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43 Cards in this Set
- Front
- Back
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How do opioids act centrally?
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they block the emotional response to pain
block identification and localisation of pain block autonomic response |
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what are the mu opioid receptors responsible for?
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analgesia
respiratory depression euphoria sedation parasympathetic stimulation |
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what are the kappa opioid receptors responsible for?
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spinal analgesia
dysphoria/sedation miosis |
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what are the sigma opioid receptors responsible for?
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dysphoria
hallucinationa |
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what are the delta opioid receptors responsible for?
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various subclinical effects
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what is the order of CNS effects seen w/ opioid use?
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-analgesia and reduced affective response to pain
-euphoria -sedation --> --> --> narcosis -respiratory depression |
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what effects of opioids can be seen w/ fast administration?
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euphoria
nausea/vomitus - chemoreceptor trigger zone |
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what are the cardiovascular effects of opioids?
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some bradycardia
orthostatic hypotension |
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what are the GI tract effects of opioids?
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increased smooth muscle tone
increased sphincter tone antisecretory proabsorptive |
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what are the genitourinary effects of opioids?
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increased smooth muscle tone in bladder and urether
increased tone of bladder sphincter |
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when to use opioids?
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analgesia
anesthesia acute pulmonary edema cough diarrhea |
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what is the gold standard opioid?
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morphine
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what is morphine's duration of action?
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3-5h
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what is meperidine's duration of action?
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2-3h
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what is fentanyl's duration of action?
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20-30min
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what is fentanyls duration of action?
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20-30 min
9h |
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what is methadone's duration of action?
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25h
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what are the partial opioid agonists?
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tramadol
nalbuphine |
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what are the opioid antagonists?
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naloxone 1-2h
naltrexone 48h |
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what are the antitussive opioiods?
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dextrometophane
levopropoxyphane |
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what antidiarrheal is an opioid?
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loperamide
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when is apomorphine used?
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-adjunct therapy of parkinson's
-powerful emetic -alternative med, tx of addiction |
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what is the PD of apomorphine?
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centrally acting dopaminergic drug
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how is apomorphine administered?
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sc injection, injection pen
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what is the goal of treatment in acute pain?
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reduce pain to tolerable levels
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what is the onset of analgesia in acute pain?
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quick onset is important
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what is the duration of analgesia in acute pain?
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adjusted to clinical situation
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is sedation used in acute pain?
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yes, it may sometimes be helpful
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what are the adverse effects relevant to acute pain control?
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relevant only in cases of predisposition
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what is the goal of treatment in chronic pain?
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ensure normal quality of life
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what is the onset of analgesia in chronic pain? and the duration of analgesia?
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continuous
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is sedation wanted in the setting of chronic pain?
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no
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when are adverse effects of pain control relevant in chronic pain
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always
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what are the WHO recommendations of pain control?
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1- NSAIDS
2- partial opioid agonists plus NSAID 3- strong opioid plus NSAID |
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what is the only injectable NSAID?
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ketorlac
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what are the adverse effects of opioids?
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constipation
urinary retention |
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how is constipation associated w/ opioid use managed?
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laxatives
alvimopan |
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how is urinary retention associated w/ opioid use managed?
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muscarinic drugs
alpha blockers |
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what are adverse transient effects of opioid use?
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nausea/emesis
prutitus dizziness euphoria/dysphoria/confusion respiratory depression |
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how do opioids induce respiratory depression?
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direct depression of respiratory center neurons
sedation, anesthesia |
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how do opioids induce urinary retention?
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relaxation of detrusor and constriction of sphincter
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what will aggrevate urinary retention in opioid use?
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anticholinergics
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how is urinary retention treated?
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-increase detrusor tone w/:
parasympathomimetics, carbachol, betanechol -relax sphincter tone w/: alpha1 blockers, prazosin, terazosin |
