Ch 6 Opiods
Terms in this set (49)
All of these terms refer to analgesic drugs that affect the central nervous system
One method of classifying opioids is by their mechanism of action at the receptor sites. Agents that act on the same receptor sites are most likely to be cross-allergenic.
One method of classifying opioids is by their mechanism of action at the receptor sites, as agonists, mixed opioids, and antagonists. The second statement is false because cross-allergenicity is more likely to occur in drugs with a similar chemical structure.
Which opioid is considered the prototype (i.e., drug against which all other opioids are measured)?
All are pharmacologic actions of opioids
-Sedation and euphoria
-Decrease intestinal tract motility
The opioids are linked to hepatic, renal, and hematologic tissue damage. The adverse effects of the opioids are extensions of their pharmacologic effects, which is proportional to their analgesic strength.
The first statement is false; the second statement is true. The opioids are unique in that they do not directly damage the liver, kidneys, and other tissues. Their adverse effects are extensions of their pharmacologic effect; the stronger the agent is, the more adverse effects will occur, such as depression of the central nervous system, causing coma or death in large doses of morphine.
What is the usual cause of death in opioid overdose?
Opioids mimic the action of which endogenous substances by binding to these naturally occurring receptor sites
Enkephalins, endorphins, and dynorphins
Patients who are given analgesic doses of opioids frequently suffer from nausea and vomiting caused by the stimulation of the chemoreceptor trigger zone in the brain. How can this adverse effect be reduced?
-By taking the medication with a meal
-By discouraging movement or ambulation
Naloxone (Narcan) is an example of
Ms Jones, in her 37th week of pregnancy, is being treated at a methadone clinic for her heroin addiction. If she goes into labor and her baby is born, which effect would her opioid use have on her baby?
Fetal respiratory depression and withdrawal symptoms
Which route of administration will reduce the systemic distribution of opioids?
Tolerance does not develop to which effects of opioids?
Miosis and constipation
Which factors determines the addiction potential of opioids?
Potency of the analgesic and frequency of use
"Shoppers" are addicts who try to use dentists or physicians who will prescribe their drug of choice. Shoppers are usually willing to try any opioid or controlled substance the physician is willing to provide.
The first statement is true; the second statement is false. "Shoppers" are addicts who try to use dentists or physicians who will prescribe their drug of choice. Shoppers are usually specific about the drug they want, and they may claim allergies or lack of effectiveness of medications that the physician wishes to prescribe.
What is the largest group of opioids?
Differences in action of different opioids in tolerance to pain may be the result of variations in the endogenous levels of the neurotransmitters. Differences in the action of different opioids at these and other specific receptors explain some of the variations among the different opioids adverse reactions.
Both are true
Which statements are correct concerning opioid receptors?
-Stimulation of μ-receptors produces analgesia.
-The κ-receptor is responsible for dysphoria.
-Naloxone is an antagonist at the three receptor sites.
-Morphine has no effect on the κ-receptor.
Which routes of absorption can be used with opioids?
-Absorbed through the mucous membranes of the mouth, nose, and lung
What is the major route of metabolism for the opioids?
Codeine has all effects in usual therapeutic doses except which of the following?
Which statements are correct concerning depression of the respiratory center by opioids?
-Respiratory depression is dose related.
-Opioids decrease the sensitivity of the brainstem to carbon dioxide.
-Opioids decrease the rate and depth of breathing.
-In elderly adults or debilitated persons, the usual therapeutic dose can cause significant reductions in pulmonary ventilation.
Patients with which condition are least sensitive to the respiratory depression induced by opioids?
Nausea and vomiting with analgesic doses of opioids is caused by which of the following?
-Direct stimulation of chemoreceptor trigger zone in the medulla
Small doses of even weak opioids often cause constipation. With continued administration, tolerance will develop to this effect.
The first statement is true; the second statement is false. Small doses of even weak opioids often cause constipation. The duration of constipation with opioids outlasts their analgesic effect, and even with continued administration, tolerance does not develop to this effect.
Opioid abuse or overdose can often be diagnosed by which sign?
Myosis (pinpoint pupils)
Large doses of the opioids have which effects on the cardiovascular system?
-Postural hypotension, syncope
-Stimulation of vagus nerve
Why would a patient who is taking opioids develop a runny nose and itchy eyes?
Because of the release of histamine
The rate of development of tolerance and addiction is related to the strength of the opioid and its frequency and length of use. Addiction to opioid analgesics is a common problem when they are used to treat dental-related pain.
The first statement is true; the second statement is false. The degree of tolerance and addiction potential of opioids is proportional to their analgesic strength and frequency and duration of use. Because the duration of use in dentistry is usually short, addiction or tolerance is not usually a problem.
Opioid withdrawal includes all signs and symptoms
-Nausea and vomiting
-Tremors and chills
-Yawning, lacrimation, perspiration, and rhinorrhea
Which opioid is frequently used to help patients discontinue opioid use and is used both short term and long term for maintenance?
Opioids should be used with caution with other central nervous system depressants. The respiratory depression produced by the opioids is additive with that produced by other central nervous system depressants.
Both are true
The patient states that he is allergic to morphine. Which other opioid would be safe to administer to this patient?
What is the most commonly used opioid in dentistry?
How much codeine is added to acetaminophen for the prescription medication Tylenol #3?
All of the statements are true regarding codeine except which of the following?
Codeine is so effective that it is the drug of choice for dental inflammatory pain.
Meperidine (Demerol) is a good choice for oral use because it has a long duration of action and few drug interactions.
Both statements are false. Meperidine (Demerol) has a rapid onset but a short duration of action. There are drug interactions among meperidine and Monoamine oxidase inhibitors (MAOIs) and phenothiazines, making it a poor choice for controlling oral pain.
Which statement is correct regarding the opioid hydromorphone (Dilaudid)?
- It is reserved for management of severe pain
-It is favored by addicts because of its strength.
Methadone (Dolophine) has all of these advantages over morphine or hydrocodone except which of the following?
Great risk for death and life-threatening changes in respiration and heart rate
Which opioid family is most commonly used perioperatively or during general anesthesia?
Naloxone (Narcan) is an opioid antagonist that is active parenterally. If given to an addict who has overdosed, large doses must be administered to counteract the opioid-induced respiratory depression.
The first statement is true; the second statement is false. Naloxone will reverse opioid-induced respiratory depression. However, small doses must be carefully titrated or opioid withdrawal may be produced.
Tramadol (Ultra) is classified as a pure opioid agonist that binds with the κ-receptor and the δ-receptor.
Both statements are false. Tramadol (Ultra) is unique in its classification as an analgesic. It has an opioid agonist action but also inhibits the reuptake of norepinephrine and serotonin, modifying the ascending pain pathways. It has some, but not all, of the properties of an opioid because it does not affect the κ receptor and the δ receptors, but it binds with the μ receptor.
Opiates vs Opiods
Opiate- poppy derived
Opiods- chemically made
Common opioid antagonists
(Naloxone)Narcan, (Nalmefene) Revex,-Reversal
(Naltrexone) Re Viat, Vivitrol-Used for management once clean(also used for alcoholics)
Unique analgesic w/ an interesting mechanism of action.
Inhibits the re-uptake of norepinephrine and serotonin.
Lack of addiction potential questionable.
Hydrocodone, Hydrocodone ER
Oxycodone + aspirin
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