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65 Cards in this Set
- Front
- Back
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Opioids are used |
To control pain in patients where NSAIDS are contraindicated |
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Opioids mechanism of action |
Binds to receptors in the CNS and spinal cord. |
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Receptors are stimulated |
To varying degrees by individual opioids |
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Agonist |
Mophine, codeine |
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Agonist |
Mophine, codeine |
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Mixed opioids |
Sub group, agonist antagonist, partial agonist. Pentazocine, buprenorphine |
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Antagonist |
Naloxone |
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Opioids pharmacokinetics |
ADME Absorption Distribution Metabolism Excretion |
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ADME |
Absorption: opioids are usually absorbed well orally. Metabolism: occurs in the liver, duration of action is 4-6 hours |
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ADME |
Absorption: opioids are usually absorbed well orally. Metabolism: occurs in the liver, duration of action is 4-6 hours |
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Distribution of opioids |
Metabolized in liver reduces bioavailability. |
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ADME |
Absorption: opioids are usually absorbed well orally. Metabolism: occurs in the liver, duration of action is 4-6 hours |
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Distribution of opioids |
Metabolized in liver reduces bioavailability. |
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Excreation of opioids |
Excreted in urine |
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Analgesic opioid |
Is the most commonly used Morphine, oxycodone, oxymorphone, hydrocodone, extended release hydrocodone, Codeine Meperidine Hydromorphone Methadone Fentanyl family |
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Opioids uses |
Analgesic: Treatment of moderate-severe pain. Cough suppression: for non-productive cough GI hypomotility; treatment of diarrhea. Sedation: relieves anxiety and depresses CNS |
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The Prototype opioid |
Morphine |
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The Prototype opioid |
Morphine |
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Mophine is used parenterally |
To treat postoperative pain in hospitalized patients |
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The Prototype opioid |
Morphine |
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Mophine is used parenterally |
To treat postoperative pain in hospitalized patients |
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Morphine orally |
Treatment of terminal illness |
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Sustained release tablet morphine |
Outpatient use in terminally ill. |
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Oxycodone + Asprin |
Percodan |
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Oxycodone + Asprin |
Percodan |
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Oxycodone + acetaminophen |
Percocet & Tylox |
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Hydrocodone + ibuprofen |
Vicoprofen |
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Hydrocodone+ acetaminophen |
Vicodin |
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Hydrocodone types |
Hydromorphone Hydrocodone ER |
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Most common RX drug in dentistry |
Codeine, weak analgesic effects, better effects when combined with NSAIDs |
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Codeine+ APAP |
Tylenol #3 |
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Opioid analgesics used in dentistry |
Tylenol 3 Hydrocodone Combination APAP Vicodin Oxycodone Combination with APAP Percocet. |
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Adverse reaction from opioids |
GI effects Constipation Reduces GI motility Nausea Hypersensitivity reaction Dermatological reaction. |
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Opioids can cause |
Respiratory depression |
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Respirtory depression |
Causes death when overdose Vasodilation results in intracranial pressure Hypothyroidism Elderly have decreases pulmonary ventilation Mask CNS diagnostic symptoms Reduced ventilation produces vasodilation Hyperthyroidism |
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When opioids are taken with antidepressants |
It increases the risk of respiratory depression Md needs to decide if it is worth it. |
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Opioid contraindication |
Alcoholism Head injury Chronic pain Respiratory disease Pregnant Nursing Constipation |
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Opioid analgesic care consideration |
Addiction and dependence tolerance develops. Withdraw symptoms upon abrupt cessation Respiratory effect: respiratory depression leads to death from overdose. |
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Opioid contraindication |
Chronic respiratory disease Head injury Hepatic, renal function impairment. Prostatic hypertrophy constipation |
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Signs of overdose |
Pinpoint pupils Coma Respiratory depression |
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Signs of overdose |
Pinpoint pupils Coma Respiratory depression |
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How to treat overdose |
Antagonist : naloxone |
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Withdraw symptoms after abrupt stop |
Yawning Lacrimation Perspiration Rhinorrhea Goosebumps Irritability Vomiting and nausea Tachycardia |
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Withdraw symptoms after abrupt stop |
Yawning Lacrimation Perspiration Rhinorrhea Goosebumps Irritability Vomiting and nausea Tachycardia |
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Two signs of addiction |
Craving, loss of ability to control amount |
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Withdraw symptoms after abrupt stop |
Yawning Lacrimation Perspiration Rhinorrhea Goosebumps Irritability Vomiting and nausea Tachycardia |
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Two signs of addiction |
Craving, loss of ability to control amount |
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Chronic administration |
Tolerance occurs except to miosis and conscription Habituation Dependence |
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Withdraw symptoms after abrupt stop |
Yawning Lacrimation Perspiration Rhinorrhea Goosebumps Irritability Vomiting and nausea Tachycardia |
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Two signs of addiction |
Craving, loss of ability to control amount |
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Chronic administration |
Tolerance occurs except to miosis and conscription Habituation Dependence |
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Addiction |
Porportional to analgesic strength. Dependant on drugs ability to produce euphoria and reduce anxiety. Length of administration Development of tolerance related to strength and quality |
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Allergic reaction |
Skin rashes, urticaria, contact dermatitis Some brands are formulated with sodium bisulfate-be aware of sulfite hypersensitivity |
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Opioid drug interaction |
Increased risk of additive adverse effects Increased risk of CNS depression Increase respiratory desperation rates Increased risk of constipation Alcohol anti-anxiety drugs. |
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Agonist-antagonist opioids |
Pentazocine (talwin) oral Burtorphanol (stadol) nasal spray Butorphanol(bureaus) transdermal patch 50 mg pentazocine + 0.5 mg naloxone = street drug |
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Agonist-antagonist opioids |
Pentazocine (talwin) oral Burtorphanol (stadol) nasal spray Butorphanol(bureaus) transdermal patch 50 mg pentazocine + 0.5 mg naloxone = street drug |
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Partial agonist |
Buprenorphine (buprenorphine, subutex) Schedule 3 Oral and parental |
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Mixed opioids |
Naloxone(narcan) treating agonist or overdose Nalmefene (revex) reverse opioid overdose Naltrexone (Re, Via, Vivitrol) maintain opioid free state in detoxified, formerly opioid dependent patients. Used to manage alcohol abstinence. |
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Full agonist/ reuptake inhibitors |
Tapentadol: oral opioid receptors agonist and norepinephrine reuptake inhibitor Similar efficacy tp extended release oxycodone. Tramadol: analgesic that inhibits the reuptake of norepinephrine and serotonin, Son-in-law to codeine and acetaminophen |
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Analgesics account for how many rx |
40.2% for patients age 18-30 |
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General opioids mixed with alcohol or barbiturates |
Additional CNS depression |
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Propxyphene mixed with carbamazepine |
Carbamazepine toxicity |
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Meperidine mixed with Barbiturates, chlorpromazine, neuroleptic, monamine oxidase inhibitors. |
Toxicity of meperidine, increased BP, leading to CNS depression, severe reaction, excitation, rigidity, increased bp |
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Methadone, mixed with barbiturates, pheytoin, rifampin. |
Decrease lethadone levels, withdraw. |
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Dental hygiene considerations or opioids |
Conduct through med history Remind patients to not supplement with otc drugs Be aware of patient positioning Determine the contrindication or drug interaction Avoid use with other sedating drugs Be aware of signs of abuse Be aware of Nonopioid/ opioid combo. Patient should avoid making life changing decisions |
