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opioids

Terms in this set (80)

morphine codeine group includes
hydropmorphone(Dilaudid), Hydrocodone(Vicodin), Dihydrocodeine(synalgos-Dc), Oxycodone(Percodan, Percocet, Tylox)
if someone is allergic to codeine they shouldnt be given
morphine, hydromorphone, hydrocodone, Dihydrocodeine, Oxycodone
Methadone groups included
Methadone(Dolophine), Propoxyphene(Darvon)
Morphinan gorups included
Butorphanol(Stadol), Mentaocine (talwin-nx)
Meperidine
Meperidien(Demerol), Fentanyl(Sublimaze), Diphenoxylate(Lomotil), Loperamide(Imodium)
other
Buprenorphine(Buprenex)
Opiod agonist
Morphine, codeine
Mixed opioids, agonist antagonist
Pentazocine
Mixed opioids, partial agonist
buprenophrine
antagonist
Naloxone
Mechanism of action of opiods
bind to receptors in CNS and spinal cord, producign an altered perception reaction to pain
absorption
from the lungs and nasal and orac mucosa, through mcous membranes of nose and intact skin, such as butorphanol(Stadol) spray

Transdermal patch fentanyl(Duragesic)
distributions after absopriton
first pass metabolisn in liver or intestinal cell wall, 2/3rds of coeine orally reaches systemic circulation
metabolism
conugation with glucuronic acid in liver, lasts 4-6 hours
excretion
extreted by kidneys, glomerular filtration
onset of opioids
within 1 hour
is a opdioid agonist
morphine
which drug raises pain threshold and affect the cerbral cortex to depress reaction to pain, both m and k receptors are involved
codeien
reactions of opoids
sedationa nd euphoria, cough suppression by depressing cough center in medula, slow down parastalsis in intestines, slow down diarrhea.
which odpioid like agent withouth analgesic property is used to treat diarrhea
diphenoxylate(Lomotil)
adverse reaction
damanges are due to extension of pharmocologic effects
in pharmacologic effects, adverse reactions are directly proportional to their
anaglesic strength
odpio analgesic agonists depress
respiratory center in DOSE related manner
what is the cause of death in opioid overdoee
respiratory arrest
which patient should not use opioids
head injuries, hypothyroidism
analgesic doses of opiods often produce
nausea and vomiting, constimpation
Miosis
pinpoint pupils, caused by opioid overdose
opiod act as antidiuretic, prevent release of ADH from pituitary gland, problem with paitns with
prostatic hypertrophy
cardiovascualr effects of opiods
cause postural hypOtension, bradycardia, and syncope
opioids can also cause biliary tract constriction
causing pain with gallstones, not good for patients passing gallstones
opioids caause rashes and itchness because
release histamine
the degree of addiction potentiaon of opioids is proportional to their
analgesic strength
which drug should be used to control dental pain in an addict
NSAIDS
which drug is used to treat opioid overdose
antagonist, naloxone
the symptoms of withdrawal
yawning, lacrimation, perspiration, rhinorrhea, irritability, nausea, vomting, tachycardia, tremors, and chills
contraindication and cautions in opioids use with alcoholics or addict
greater potential for abuse
contraindication and cautions in opioid use with head injury
can increase itnracranial pressure
contraindication and cautions in opioid use with chronic pain
addiction potential limits, duration
C & C in Opioid use with respiratory disease
respiratory depression can occur
C & C opioid use with pregnancy, nursing, nausea, and constipation
respiratory depression near term, watch infant additive nausea, exacerbates or produces constipation
four general methods for treating opioid addiction
substituting equivalent amoutn of an oral opioid, methadone for the injectable form that the addict had ben using heroin and then with oral form

cold turkey, then use penhothiazines, clonidine, or benzodiazepines to reduce symptoms

high dose of methadone,

administer long lasting antagonist, naltrexone(Trexan
no treatment is successful in all patients
Prototype opioid agonist
morphine
use alone or combined with aspirin or acetaminphen to provide reliefe of moderate to seer pain
Oxycodone
oxycodone with aspirin
Percodan
oxycodone with acetaminophen
Percocet adn Tylox
General Opioids such as alcohol adn barbiturates potential outcome
addiditve CNS depression
specific opioids, propoxyphene, meperidine
carbamazepine, Barbiturates, Chlorpromazine, neuroleptics MAOIs
Carbamazepine toxicity, increase toxicity of mepridine, decrease BP CNS depression
Methadone

Barbiturates, Phentyoin Rifampin
severe reactions, excitiation, rigidity, increase BP, decrease Methadone levels, withdrawal
5mg of this drug and 500mg of acetominophen
hydrocodone
most commonly used opioid in dentstyr combined with acetaminophen
codeine
has a weak analgesic action compared with morphine, hydromorphone, hydrocodone, or even oxycodone
codeine
synthetic and is chemcially similar to methadone is
propoxyphene
intended for acute management of moderate to severe pain, 100mg equal to 10mg of morphine, inadequate pain control
meperidine
interacts with MAOIs and phenothiazines, poor choice for oral use, short duration of action
meperidine
reserved for management of sever pain, more potent than morphine and better absorbed orraly, favorite for addict because of its strenght
hydromorphone
primarily in treatment of opioid addicts, used to withdraw patients graducatlly or for methadone maintenance, longer duration of action, risk of dependence still exists
methadone
are short acting parenterally administered agonist opioid analgesics that are used perioperativly or during gernal anesthesia
Fentanyl(Duragesic, Sublimaze), sufentanil(Sufenta), and alfentanil(Alfenta)
mixed opioids, agonist-antagonist
pentazocine, butorphanol(Stadol)
only agonist-antagonist opioid available in oral form, produces CNS effects not unlike the opioid agonists, including analgesia, sedation and respiratory depression
pentazocine(Talwin)
adverse reaction of Talwin
sedation, dizziness, nausea, vomitng, headache
drug choice to treat pentazocine overdose is
naloxone
firt and only avialbie partial agonist is
buprenoprhine(Buprenex, Subutex supresses withrawals
essentiall pure opioid antagonist active parenterally
naloxone (Narcan)
use to treat agonisit or mixed opioid overdose
naxolone
another parenteral opioid antagonist use to reverse opioid oversdoes
nalmefene(Revex)
long acting orally effective opioid antagonist
naltrexone(ReVia, Vivitrol)
unique analgeix with itneresting mechanisms of action, inhibits reuptake of norepinephrine and serotinin, does not affect k or O receptros
tramadol(Ultram)
averse reaction fo tramadol
CNS efects, dizziness, somnolence, headache, stimulation, nausea, diarrhea, constiation and vomiting, palpitations, diaporeses, and seizures
receptors
Mu kappa sigma
receptor that causes respiratory depression, euphoria, dependence
mu receptor
receptro that causes miosis, sedation, spinal angalgesia
kappa
receptor that causes dysphoria, haluccinations, respiratory & motor stimulation
sigma
trade name for mepiridine
demerol
trade name for hydromoprhone
Dilaudid
trade name for propoxyphene
Darvan
agonist-antagonist
pentazocine Talwin
partial agonist
buprenorphine
antagonist
naxolone
which precipitates withdrawal symptoms, agonist-antagonist drug
pentazocine(Talwin)
which is the synthetic drug
meperidine(Demerol)
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