1
Q
When and where was opium first referenced?
A
In 380 BCE by Theophrastus in a textbook on therapeutics
2
Q
Who isolated morphine from opium?
A
Seturner, a German pharmacist, in 1803, who discovered the pain relieving properties
3
Q
How much morphine does opium contain?
A
10% morphine
4
Q
What does the name morphine come from?
A
morpheus
5
Q
What is morphine used for?
A
to relieve pain of great intensity
6
Q
What else does opium contain?
A
0.5% Codeine (constituent of Tylenol-3)
7
Q
What is the Ebers papyrus?
A
A papyrus from 1550 BC intended to be a textbook of drug use for medical students
8
Q
What did the Ebers papyrus show?
A
good knowledge of purgatives such as Senna, which is still used today
9
Q
When were the earliest recorded drug experiment performed?
A
2700 BC in ancient china by the emperor Shen Nung
10
Q
What was the drug Ma Huang used for?
A
coughs, influenza, and fevers
11
Q
What did Ma Huang contain?
A
ephedrine
12
Q
What is Curare?
A
a plant derived drug used by indigenous peoples in the amazon
13
Q
How was curare used as a poison?
A
as a coat for arrow tips which caused paralysis in the voluntary muscles of an animal, eventually causing death by respiratory paralysis
14
Q
How was curare used as a drug?
A
as a surgical anesthetic allowing for muscle relaxation
15
Q
What is ergot?
A
a poisonous fungus that grows on the heads of rye during wet seasons
16
Q
How was ergot an issue?
A
It was ground together with the rye, resulting in epidemics from bread
17
Q
How did religion intertwine with therapy?
A
As traditional healers were both physicians and priest, resulting in influence by religion and magic
18
Q
How were intoxicating substances used by traditional healers?
A
in order to alter the state of consciousness and facilitate ommunication with gods
19
Q
What is peyote?
A
A cactus used to achieve a mystical state for spiritual and ritualistic use in mexico
20
Q
What is the active ingredient in peyote?
A
Mescaline, which causes hallucinations, a feeling of well-being, and distortion of perception similar to that experienced with LSD
21
Q
What is a drug?
A
Any substance received by a biological system that is not received for nutritive purposes that influences the biological function of the organism
22
Q
What was the era of chemical synthesis?
A
the 19th century
23
Q
What percentage of drugs are derived from plant sources?
A
25%
24
Q
What are the two major categories of drugs?
A
Drugs acting on the brain and drugs acting against infectious disease
25
What are drugs that act on the brain?
drugs that alter the normal chemical signalling in the brain
26
What is LSD?
lysergic acid diethylamide. A potent hallucinogen
27
How first synthesized LSD?
Albert Hoffman, a swiss pharmacologist trying to synthesize improved drugs based on ergot
28
What did the discovery of LSD support?
The idea that certain mental illnesses might be due to the production of potent substances in the brain
29
What did Paul ehrlich discover?
Complexes of arsenic and organic molecules called organoarsenicals selectively bound to parasites. This was applied to other infectious diseases and eventually led to a cure for syphillis
30
What did Gerhard Domagk discover?
Slugs drugs in 1930s germany
31
What are sulpha drugs?
The first successful synthetic drug for the treatment of bacterial disease
32
What was discovered by Alexander Fleming in the 1940s?
penicillin fro the treatment of gram positive bacterial disease
33
What was discovered by Selman Waksman in the 1950s?
streptomycin which was used to treat TB and G- disease
34
What are the five key steps of drug development?
basic research and drug discovery, preclinical trials, clinical trials, health Canada review and manufacturing, and post market surveillance and phase IV clinical trials
35
What is step 1 of basic research and discovery?
identification of the target
36
What goes on in step 1 of basic research and discovery?
a target could be a receptor, etc..
once a compound that binds well is identified, it will be studied to determine its pharmacological effects at the molecular, cellular, organ and whole animal level
37
What is step 2 in basic research and discovery of target/
studying the target
38
What goes on in step 2 of basic research and discovery of target?
if a compound shows promise, it is a lead compound and enters more detailed studies for safety and efficacy.
39
What are the two main categories of preclinical studies?
pharmacology and toxicology studies
40
What are pharmacology studies?
determine the detailed mechanism of action of the new drug
41
What are toxicology studies/
Determines the potential risks or harmful effects of the drug.
