Term
| what are the 3 types of opiod receptor |
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Definition
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Term
| Name the endogenous opiods |
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Definition
Enkelphalin Dynorphin Beta-Endorphin |
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Term
| Where is Enkephalin distributed |
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Definition
| Brain, spinal cord, adrenal medulla and GI |
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Term
| Which receptors does Enkephalin bind too? |
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Definition
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Term
| Which receptors does Dynorphin bind to |
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Definition
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Term
| What's the distribution of Dynorphin |
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Definition
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Term
| Where would you find beta endorphin |
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Definition
| Cell bodies in the intermediate lob of the pituitary and the hypothalamus |
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Term
| Beta-endorphin is released due to _____? Which receptors does it bind to |
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Definition
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Term
| Name the factors regulated by MU |
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Definition
Analgesia Sedation Miosis Euphoria Constipation Respiratory distress Nausea/vomiting Pruritius |
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Term
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Definition
Sedation Miosis Analgesia diuresis dysphoria psychotomimetic effect |
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Term
| delta receptors regulate what? |
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Definition
Analgesia Emotion Reward Seizures |
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Term
| Opiods as a analgesic act on 3 locations, what are they |
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Definition
Central or supraspinal Spinal Peripheral |
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Term
| When an opiod acts as an analgesic on the supraspinal, what does it activate? |
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Definition
| Activation of descending pain inhibitory pathways |
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Term
| What's the mechanism of action of an opiod on the spinal cord |
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Definition
| Inhibits the Dorsal horn pain transmission neurons |
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Term
| Where are the opiod receptors located in the periphery |
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Definition
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Term
| What's the effect of opiods on respiration |
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Definition
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Term
| How do opiods decrease respiration |
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Definition
Decrease the response of the brainstem respiratory centers to carbon dioxide tension Decrease pontine and medullary centers that regulate respiratory frequenceReduce TV and respiratory rate |
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Term
| How do opiods suppress cough |
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Definition
| Depresses the cough reflex in the brainstem |
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Term
| How do opiods cause nausea and vomiting |
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Definition
| Stimluate chemo receptor zones in the medulla |
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Term
| Miosis due to opiods occurs because |
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Definition
| Pupillary constriction due to central effect on CN III |
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Term
| What is opiods effect on the GI tract |
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Definition
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Term
| How do opiods cause constipatoin |
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Definition
increase smooth muscle tone decrease propulsive motility decrease gastric acid, pancreatic, biliary and intestinal secretion |
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Term
| What is pruitis? do opiods cause this? |
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Definition
| pruitis is caused by opiods and it is flushing and warming of the skin also sweating and itching |
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Term
| What are opiod effects on the CVS |
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Definition
Histamine release leads to peripheral vasodilation Orthostatic hypotension Cerebral vasodilation secondary to respiratory depression |
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Term
| What are signs of acute opiod toxicity |
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Definition
1. stupor, miosis and depressed respiration 2. Coma follows and BP falls 3. Puppillary dilation, shock and death |
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Term
| Morphine acts primarly on what receptor? |
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Definition
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Term
| How is morphine metabolized |
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Definition
| glucuronidation in the liver |
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Term
| What is the active form of morphine |
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Definition
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Term
| How is morphine eliminated |
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Definition
| the conjugated form is eliminated by the kidney |
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Term
| what are the side effects of morphine |
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Definition
1. nausea & vomiting 2. Sedation/dizziness, mental clouding 3. Flush of the face and neck 4. Pruritis 5. Postural hypotension |
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Term
| How would you treat the mental status change from morphine |
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Definition
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Term
| What are the contraindiction for morphine |
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Definition
1. Compromised respiratory function 2. Kidney disease 3. Liver disease 4. Head trauma |
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Term
| At what dose is codeine used as a antitussive? |
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Definition
|
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Term
| what are the adverse effects of codeine |
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Definition
1. Low incidence of nausea, dizziness, sedation & constipation |
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Term
| Codeine has a ___ dependence |
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Definition
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Term
| what would you use codeine for? |
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Definition
1. Oral analgesic & antitussive 2. Mild and moderate pain |
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Term
| Heroin is more ____ soluble than morphine and is metabolized to ______ |
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Definition
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Term
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Definition
1. cough 2. Mild to moderate pain |
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Term
| Oxycodone is equipotent to |
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Definition
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Term
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Definition
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Term
| Dihydrocodeine is used for |
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Definition
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Term
| Dihydrocodeine is formualted w/ |
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Definition
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Term
| Hydromorphone has a high ______ liability |
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Definition
