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Opioid Analgesics, Opioid Antagonists, and Non-Opioid Centrally Acting Analgesics Chp 28
Terms in this set (49)
are drugs that relieve pain without causing loss of consciousness
are the most effective analgesics available
There are three major classes of opioid receptors:
Designated mu, kappa, and delta
Morphine and other pure opioid agonists relieve pain by:
mimicking the actions of endogenous opioid peptides-primarily at mu receptors.
Opioid-induced sedation and euphoria can
complement pain relief.
Because opioids produce euphoria and other desirable subjective effects, they have a high liability for ____.
is the most serious adverse effect of the opioids
Other important adverse effects are
constipation, urinary retention, orthostatic hypotension, emesis, miosis, birth defects, and elevation of ICP.
Because of first-pass metabolism
oral doses of morphine must be larger than parenteral doses to produce equivalent analgesic effects
Because the blood-brain barrier is poorly developed in infants
these patients need smaller doses of opioids (adjusted for body weight) than do older children and adults.
With prolonged opioid use
tolerance develops to analgesia, euphoria, sedation, and respiratory depression, but not to constipation and miosis.
Cross-tolerance exists among the various opioid agonists, but not between
opioid agonists and general CNS depressants.
With prolonged opioid use, physical dependence
When would an abstinence syndrome occur?
if the opioid is abruptly withdrawn
In contrast to the withdrawal syndrome associated with general CNS depressants, the withdrawal syndrome associated with opioids, although unpleasant, is not _______________.
To minimize symptoms of abstinence
opioids should be withdrawn gradually
Precautions to opioid use include
pregnancy, labor and delivery, head injury, and decreased respiratory reserve
Patients taking opioids should avoid anticholinergic drugs (antihistamines, tricyclic antidepressants, atropine-like drugs) because
these drugs can exacerbate opioid-induced constipation and urinary retention.
Opioid overdose produces
a classic triad of signs: coma, respiratory depression, and pinpoint pupils
All strong opioid agonists are essentially equal to morphine with regard to
analgesia, abuse liability, and respiratory depression
Use of meperidine should be avoided so as to prevent
accumulation of normeperidine, a toxic metabolite.
like morphine, codeine and other moderate to strong opioid agonists produce
analgesia, sedation, euphoria, respiratory depression, constipation, urinary retention, cough suppression, and miosis.
These drugs differ from morphine in that they produce
less analgesia and respiratory depression and have a lower potential for abuse.
The combination of codeine with a non-opioid analgesic (aspirin, acetaminophen) produces greater
pain relief than can be achieved with either agent alone.
Most agonist-antagonist opioids act as agonists at ____ receptors and antagonists at ____ receptors.
1) kappa 2) mu
Pentazocine and other agonist-antagonist opioids produce
less analgesia than morphine and have a lower potential for abuse
With agonist-antagonist opioids, there is a ceiling to
If given to a patient who is physically dependent on pure opioid agonists, an agonist-antagonist will precipitate ____.
Pure opioid antagonists act as antagonists at
mu receptors and kappa receptors
Naloxone and other pure opioid antagonists can REVERSE
respiratory depression, coma, analgesia, and most other effects of pure opioid agonists.
The exception is __________________, which doesn't cross the blood-brain barrier.
Pure opioid antagonists are used primarily to treat
Two agents - ________________ and ______________- are used for opioid-induced constipation
methylnaltrexone and naloxegol
For opioid induced ileus
If administered in excessive dosage to an individual who is physically dependent on opioid agonists, _______________ will precipitate an immediate withdrawal reaction
Opioid dosage must be INDIVIDUALIZED. patients with a LOW tolerance to pain or with extremely painful conditions need what?
Patients with sharp, stabbing pain need higher doses than patients with
Older adults generally require ________________ than younger adults.
Neonates require higher or lower doses
As a rule, opioids should be administered in what type of schedule?
fixed schedule for the first 24 hours postoperatively (with supplemental doses for breakthrough pain) rather than PRN.
Most PCA devices are electronically controlled pumps
that can be activated by the patient to deliver a preset dose of opioid through an indwelling catheter.
Some PCA devices also deliver
a basal opioid infusion
PCA devices provide
steady plasma drug levels thereby, maintaining continuous pain control while avoiding unnecessary sedation and respiratory depression
Use of parenteral opioid during delivery can
suppress uterine contractions and cause respiratory depression in the neonate
Addiction is a primary chronic disease characterized by
an individual pathologically pursuing rewards and/or relief by substance use and other behaviors.
Physical dependence and _______________ are not the same.
Abuse is defined as
drug use that is inconsistent with medical or social norms
Because of excessive and inappropriate fears about addiction and abuse, provides frequently prescribe
less pain medication than patients need, and nurses frequently administer less medication than was prescribed.
Dispel your concerns about abuse and addiction, and give your patients the medication they need to
relieve suffering. That's what opioids are for, after all.
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