42
What will toxicology studies be performed to look at?
acute toxicity, chronic toxicity, and effects of reproductive, carcinogenic, and mutagenic potential
43
How long will toxicology studies take to complete?
They are expensive and will take up to 6 years
44
What are the three main steps that are required before a manufacturer can initiate clinical studies?
proof of safety, methodology, and investigation
45
What is proof of safety?
proof of safety and efficacy of the drug in several animal species must be submitted to government regulatory agencies ( health products and foods in Canada and the FDA in US)
46
What is methodology?
the methodology of the proposed clinical trials in humans is required
47
What is investigation?
The submission is evaluated by qualified scientists in the regulatory agency. If they are satisfied with the submission, permission will be given for highy qualified investigators to begin investigation in human
48
How many drugs typically make it to clinical trials and how many make it to phase 3?
generally 5-30 make it to clinical trials and 1 or 2 make it to phase 3
49
What do phase 1 clinical trials evaluate?
The absorption distribution, elimination and adverse effects of the new drug using one or two doses of the new drug to test tolerability
50
How many volunteers do phase 1 tests use?
20-80 healthy volunteers
51
What do phase 2 clinical trials evaluate?
Whether the drug is effective in treating the condition for which it is recommended
52
How many people do phase 2 clinical trials use?
100-500 with the disease
53
What are phase 3 clinical trials?
randomized control trials. the main studies used for the licensing and marketing of the drug
54
How many participants phase 3?
1000+
55
What is the goal of phase 3?
to determine how safe and effective the drug is compared to no treatment and current therapy
56
What is the duration of phase 3 clinical trials?
months to years
57
What is the location of phase 3 clinical trials?
centres in many cities
58
What is the cost of phase 3?
1-50 million dollars
59
What are the three larger stages of phase 3 clinical trials?
determining enrolment prior to the study
allocating participants to treatment groups and conducting the test
monitoring and analysing the results
60
What is the target population?
The group of patients for which the drug id intended
61
What is the study population?
A subset of the population that meets all required criteria
62
What are the two factors to determine when makes it into the study population?
inclusion/exclusion criteria and consent
63
What are inclusions/exclusion criteria?
characteristics of who can be included and who can't be included generally to eliminate variables other than the drug under study. common comorbidities however, are not excluded
64
What is consent?
A document written in non-scientific language that outlines the purpose of the study, the procedures, and all potential risks and benefits. This is reviewed by an independent institutional ethics review board and the participant can revoke consent at any time
65
How are most phase 3 studies conducted?
In a double blind manner where neither investigator, nor patient knows what they are assigned to
66
How is treatment allocation randomized?
by a computer generated system, sorting into experimental treatment or control to ensure that confounding variables are distributed equally and removes potential bias
67
What is the placebo?
no active drug, but appears identical. Usually leads to some relief as everyone responsds partly to the act of taking th edrug
68
What is the gold standard?
A drug that is accepted by the medical community as the best available. If a gold standard is available, that is what is used. If not, a placebo is used
69
What is an outcome in results?
Measurement of how much the drug worked in different patients in order to compare to placebo
70
How should outcome be measured?
objectively and reliabley. Ex. taking BP at same time of day by same person
71
What factors greatly influence the interpretation of a phase 3 clinical trial>
compliance, quality of life, and statistics
72
What is quality of life?
how the drug affects the life of the participants. hoped to be good, sometimes bad. considered the usefulness of the drug
73
What is compliance?
how well patients adhere to the regiment. can be as low as 50-60. Checked by counting how many drugs were unused or by checking if a nurse signed off on administration
74
What is statistics?
the measured outcome for the experimental drug that must be compared to the measured outcome for the control. drug using stats
75
What occurs after successful completion of initial phase 3 trials?
THe manufacturer will submit to the regulatory body a new drug application containing the details of the clinical trials to Health Canada. If deemed affective, approved,
76
What happens once the regulatory agency has reviewed the drug?
manufacturing can begin
77
How are generic and brand name selected?
a generic name is selected in preclinical development phase and a patent is applied for around the same time with the brand name, which will give the company exclusive marketing rights for 20 years. Usually only effective for 10-12 years after clinical trials conclude
78
What happens once the patent expires?
manufacturers can make copies of the original brand name drug and sell it under their own brand names
79
What is bio equivalence?
the original and generics will all contain the same active ingredients in the same amounts with usually same dosage to ensure they are just as effective
80
How is bioequivalence studied?
