A-CNS Pharma > Opioids > Flashcards

Opioids Flashcards

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1
Q

بسم الله الرحمن الرحيم وبه نستعين

What are opioids ?

A

Drugs with morphine like actions

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2
Q

Anaglesiscs?

A

Drugs relive pain due to multiple causes.
Opiods : Morphine + synthetics
Non opioids : NSAIDS + Paracetamol

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3
Q

Mild pain
mODERATE Pain uncontrolled
Moderate to severe pain
Comfortable pain free

A

Non opidods + adjuvants
Weak opioids + non opioids + adjuvantts
Stron opioids + non opioid + adjunatn
Invaseive

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4
Q

Non opioids ?
Adjuvants ?

A

NSAIDS + Acetamnipohen
Antidepressants + AntiConvulsants

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4
Q

Non opioids ?
Adjuvants ?

A

NSAIDS + Acetamnipohen
Antidepressants + AntiConvulsants

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5
Q

Weak opioids ?

A

Termadol + codiene

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6
Q

StRONG OPIOIDS

A

MOHAB FANTA
Morphine
Oxycodiene
Hydromorphone
Bubronephrine
Fentanayl

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7
Q

Opioids analgesices used in ?

A

Moderate to severe pain
named dueOPium poppy= Opium ——-10% is morphine

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8
Q

Opioids analgesices used in ?

A

Moderate to severe pain
named dueOPium poppy= Opium ——-10% is morphine
Codiene also dervied from opium

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9
Q

Opiates and opioids ?

A

Opiates are derivatves of the alkaloids of opium poppy
Opioids : The class of drugs inculding : Opiate , Opiopepetins , Synthetic and semsyntheic drugs work as Opiates

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10
Q

Narcotic ? why ? opioids

A

Because of
Stupor +Analgesisa
Stupor = Drowisness and impairment without loss of Consiousness

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10
Q

Narcotic ? why ? opioids

A

Because of
Stupor +Analgesisa
Stupor = Drowisness and impairment without loss of Consiousness

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10
Q

Narcotic ? why ? opioids

A

Because of
Stupor +Analgesisa
Stupor = Drowisness and impairment without loss of Consiousness

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10
Q

Mention sourcrs of opioids

A

S2EP
Plant : Morphine - Codiene
Endogenous : endorphins enkephalins and dynorphins
Synthetic: FTM ( Fentanyl+ tramadol+ Methadone )
Semisynthetic : Heroin + Oxycodiene

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11
Q

Classifiacation of opioids at Function

A

3As:
-Analgesics + Antitissuves+Antidiarrheal
1-Analgesics وقسمناهم
2-Antitussives CD Codeine - Dextromethorphan
3-Antidiarrheal : LD
Lopramide + Diphenoxylate

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11
Q

Natural opiodis ?

A

Morphine + codiene agnoists

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12
Q

Semisynthetic :
opioids?

A

HO HO H !
Hydrocodone
Oxycodone
Hydromprohone
OxyMorphone
Heroin

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13
Q

Classificaion of Synthetics Opioids?>

A

FT2M2 agonists
Fentaynyl
Tramadlo
Tepentatdol
Mehadone
Mepridine

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14
Q

Partial agonists of opioids ?

A

Bubrenorp.hin.e
Pentazocine
Nalubuphine

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15
Q

Antagonists of Opioids
عشان نزع السمية

A

1- Nalxone
2- Nalterxone

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16
Q

Opioids receptors ?

A

Mu- Delta - kuppa Receptors

Mu most imp resp fort Analgeisa + sedation + respirtaory deprssion !

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17
Q

General explanation of Opioid receptors work

A

Gi decreasing CAMP Presynaptic
Closing Ca channels
Preventing Glutamate release
Opeining K channels postsynaptic Hyperpolarization and Prevents AP

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18
Q

Opioids receptor activaed ?

A

Supraspinal : Brainstem + thalamus+cerberal Cortex
Spinal
Pehriphey ? afferent nerves conducting pain
Increasing Dopamine in Nucleus Accumbenes casuing Euphoria and prevent the emotional feel of pain

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19
Q

Ascending pain pathway is ?
Descending pain pathway?

