List the strong opioid agonists
- Heroin
- Morphine
- Hydromorphone (Dilaudid)
- Methadone (Dolophine)
- Meperidine (Demerol)
- Fentanyl (Sublimaze)
- Alfentanil (Alfenta)
List the Moderate-to-Strong Opioid Agonists
- Hydrocodone (Codan)
- Oxycodone (OxyContin)
- Oxymorphone (Opana)
List the Moderate Opioid Agonists
- Codeine
- Tramadol (Ultram)
- Tapentadol (Nucynta)
List the Mixed Opioid Agonist-Antagonists
- Pentazocine (Talwin)
- Buprenorphine (Buprenex)
List the opioid antagonists
- Naloxone (Narcan)
- Naltrexone (ReVia)
List the opioid combination drugs
- Hydrocodone/acetaminophen (Vicodin)
- Oxycodone/acetaminophen (Percoset)
List the opioid antitussives
- Dextromethorphan (with guaifenesin; Robitussin DM)
- Codeine
List the opioid receptors
- Mu - u
- kappa - k
- delta - S
MOA of all of the opioid receptors? What extra MOA does the Mu receptor have
- coupled to Gi/o
- close voltage gated Ca2+ channels on presynaptic nerve terminals
- decreases neurotransmitter release and decreases neuronal activity in these pathways
- u receptors: open K+ channels on postsynaptic neuron -> cause hyperpolarization and inhibit nerve transmission
effects of u receptor stimulation
- analgesia: pain relief
- euphoria
- sedation
effects of k receptor stimulation
- analgesia in some people
- dysphoria in others
effects of delta (S) receptor stimulation
- dysphoria
what is GABAs effect on pain modulation? What effect does opioids have on GABA
- GABA normally inhibits descending neuronal pathways that modulate pain
- opioids decrease the release of GABA, allowing the pathways to be activated which decreases pain transmission in the dorsal horn of the spinal cord
how does opioids cause analgesia
- decrease sensation of pain
- decreases reaction to pain : decrease suffering
- tolerance develops to analgesia
list the effects of opioids
- analgesia
- sedation/mental clouding
- euphoria or dysphoria
- Emesis
- constipation
- inc tone, harder to urinate and pass stones
- Depression of cough reflex
- Respiratory depression
- Miosis
- Truncal rigidity
describe the sedative effects of opioids
- dream-like state: mental clouding
- not for sleep aids
- causes CNS depression -> coma -> death
why do opioids cause emesis
stimulate chemoreceptor trigger zone
effect of opioids on respiration
- respiratory depression
- decreases response of brain stem to elevated CO2
why are opioids useful in pulmonary edema
- decrease response of brain stem to elevated CO2 and thus decrease the feeling of suffocating and make patient feel more comfortable
why should opioids by cautiosly used in patients with head trauma
- CO2 increases (due to decreases response of brain stem to elevated CO2) and causes vasodilation which increases cerebral blood flow and increases intracranial pressure
which opioid does not cause miosis
meperidine
what effects of opioids does a patient not develop a tolerance to
- Miosis
- Constipation
- seizures
truncal rigidity is most common with what type of opioids?
- highly lipid soluable drugs like fentanyl
what cardiovascular effects do you expect with opioids
- slowing of heart rate due to pain control
- exception is meperidine -> tachycardia