With a comparative bioavailability study, where blood levels after administration of both the original brand name drug and the new brand name drug under controlled conditions
81
What is phase 4?
post market surveillance where risks that are missed are noted
82
What factors must be looked at to assess drug action?
drug targets, drug response, efficacy and potency, therapeutic drugs
83
What are receptors?
A molecule or a sample of molecules located on the outside or inside of a cell that has a regulatory or functional role in the organism.
84
How are receptors normally activated?
By endogenous ligands, which are substances ordinarily found in the body, such as hormones and neurotransmitters
85
What does location of a receptor dictate?
How a drug will act and whether the response that results from the drug receptor interaction is beneficial or detrimental
86
What are examples of how drugs target non-specifically?
through chemical reactions or through physical chemical forces?
87
What is an example of a chemical reaction by a drug?
antacids neutralizing the stomach acid through simple acid base chemistyr
88
What is an example of a physical chemical force?
cholestyramine works by chemically binding bile acids, preventing reabsorption and increasing the elimination of bile salts that are used to make cholesterol
89
What are agonists?
Drugs that bind and stimulate the receptor
90
What are antagonists?
drugs that bind to but block the response at a receptor
91
What is dose response relationship?
THe intensity of pharmacological effects in proportion to it'd dose
92
What did the cannabis/alcohol study examine?
The effects of cannabis and alcohol on driving performance?
93
What was the methodology of the cannabis study?
subjects were given a dose of cannabis and asked to perform a simulated automobile driving task. The subjects were later given a dose of alcohol equivalent to 6 shots of whisky in a half-hour period and asked to perform the same task
94
What were the results of the study?
No significant impairment for cannabis. Significant impairment for alcohol. CAnnabis is safer than alcohol
95
What was the dosage of cannabis and alcohol?
cannabis: smoke until a social high which was validated by a previously determined minimum dose as well as a pulse rate measurement
alcohol: a dose required to produce a 0.10 BAC
96
Was the cannabis study a valid comparison?
No as the dosage between the drugs had a wide discrepancy
97
What other questions could be asked to properly state if alcohol is more or less harmful than cannabis?
what is the quantity consumed, what is the frequency of use, what are the user demographic, what are the environmental factoras
98
What response is observed at a low dose?
very little as not many receptors are impacted
99
What is observed at the threshold?
more and more receptors are activated until the desired response is seen. The number of receptors that need to be activated before an effect will be seen
100
What are therapeutic doses?
Once the threshold is reached, a small increase in dose will result in a large increase in responee
101
What is maximal effect?
Once maximal effect is reached, increased dosage yields no effect on the therapeutic responses
102
What does a dose response graph look like?
A concave down curve with dose on x and response on y. taking the log of dose yields a linear section
103
What is observed at low doses on the log dose scale?
low increase in response to low dose
104
What is observed in the therapeutic range?
Increase in dose is directly proportional to response. linear section
105
What is the ED50?
The dose that will result in 50% of the maximal effect
106
What is the maximal response?
Increases in dose offer no effect
107
What is efficacy?
the maximum pharmacological response that can be produced by a single drug in that biological system
108
What is potency?
The dose of a drug required to produce a response of a certain magnitude (usually ED50).
109
Which matters more clinically, efficacy or potency?
efficacy
110
What is therapeutic range?
the concentration in blood that produces a desirable response. ideally kept the concentration above the level that produces a desriable response and below the level that produces an unacceptable toxic response
111
What is pharmacokinetics?
A term that refers to the movement of a drug into, through, and out of the body
112
What processes occur after the administration of a drug?
absorption, distribution, metabolism, and excretion, which all control the concentration of the drug in the blood which then determines the concentration of the drug at the site of action
113
What are the three routes of administration?
topical, enteral, and parenteral
114
What are topical routes of administration?
application directly to a particular place on or in the body such as on the skin, through the skin, or inhalation
115
What is enteral administration?
administration via the GI tract either through mouth or aritficial opening. mouth, rectum, sublingual (under tongue) or buccal (cheek)
116
What is parenteral administration?
administration bypassing the GI tract such as IV, intramuscular, and subcutaneous
117
What are examples of conditions treated by topical treatment on the skin?