A

spinothalmic tract
Descending start from periaqudrcta grey area desending to spinal cord releasing Enkephalins + NE + 5HT
repressing spinothalamic Tract of pain
So how opiodes relieve pain ?
Increasing the Opiopepetins : Enkeplains
Working on its Receptors on spinothalmic tract inhibiting pain pahtyway

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20
Termadol
Inhibit reuptake of Serotonin and NE increaing their inhibitory effect on spinothalamic Tract And it is Non opioid activity on side to its opioid activity
21
Classify Opioids Analgesics at its efficay?
Strong : Agnoists as PFHM Pethidine Fentanyl Heroin Methadone - Morphine Partial agonists as Bubrenorphine ______________________ Moderate Codiene and oxycodeine + NSAIDS + Antussive activity _______________________ Weak : Propoxyphene Analgesics + NSAIDS PARACETAMOL
22
Main )))))Actions of opioids mention and classify it to indications and contraindications
Anaglesia+ Sedation + euphoris 1-Analgeisa I: post operative : acute trauma - MI CI : Undiagnosed acute abdomen 2-Sedation I: anaethesia preoperateve preanathrsia medications CI: casuing Sedation and Narcosis in dangerous cases 3-Euphroia not indication it is cause of contra indication as casuing dependence
23
Indication of Opoiids mention
Anglesisc post operative acte reuama cancer MI Sedation in anathesia and Sugery
24
Contraindication of Opioids /
Analgesic in Undiagnosed Acute abdomen Sedation and Narcosis in some situations Casuing euphoria
25
How opioids casuing euphoraa?
Inhibite release of Glutamte which inhibit dopamine release casuing Increased Dopamine in Nucleus accumbnes and Ventral Tegmental Area Casuing euphoria
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Maiinly casue of Death in Case of opioids?
Repiratoy center inhibition by toxicity
27
Inhbitory effects of Opioids works on?
4 centers + Uterine Respiratory Center Cough Center VMC thermoregulatory center
28
Opioids and cough center?
They are antitussive Codeine + Dextromethorphan كان بيعمل إدمان تلاقيهم بيشتروا ازارة ويشربوها مرة واحدة !
29
Opioids and Respiratory Center
Most common cause of death due to opioids cuz of respiratory depression . Make body insensitive to CO2 and Inadqeuate Respiration Also in Case of Ceaserain section In addicted woman Casuse Asphyxia Neonatorum . Increasing Co2 casuing Cerberal VD icreasing ICP contraindicatd in head injury
30
Make body insensitive to CO2 and Inadqeuate Respiration
opioids
31
in Case of Ceaserain section In addicted woman opioids are CI why ?
Casuse Asphyxia Neonatorum .
32
Opioids are contraindicatd in head injury why ?
Make respiratorty centers insensitive to Co2 Increasing Co2 casuing Cerberal VD icreasing ICP contraindicatd in head injury
33
Why Opioids are CI in Labour?
Decrasing Uterine tone + Ceaseine section casue Ashpyxia Neonatorum
34
Acute pulmonary edema is indication of Opioids ?
Yes , becasue opioids Repress VMC Causing Venulodilator and Arteriolodilator effects Causuing decreas in PreLoad and AfterLoad of Heart Decreasing Respiratory distress + Anxiety But in normal p casues Hypotension
35
Hypothermia and opioids
Opioids depress the Thermoregulatory centers Causing Hypothermia
36
Describe inhibitory effects of opioids ?
-Depress the COUGH center so I: Antitussive Codeine+ Dextrometh -Depress respiratory center so CI: Respiratory depression + Asphyxia nenoatrum in CS -Depress VMC so I: Acute pulmonary edema CI : Hypotension -Depress uterine tone CI: labour Depress Thermoregulatory center : AE CI : Hypothermia
37
Inhibitory indications of Opioids ?
- Antitussive inhibiting cough cent -Acute pulmonart edema inhibiting VMC
38
Inhibitory Contraindications of Opioids ?
-Respiratory depression -Asphyxia Neonatorum -Labour delay -Hypotension -Hypothermia
39
المدمن بيتعرف من؟
Miosis Constipation
40
Opioids and pupil
Stuimulate occluomotor nucleus or The parasympathtic nuclerus of third 3rd cranial nerve casuing pin point pupil or called Miosis adverse effect and distingusih addicts
41
Opioids and Vomiting ?
Stimulating The CTZ Chemoreceptor Trigger zone
42
Opioids and diarrhea?