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Term
| Hydromorphine is more ______ than morphine |
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Definition
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Term
| When should you give hydromorphine to a patient |
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Definition
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Term
| The metabolite form of Meperidine produces |
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Definition
| CNS excitation that leads to tremors and convulsion |
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Term
| What's the MOA of merperidine |
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Definition
| Mu receptor agaonist and some anti-muscarinic properties |
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Term
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Definition
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Term
| What advantages does methadone have over morphine |
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Definition
| Equipotent w/ greater oral availability |
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Term
| Methadone acts on what receptors |
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Definition
| It's a Mu agonist and a NMDA antagonist |
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Term
| What do you use to treat heroin dependency |
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Definition
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Term
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Definition
Moderate to severe pain Treament of heroin dependency |
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Term
| Is propoxyphene a CNS stimulant? |
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Definition
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Term
|
Definition
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Term
| When would you use Fentanyl, Sufenanyl and Alfentanil |
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Definition
Supplement during GA Provides CV stability during surgery Good for short procedures |
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Term
____ is 100x more potent than morphine _____ is 10x more potent than fentanyl |
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Definition
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Term
| What is the definition of a Mixed Opiod receptor |
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Definition
| Possess both opiod receptor agonist and antagonist |
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Term
| What advantages do mixed opioids have |
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Definition
Less respiratory depression Lower abuse potential |
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Term
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Definition
1. Pentazocine 2. Butorphanol 3. Buprenorphine 4. Nalbuphine |
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Term
| Which receptors do Pentazocine bind to |
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Definition
1. Kappa agonist 2. Weak mu antagonist |
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Term
| Pentazocine is metabolized by |
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Definition
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Term
| Pentazocine can have what effect in an opioid dependent person |
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Definition
| Can percipitate in abstience syndrome |
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Term
| What advantage does Pentazocine have over morphine |
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Definition
| Can not antagonized morphine induced respiratory depression |
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Term
| What are the adverse effects of Pentazocine |
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Definition
1. conspitation, dizziness
2. Psychotomimetic effefcts
3. Increase HR and BP |
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Term
| Butorphanol is a agonist at which receptor. How about a weak agonist |
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Definition
| Kappa agonist and a weak mu agonist |
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Term
| Butorphanol is used when? |
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Definition
Moderate to severe pain
Migraines |
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Term
| What is the adverse effect of Butorphanol |
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Definition
| Dysphoria due to kappa agonist |
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Term
| What kind of agonist is Buprenorphine |
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Definition
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Term
| Buprenorphine can prevent _____ w/draw |
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Definition
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Term
| When do you use buprenorphine |
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Definition
Moderate to severe pain
Treatment of heroin dependence |
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Term
| Nalbuphine is an agonist which receptors and an antagonist at |
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Definition
Kappa receptor agonist
Mu receptor antagoinst |
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Term
| Can Nalbuphine precepitiate withdraw in opiod dependent person |
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Definition
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Term
| What are the adverse effects of Nalbuphine |
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Definition
Sedation, seating and headace
dysphoria at high doses |
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Term
| What's the MOA of Tramadol |
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Definition
weak mu agonist
Inhibits uptake of NE and 5-HT |
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Term
| when would you use Tramadol. What are it's adverse effect |
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Definition
Moderate pain
Nausea, constipation |
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Term
| Diphenoxylate and Loperamide are used for |
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Definition
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Term
| Opioid receptor antagonist have a high affinity for which receptor? |
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Definition
| Mu followed by kappa and delta |
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Term
| would you give Naloxone orally? |
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Definition
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Term
|
Definition
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Term
| Naltrexone has a _____ duration of action |
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Definition
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Term
| Naltrexone is used as an adjunct for |
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Definition
| treatment of Heroin and alcoholism |
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Term
| What adverse reactions do opiods have? Why don't you want to give opiods when they're taking these drugs |
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Definition
Antipsychotics, tricyclic antidepressants and sedative-hypnotics
Can lead to greater respiratory depression and orthostatic hypotension |
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Term
| Do you want to give opiods to a person on a local anesthetic? |
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Definition
| No, supra-additive toxicity can happen |
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Term
| If you give _____ and MAO I, it can result in severe reactions that include excitation, ridigity, HTN and death |
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Definition
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Term
| Do you want to use opioids in labor? |
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Definition
| No, it can cross the placental barrier and cause neonatal opioid depression |
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Term
| Would you use morphine in Acute pulmonary edema? Why? |
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Definition
| Yes, it's effective in relieving the dyspnea from pulmonary edema associated w/ LV failure |
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