eczema, acne, and infections. some drugs applied to the skin can be absorbed and produce a systemic effect
118
Describe transdermal drug delivery
application of a drug to the skin for absorption into the general circulation for a systemic effect. nicotine pouches for example. This method is convenient, delivers steady, long term drug supply, and bypasses the enzymes of the GI tract. However, it can also cause physical irritation
119
Describe inhalation
rapid absorption by the lungs for both local and systemic affects. Gauseous anesthetics are an example of systemic, steroids are local. An advantage is that doses for local effects are small and avoid toxicity. A disadvantage is that the patient my not use the drug properly
120
What are the advantages of oral administration?
common, convenient and inexpensive, and non-invasive/self-administered
121
What are the disadvantages of oral administration?
variable absorption between patients due to differences in intestinal motility and disease
122
What are the advantages of rectal administration?
good for systemic or local effect, can be used in patients who are nauseated or vomiting or for comatose patients, and enzymes are bypassed
123
What are the disadvantages of rectal administration?
few medications are suitable for this, and absorption by the rectal mucosa I slow, incomplete and variable depending on the time the medication is retained
124
What are the advantages of sublingual and buccal administration?
enzymes of the stomach, intestines, and liver are bypassed
125
What are the disadvantages of sublingual and buccal administration?
not all drugs are adequately absorbed, and the drug may be swallowed which then behaves as if it was administered orally
126
What are the benefits of IV?
immediate effects and can be used for drugs that are typically poorly absorbed
127
What are the disadvantages of IV?
the response is irreversible meaning high risk for drug reactions, administration requires Human Resources such as nurses, and preparation must be sterile and free of pyrogens
128
Describe intramuscular
Drug is injected deep into the muscle, limiting volume to 2-3mL in an adult
129
Describe subcutaneous injection
deepest layer of skin and the route of administration allows for the modification of drug preparations to control the timing of the release of the drug from the injection site
130
Why does a good relationship not necessarily exist between dose administered and concentration of the drug in the blood?
Because not ll the drug necessarily ends up in the b lot during absorption
131
What is bioavailability?
The fraction of an administered drug that reaches the systemic circulation in an active form
132
What organ is topical administered to?
skin, eye, ear, nose, and lungs
133
What is the onset of action for topical?
rapid to slow depending on organ
134
What is the bioavailability of topical?
5-100%
135
Describe the onset of action in enteral?
mouth: slow (30m-1h)
rectum. slow and incomplete
sublingual: rapid (1-2m)
buccal: intermediate (3-4m)
136
Describe the bioavailability of enteral?
mouth: 5-100
rectum: 30-100
sublingual: 30-100
buccal: 30-100
137
Describe onset of action in parenteral?
veins: 15-30s
muscle: 10-20m
subcutaneous:12-30m
138
Describe the bioavailability of parenteral
IV: 100
IM: 75-100
SCT: 75-100
139
What is absorption?
The movement of a drug from the site of administration into the blood. The drug must be able to cross biological membranes
140
How do drugs cross biological membranes?
moving from the lumen to the interstitium. Diffusion through aqueous pores at lower molecular weights. Diffusion through lipid bilayer at high molecular weight. Active/Carrier transport also needed as well
141
What is distribution?
The movement of a drug from the blood to the site of action and other tissues. Drugs will reach all tissues and organs regardless of the target site. Concentration of drug at the sties of distribution are in equilibrium with its concentration in the blood. Rate of distribution from an organ depends on blood flow to that organ
142
What occurs after administration of thiopental?
the concentration of the drug in the blood Is high. the concentration of thiopental in the brain will be elevated and the patient will fall asleep. low muscle and fat distribution
143
What occurs in distribution of thiopental?
increased concentration in muscle and fat and decreased concentration in the blood. drug leaves brain and moves to the blood. patient awakens after 15-30 minutes
144
What occurs in the termination of the effect in thiopental?
drug hasn't removed from the body but has left the brain
145
What is drug metabolism?
THe conversion of a drug to different chemical compounds in order to eliminate it
146
What must a drug be to be eliminated by the kidneys?
water soluble. most drugs must be converted to more water soluble compounds. metabolism also occurs in the kidneys, intestines, lungs, skin, and most other organs
147
What are p450?
enzymes capable of bio transforming drugs. They are found in most tissues but are present in high concentrations. Many phase 1 bio transforming enzymes exist however the cytochrome p450 family is transforms the vast majority of clinically used drugs
148
What is a phase 1 reaction ?