Its antidiarrheal (indications) as it is spsamogenic Causing closure of Sphincters of anal and urinary of bladder Stool and urine retention constioation
43
Opioids and gall bladder ?
In case of Biliary colic is spamogenic closing the sphincter of oddi and increasing inflammation may casue rupture and peritonins and septic shock
44
Opioids and Asthma and Hypotension
Opioids release Histamine cassuing bronchoconstriction so CI in Athma And hypotension VMC - HISTAMINE
45
Hypotension in opioids is due to ?
Histamine release vmc depression
46
Stimulatory indication of opioids ?
Antidiarrheal
47
Stimulatory Advers effe and CI of opioids
+Occlumotor nucleus Miosis +CTZ Nausea and Vomiting Spasmogenic = constpiaton Spasmogeinc = CI in biliary colic Histamine releas = CI in Asthma + Hypotension
47
Stimulatory Advers effe and CI of opioids
+Occlumotor nucleus Miosis +CTZ Nausea and Vomiting Spasmogenic = constpiaton Spasmogeinc = CI in biliary colic Histamine releas = CI in Asthma + Hypotension
47
Stimulatory Advers effe and CI of opioids
+Occlumotor nucleus Miosis +CTZ Nausea and Vomiting Spasmogenic = constpiaton Spasmogeinc = CI in biliary colic Histamine releas = CI in Asthma + Hypotension
47
Tolerance occurs with all effect except ?
Miosis + Constipation
48
Stimularoy action of Opioids mention
+Occulmotor nucleus +CTZ +Spasmogenic +Histamine relase
49
Contraindications of Morphine inspite of Severe pain ?
1-Undiagnosed acute abdomen 2-Labour 3-biliary colic 4-Head Injury
50
Other side effect of opioids ?
Seizures decreasing threshold of epilepsy in high doses
51
Othe CI of Opioids ?
Extreme age Hypothyroidism Liver dysfunctions
52
Morphine is given
Parenteral IV IM SC Epidurally
53
Morphine is not perefered ?
Orally due to extensive first pass metabolism 20-40 %
54
Duration of action of Morphine ?
4-6 hOURES
55
Pehthidine Mepridine
IM + oral
56
Pethidine in potency and efficacy ?
Potency less than Morphine Efficacy Equal to Morphine
57
What is used instead of Morphine in Biliary colic + Labour + why?
Pethidine or Mepridine in Biliary colic:- less spasmogenic in Labour :- less repiratory depression not casuing Asphyxia neonatorum Less Utrein relaxation not delaying labor
58
Why Pethdine casue less constipation ?
Short action 2-3h meanwhile Morphine 4-6 h
59
Blurred Vision and Dry moth appear with ? why?
Pethidine as it has atropine like actions parasympathatic antagonist May casue mydriasis
60
Pethdine Increase risk of convulsion especially in / ?
1-Renal failure 2->48 h of acute pain so its used only in acute not chronic _____________________ Due to of accumulation of (Normeperidine)
61
Indications of Pethidine ?
Postopertative pain Biliary colic +Labour
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Advantage of pethidine over morpine are ' ;
-Less repiratory depression so less asphyxia neonatrum and death -less spamogenic less constipation due to low duration and used in biliary colic and labour not causing delay or uterine relaxation
63
disadvantage of Mepridine pethidine against Morphine are?
Atropine like action Blurred vision + dry mouth + Mydriasis Risk of Convulsants due to accumulation of normeperdiine in RF or after 48
64
هل في تراجع في استخدام البثيدين ؟
اه عشان طلع بيتحول في الكبد ل Norpethidine toxic metabolite وده سام للطفل اللي الكبد مش هيقدر يعمل فيه conjugation + excretion فهيعمل Asphyxia Neonatorum \
65
Desrive Fenatnyl Potency and oneset and duration
Potency 100 fold than morphine onset rapid due to lipophilicity 1-5m Short duration .5 -2 hours
66
Functions of fentanyel mention
1-Epidural anasthesia + analgesisa: Posteperatively + during labor 2-Transmucosal + Transdermal patches in chronic pain as cancer
67
مشاكل Fentanyel ايه ؟
الجرعة العالية بتعمل تخشب في عضلات جدار الصدر فيقلل اتساعية الصدر و يقلل القدرة علي التنفس decrasing thoracic complicamce+ Ventilation
68
Indications of Fentanyl Mention
1-Analgesic : pre post operative + labor 2-Anasthesia : Pre-anesthetic medication 3-Conscious sedation + Neuroleptanalgesia+ Neuroleptanethesia
69
Conscoius sedation mean ?
Amensia+ Analgesia + sedation without loss of Conscousness
70
Consous sedation imp ?
