Opioids

Question 1

What is the definition of pain defined by the WHO?

Answer 1

An unpleasent sensory and emotional experience associated with actual or potential tissue damage described in terms of such damage.

Question 2

What is the ladder of medication used in pain?

Answer 2

• 1 - Non-opioid analgesics
• 2 - Weak opioids
• 3 - Strong opioids

Question 3

List weak opiods:

Answer 3

Loperamide, codeine, tramadol

Question 4

List strong opioids:

Answer 4

Morphine, buprenorphine, fentanyl

Question 5

List non-opioid analgesics:

Answer 5

Acetaminophen - prostaglandin inhibitor

COX-1-inhibitors - Aspirin, Indomethacin - NOT RELEVANT

COX-2-inhibitors - Celecoxib, Meloxican

Non-specific COX inhibitors - Naproxen, ibuprofen

Question 6

COX-1 vs COX-2 functions:

Answer 6

• COX-1 - Mainly functions in mucosal protection, renal blood flow, platelet aggregation, endothelium
• COX- 2 - Mediate pain and inflammation

Question 7

How do opioids work:

Answer 7

• Bind mule, kappa and gamma receptors
• Mule
• main receptor involved in pain
• Inhibits release of neurotrnasmitters like Substance P and glutamate which is involved in transmitting pain signals
• Activation of inhibitory descending pathways
• Modulation of pain perception
• Peripheral effects - Inhibition of nociceptors, modualtion of inflammatory response

Question 8

What are the side effects of Non-opioid analgesics?

Answer 8

Gastric and duodenal ulcers
Incresed risk of heart attack and stroke
Renal function impairment
Aplastic anemia

Liver toxicity (rare)
Allergic reaction
Fluid retention and anemia
Headache and dizziness

Reye syndrome (aspirin)

Question 9

What are the side effects of opioids?

Answer 9

Constipation
Nausea
Vomitng
Drowsiness and sedation
Respiratory depression
Itching
Sweating
Dry mouth
Confusion and cognitive impairment
Hypotension
Tolerance and dependance
Addiction
Overdose

Question 10

What are the uses of opioids?

Answer 10

Pain
Anesthesia
Cough
Diarrhea

Question 11

Adjuvant drugs:

Answer 11

Antidepressants, neuroleptics, antispasmodics, corticosteroids, anticonvulsants

Question 12

How do NSAIDs work?

Answer 12

COX inhibition
stops ceonversion of arachidonic acid into prostaglandins
They decrease sensatization of onciceptors to mechanical and chemical stimuli