A reaction to add or unmask a functional group on the drug to prepare it for the addition of a large water soluble molecule in the phase 2 reaction.
149
What are phase 2 reaction?
a large water soluble moiety is added such as glucuronic acid or sulphate to make the product water soluble for the kidney
150
What occurs after phase 2 reactions?
The water-soluble molecule is then excreted bye the kidneys
151
Why is the cytochrome family important to consider when taking many drugs?
the drugs may compete for the enzyme resulting in reduced biotransformation leading to toxic effects
152
What is drug excretion?
Moving the drug and it metabolites out of the body
153
What occurs in the kidney?
The majority of drugs are eliminated here. water soluble drugs are excreted in the urine while lipid soluble drugs are reabsorbed back into the blood
154
What occurs in the GI tract?
some drugs can be excreted from it after they undergo transformation in th eliver
155
What occurs in the lungs?
drugs that are volatile or in a gaseous form can be excreted by the lungs
156
What occurs in breast milk?
drugs are often found in breast milk. minor route of elimination however the infant can be exposed to a therapeutic or toxic dose
157
What occurs in saliva and sweat?
drugs can come out. Often the presence of drugs of misuse can be detected in the saliva of those who have taken it
158
What is the half-life of a drug?
time needed for the liver to remove half the drug from the body
159
What is variation in drug response?
recommended dose is the amount that will cause the desired effect in most people, however wide responses occur which is why dosage is variable
160
Why does variation in drug response occur?
genetic factors, environmental factors, disease stages, altered physiological states, presence of other drugs can all influence how the concentration in the blood changes and the response changes
161
How do genetic contribute to variation?
changes the recpetors and the manner of handling and elimination throw differences in enzymes
162
How does environment change drug response
Exposure to chemical can alter the up regulation or down regulation of enzymes . Example is alcohol which increases the amount of biotransformers
163
How do other disease states contribute to variation?
Alter the manner of handling. Ex. liver disease slows metabolism
164
How do altered physiological states affect variation?
things like age resulting in lower neural function, and liver and kidney function decreasing resulting in greater elimination. pregnancy also
165
How do other drugs impact variation>
affects the biological effec of a second drug
166
What can the toxic effects of drugs be divided into?
adverse effects, and drug-drug drug-food interactions
167
What is an adverse effect?
any effect produced by a drug in a patient that is not the intended effect
168
What is extension of therapeutic effect?
an adverse effect where there is too much drug in the blood
169
What are adverse effects unrelated to the main drug action?
effects that are not related to the intended pharmacological action such as nausea
170
What is an allergic reaction?
an adverse effect mediated by the immune system by antigen-antibody combination
171
What is withdrawal and addiction?
an adverse effect that is an unwanted physiological or physchological efffect
172
What is teratogenesis?
defects in the developing fetus
173
What is an adverse biotransformation reaction?
drug is converted to a reactive metabolite that can bind to tissue components and cause tissue or organ damage
174
Why might it be difficult to predict adverse drug reactions?
rarity of occurrence, length of usage, detectability in animals, and time period specificity?
175
What is rarity of occurrence?
a toxic reaction may be rare making it hard to notice in initial testing. Ex. chloramphenicol was used extensively before it was realized that it caused fatal bone marrow damage in 1:50000 patients
176
What is length of usage?
toxic reaction may only appear after prolonged use. Ex. streptomycin was not known to cause deafness at first
177
What is detectability in animals?
Effect may not have been detectable in animals. Ex. headache, insomnia, nausea, and mental disturbances were not readily picked up in animal testing
178
What is time period specificity?
toxic effect may be unique to a particular period in time. Ex. thalidomide caused abnormal limb growth in the fetus as we did not test on pregnant animals
179
What is the therapeutic index?
A measure of the safety of a drug. The ratio of the dose required to produce a therapeutic effect and the dose required to produce a toxic effect. The higher the index, the safer the drug.
180
What is TD50?
Toxic dose 50. The dose of a drug that is toxic in 50% of the population
181
What is ED50?
Effective dose 50. The dose that is effective in 50% of the population
182
What is a drug-drug interaction?