In minor and diagnostic procedures as Endoscopy
71
Conscious sedation is done by ?
Benzodiazpines+Opoid analgesics MidaZolam+ Fenatnyl
72
Conscious sedation drug toxiciy can be reversed by ?
Flumazenil + Naloxone advantage
73
Neuroleptanalgesisa mean ?
Neurolept = antipsychotic drug + anaglesic Dorperidol +Fentanyel
74
Neuroleptanalgesisa mean ?
Neurolept = antipsychotic drug + anaglesic Dorperidol +Fentanyel Neuroleptanasthesia is done by adding 65% N2O In O2 to Neuroleptanalgesic patient
75
Neuroleptanasthesia is done by ?
Neuroleptanasthesia is done by adding 65% N2O In O2 to Neuroleptanalgesic patient
76
Subgroups or Congenres of Fentanyl mention 2
1-Sufentanil : more potent 2-Remifentanil : ريمي ريمي ريمي ultrashot as metabolized in blood and tisse esterases casuing less venilation depression
77
Remifentanil : ريمي ريمي ريمي duration and give reasion
ultrashot as IV INFUSION metabolized in blood and tisse esterases casuing less venilation depression
78
Heroin is ?
DiacetylMorphine Diacetyls Increase Lipid Solubility and Crossing BBB 3 times than morphine make it more liable to Euphoria and Addiction due to rapid onset short duration Is converted in brain into Morphine
79
How addcits use herioin ?
IS2 Injecting IV / IM after Dissolving in a spoon of Water Snorting : up by nose by 20$ Smoking : heating up poweder and inhalation of fumes by a small tube of foil
80
Methadooooooone Duration ? IMP
24-36 hours so it is useful in Detocification of Herioin in addicts as It takes longer to leave opioid receptors making the withdrawal smoother and less severe
81
Methadone Indications ?
Analgesic equal to morphine detoxification in opioid addicts long duration less severe and smoother withdrawal
82
Make a comparsion between methadone and Heroin at Route Onset Duration Euphoria
Methadone: Oral only 30 M 24-36H Absent Herion: IV IM INTRA NASAL IMMEDIATE MARKED Euphoria 3-6H
82
Make a comparsion between methadone and Heroin at Route Onset Duration Euphoria
Methadone: Oral only 30 M 24-36H Absent Herion: IV IM INTRA NASAL IMMEDIATE MARKED Euphoria 3-6H
83
Mention adverse effects of methadone
As Morphine QT interval prolongation Torsade de pointes arrythima
84
Route of Tramadol
Oral IV IM
85
Tramadol function
It is mixed opioid and non opioid Non opioid Anaglesia by inhibiting reuprake of serotinin and NE Weak Mu agonist so Partly antgonisted by Naloxone Used in Analgesia ( post oper+ chronic pain)+ Neuropathic pain
86
Bupernophrine is
partial agonist
87
Bubrenorphine has a property over Morphine explain
Ceiling effect Has same effective analgesic Effect but less Euphoria + less Resp. Depression ......
88
Bubrenrophine how to administrate ?
Sublingual Parentral
89
Mention uses of Bubrenorphine /
1-Analgesic in sever pain 2-Detox in Opioid toxicity as it is used as methadone due to ? Long duration 24 h and Less severe withdrawal
90
Mention two drugs help in detox of Morphine and give reason
Methadone Bubrenorphine due to long duration of action so less severe and smoother withdraw
91
Buprenorphine and heroin
بيمنع ان الهروين يمسك في المستقبل لان له ارتباطية قوية بالمستقبل بيحجب النشوة الناتجة عن الهروين وله ميزتان هو مفيش نشوة + مفيش تثبيط تنفسي
92
bubernorpine في وحود الهيروين يعتبر ؟
antagonist عشان كده مش هنستخدمه في العملية لو الراجل واخذ هيروين لانه يعمل اعراض انسخاب ومش هيشيل الألم
93
Pethidine or Tramadol + MAOI interactions
Pethidine increase sertoinin Tramadol decrease reuptake serotinine and NE AS MAOI Causing Serotonin Syndrome
94
Nevere give opioids + CNS depressants (Sedative+alcohol+antidepress + antipsychotic )
it will add CNS depress
95
Acute Morphine toxicity apppear as ?
Repsitaroy depression Pinpoint pupil Miosis Coma due to CNS depression
96
Treatment of Acute morphine Toxicity?
Resp Support Naloxone competitive opioid antagonist
97
How to treat addiction ?
1-Symptomatic treatment Pain ; NASIADS Vomiting: antiemetic 2-Sympatholytic: Clonidine 3-Detox : Methadone +Buprenorhpine 4-Maintanance: naltrexone to prevent relpase by euphoria
98
وقيل الحمدلله رب العالمين
الحمدلله رب السماوات والأرض رب العالمين
A-CNS Pharma
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