE reuptake blocker
Antagonists |
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what should you do for pain if the cause can not be identified
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still treat agressively, but follow further pain symptoms
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what drug is the first line of choice for acute severe pain and why
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morphine bc it is as effective as other opioids with a similar adverse effect profile and comes in a large number of dosage forms.
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when do you use Buprenorphine (Buprenex), Nalbuphine (Nubain), Butorphanol (Stadol)
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when pt is allergic to merperidone and does not tolerate morphine
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when is meperidine used
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no unless pt has allergy to morphine, bc it has worse SEs than morphine and is highly ineffective orally
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what is fenadyl and when is it used
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a dermal patch may be as effective as sustained-release morphine but is difficult to titrate.
• advantage is Q72H dosing. • should likely be used only if patient has been stabilized on a regularly dosed opioid. |
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what are Alfentanil (Alfenta), Remifentanil (Ultiva), and Sufentanil (Sufenta) used for
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use during general anesthesia and monitored anesthesia care
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what is the top choice for post op pain
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morphine
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what do use use in post op when pt doesnt need reg dosing
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move to acetometaphen with codeine
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what is the only NSAID that is IV or IM
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ketoralac
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does clonidine supress general aches and opiod cravings
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noooopppe
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what can Administration of an opioid receptor antagonist in a subject physically dependent on opioids cause
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an explosive abstinence syndrome, i.e., antagonist-precipitated withdrawal. Signs and symptoms of withdrawal can be seen within 3 minutes of injecting an antagonist.
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when is morphine contraindicated
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patients with hypotension,
head injury, compromised respiratory function, renal and hepatic disease use with extreme caution, can cause respiratory depression in neonate. |
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what are the three major gastrointestinal effects of Aspirin,
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dyspepsia, occult blood loss, and active GI hemorrhage.
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____ has a much lower potential for GI irritation and bleeding complications and would be preferred agents in a patient with a history of GI bleeding.
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Celecoxib
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what does aspirin do to platlet aggregation
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inhibits it
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what are side effects of morphine that should be followed
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Mental clouding, sedation, decreased GI motility with constipation and respiratory depression
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what is oxycodon commonly used with
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aspirin (Percodan) or acetaminophen (Percocet).
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the term__ should never be used to replace dependence or tolerance
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addiction
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what is the method for treating opioid withdrawl and what is a specific drug that can be used
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short-acting opioid such as morphine (or heroin) to a long-acting one such as methadone. The mu opioid receptor antagonist naltrexoneapproved
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how is Buprenorphine taken?
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sublingually
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what is clonidine and what is it used for
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α2-adrenergic agonist that decreases symp outflow, decreases many of the autonomic–mediated symptoms of wdrawal such as nausea, vomiting, cramps, sweating, tachycardia, and hypertension.
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what is a downfall of fenydyl
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do no provide sufficient flexibility in dosing to manage rapidly changing pain. delay of 6-12 hours in onset of analgesia after placement of the patch. On removal , the fentanyl continues to release active drug for about another 8-12 hours.
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what pts is fenydyl best for
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cancer pt with chronic pain
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Intensity of pain is dramatically altered by
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the level of anxiety and the stress response related to the original insult.
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_____ is a term more legal than medical, referring to any substance producing stupor associated with analgesia (usually associated with derivatives of opium)
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narcotic
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what are three endogenous opioid peptide neurotransmitters
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Endorphins
Enkephalins Dynorphins |
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what do opioids do to signal transduction
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Inhibit cyclic AMP production
Open G-protein modulated K+ channels allowing K+ efflux from the cell and hyperpolarization, slow IPSP Reduce presynaptic Ca++ influx which inhibits neurotransmitter release, glutamate, Substance P (which mediates pain perception) |
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what are the main effects caused by opioid stim of K receptors
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dysphoria, psychotomimetic responses (disoriented or depersonalized feelings), less miosis and respiratory depression than mu agonists, analgesia
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what is the cause of death in opioid overdose
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resp depression
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what do opioids do to the pupils
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miosis
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why is miosis diagnostic of opioid development
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bc OD of most other drugs that cause resp dep cause dilation
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why are opiods contraindicated in pt with severe head injury
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respiratory depression and carbon dioxide retention, cerebral vessels dilate and increase the cerebrospinal fluid (CSF) pressure.
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what opioid has a high first pass metabolism
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morphine- especially oral
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is morphine highly addictive and abusable
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yes
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Partial agonists act as ____when given with a full agonist
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antagonists
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what is the main function of opioid agonist
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analgesia
mu OD- resp dep K OD- hallucinations |
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what is the main effect of opioid antagonist
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precipitate withdrawal symptoms in physically dependent individuals
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what drug is this mu effects seen starting with low doses; kappa effects at high dose
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cocaine
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what drug is thisrelatively pure mu; probably misclassified [a DEA Schedule-III agent]
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hydrocodone
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what opioid is a pure mu
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oxycodone
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what opioid antagonist is short acting and injected
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naloxone
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what opioid antagonist is long acting and oral
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naltrexone
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what drug percipitates withdrawal symptoms in opioid abusers
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naloxone
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tolerance to opioids does not occur to these symtpoms
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Miosis
Constipation |
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when does tolerance become clinically relevant
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2-3 weeks
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what is the primary triad of opioif overdose
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lethargy or coma
depressed respiration pinpoint pupils (normoxic) |
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opioid Relief from dyspnea associated with left ventricular failure may be due to:
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reduced perception of shortness of breath, anxiolytic effects
reduction in cardiac preload and afterload |
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what drug is the first line tx of pain assoc w acute MI
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morphine
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what two opioids can be used for cough suppression
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Dextromethorphan (no analgesia)
Codeine (low doses) |
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what opioids are used to treat diarrhea
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Loperamide (Imodium)
Diphenoxylate (+ atropine) (Lomotil) Difenoxin (+ atropine) (Motofen) |
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what opioid is 100 fold more potent than morphine,
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fenadyl- short acting and rapid onset
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what are side effects of meperidine
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seizures and resp dep
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what is meperidine used for
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acute pain esp obstetrics
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what is the major use of Buprenorphine
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opioid detox
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what drug is this: gets into brain more rapidly than morphine
More exaggerated euphoria Converted to morphine in the body but its effects last half as long |
heroin
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what drug is this: it causes euphoria and has a longer duration of action than morphine,Used as an analgesic
Used for controlled withdrawal of dependent abusers of heroin and morphine |
methadone
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