Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
27 Cards in this Set
- Front
- Back
|
opioid ladder
|
step 1 - pain ~ asprin
step 2 - persistant pain/increase ~ codeine (weak opioid) step 3 - severe pain ~ morpheine (Strong opioid) |
|
|
drugs to know
|
morphine
fentanyl methadone meperdine buprenophrine tramadol |
|
|
natural ops
|
morphine
codeine |
|
|
semisyn ops
|
heroin
|
|
|
synthetic ops
|
fentanyl
methodone bupreophine |
|
|
ops ANTAG
|
naloxone (narcan)
naltreone (trexan) |
|
|
Use of ops
|
acute/chronic pain
~ acute pulm edema ~ cough (non-produc) ~ diarrhea ~ regional analgesics (epidural/subarach) |
|
|
MOA
|
5 receptors in the brain major ones
Mu1, kappa, Delta have ag/antag/and mix effects GCPR (Gi/go) presynap - mu receptors adencyl cyclase inhib post synp- hyperpol inhibt nuuronal act via GABA in the sub gelationsa |
|
|
Mu receptor
|
supraspinal analgisia
Visc SM phyiscal depend liability |
|
|
Kappa
|
spinal analgeisa
|
|
|
affinty of ops to receptors - Mu
|
all ag except codeine are strong
~ buprenopine (PAg) ~ both antag |
|
|
effects on organs
|
CNS
~ N/V ~ miosis ~ resp depression ~ polikothermia Periph effects ~ decreased GI ~ vasodilation/ inhib baroreceptors ~ decreaesd CRF and GnRH ~ increaesd tone of detrusor/spintcter (bladder) |
|
|
MORPHINE effects
|
decreases presyn NE release in locus Cer by acting on Mu receptors - over time up reg of NE post syn receptors
w/ withdrawl...~ ADERNERGIC STORM! no real tolerance to vomiting, resp depression, miosis |
|
|
Analgesic ~ morphine
|
STRONGEST
~ all types of pain ~ dull pain relieved more then sharp ~ nociceptive >> neuropathic (damaged neurals) ~ moder. affec on pain threshold ~ releive discomfort/suffering |
|
|
morph - MOA
|
inhib sub P (excite) in spinal cord
- inhib of nociep transmission - activation of bulbospinal (inhibit pain perception) EFFECTS ~ feel foggy/detached ~ euphoria ~ kick/thrill in tummy ~ decrease sex, hunger, thrist ~ drowsy CVS ~ arteriola/venous DIALATION - histamine release - hypercapina (due to resp depression) - DEPRESSION of baroceptors ~ can cause hypotension |
|
|
moprh- GI
|
~ increase in tone
~ decrease in propulsive contractions ~ N/V |
|
|
morph - resp
|
~ all phases of resp activity depressed
~ reduced resp to Co2 in brain ~ pons/medulla depressed ~ broncoconstrtion ~ depress in cough reflex |
|
|
morph - other effects
|
indirectly inhibits gaba in some CNS neurons - excititory
decreased PIH, CRH, GnRH incread prolactin/GH depression of IMMUNE w/ LT use |
|
|
morph - pharmokinetics
|
biotransformed w/ gluconronic A
M-6-glucuronide ~ ACTIVE (longer t1/2 then morphine) - excerted by kidney |
|
|
Fentanyl
|
potent then morph
~ maintain cardiac stab (minimal vaso D) ~ maintain gen anestheisa ~ can stay in lipid tissues...leech out later |
|
|
meperidine & congeners
|
mu/kappa ag
~ less effect on smooth musc ~ more freq CNS excite ~ stimulent on utuerus |
|
|
loperamide
|
excerts only constp effect ~ unless highdose then op effect
|
|
|
pentazocine
|
kappa/siggma (weak mu)
~ increase BP/hr ~ less constp/vomit |
|
|
bupreorphine
|
partial mu
~ dissoc slow from receptors ~ longer duration ~ lower dependence liability |
|
|
tramadol
|
syn to active metabolite
~ good for neuropathic pain MOA ~ ne and 5ht reuptake blocker, dont use with SSRI's ~ treat labor pain ~ less neonatal resp depression ~ lowers seizure threshhold |
|
|
opiod resistance pains
|
phantom limb
skeletal m spasm tension headaches increase ICP |
|
|
contra indications
|
respitory is decreased
impaired liver/kidney Crohn's, constipation prostatic hypertrop |