When one drug changes the pharmacological effect of a second drug
183
Describe the effect of drug-drug interaction in absorption?
a drug can increase intestinal movement, speeding up the passage of the second drug through the intestine, and therefore decreasing its absorption
184
Describe the effects of drug-drug interaction on metabolism?
a drug can block the inactivation of a second drug in the liver, increasing the blood level and the pharmacological effect of the second drug
185
Describe the effect of drug-drug interaction on secretion?
a drug can facilitate the excretion of a second drug by the kidney, decreasing the blood level and pharmacological effects of the second drug
186
What are drug-food interactions?
interactions involving the interference of food with drugs taken concurrently
187
What is tyramine?
a compound found in well-matured cheese capable of raising blood pressure and is broken down in the liver by the enzyme monoamine oxidase.
188
What happens if monoamine oxidase inhibiting antidepressants are taken concurrently with foods containing tyramine?
No breakdown of the tyramine and blood pressure increases will be expected
189
How does grapefruit affect absorption of certain drugs?
a component of grapefruit inhibits metabolizing agents in the GI tract resulting in greater absorption of the active drug. Results are higher blood concentrations possibly leading to overdose. No hospital in Ontario save
190
What is the cerebral cortex?
The largest part of the brain. very rich in neurons. Responsible for sensory and motor coordination, mental processes, intelligence, memory, vision, judgement, thought, speech, emotions, and consciousness. These neurons can be excited or depressed by degus
191
192
What is neuroplasticity?
The constant process of reshaping the connections between neurons
193
What are dendrites?
Short with highly complex branching patterns. Receiving site for incoming information through receptors on the dendritic membrane
194
What is the cell body?
The largest part of the neuron with the nucleus and the cytoplasm. Contains abundant prepackaged NTs which can be secreted
195
What is the axon?
A single fibre that extends from the cell body and ends at a synapse. carries info from the dendrite
196
What is the synapse?
The junction between two neurons. The area where the neurons axon ends and another neuron's dendrite or cell body begins
197
What is synaptic transmission?
The passage of a singnal from one neuron to another. Rapid and chemical in nature. Facilitated by neurotransmitter release and reception
198
How are neural transmissions terminated?
reuptake from the synaptic cleft by the presynaptic neuron. enzymatic breakdown of NT. Uptake of NT by an adjacent glial cell
199
How do drugs affect the synapse?
By either interrupting synaptic transmission or enhancing/facilitating it
200
What is gluatamate?
The primary excitatory NT in the CNS, found in almost all neurons. Acts on glutamatergic receptors. Neurons that release glutamate are called glutamatergic neurons and are important for learning
201
What is serotonin?
a NT where hyperactivity of the serotonergic system is involved in anxiety and hyperactivity is implicated in depression. Some CNS stimulants act by increasing the serotonin at the synpase
202
What are catecholamines?
dopamine and norepinephrine are two examples
203
What is dopamine?
dopaminergic pathways are involved in the control of some hormonal systems motor coordination, and motivation and reward. Alterations in these dopamine mediated motivation and reward systems are thought to be inveolded in addiction
204
What is norepinephrine?
Can bind to a large number of receptors types but two main classes are alpha and beta. Activation leads to ecitiation of the cell
205
What is acetylcholine?
produces and excitatory effect in the CNS. nicotinic receptors and muscarinic receptors bind acetylcholine
206
What are nicotinic receptors?
found in certain regions of the brain and are stimulated by acetylcholine or nicotine
207
What are muscarinic receptors?
found in many regions of the brain and are involved In learning, memory, and cognitive function stimulated by acetylcholine or muscarine. Drugs that block these receptors produce amnesia. loss of these cholinergic receptors is thought to be associated with Alzheimers disease
208
What is GABA?
gamme-amino-butyric acid is the primary inhibitory NT in the CNS. HABAergic neurons and GABA receptors are found in high concentration in the cerebral cortex, among other areas. Many CNS depressants enhance GABA function
209
What is the limbic system?
A region of the brain that integrates memory, emotion, and reward. Controls emotion and behaviour along with the hypothalamus. Contains the dopaminergic reward centres
210
What are opioid peptides?
3 main classes: enkephalins, endorphins, and dynorphins. They have varying degrees of selectivity for the three opioid receptors, mu, delta, and kappa. All opioids interact with these recpetors
211
PHAR 100
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