Opioids

Question 1

what are narcotics

Answer 1

• ‘opioids’ = any natural or synthetic drug that has morphine-like pharmacological action
• major effects of opioids are on CNS and bowel

Question 2

what binding sites are called the opiate receptors (for opioids to act as agonists) in the CNS

Answer 2

• mu
• delta
• kappa

Question 3

what are pure agonists (opioids)

Answer 3

• activate both Mu and Kappa receptors
• strong or moderate in producing an analgesic (relief of pain) effect
• ex. morphine

Question 4

what are mixed agonists-antagonists (opioids)

Answer 4

• activate Kappa receptors but block Mu receptors
• analgesic (relief of pain) effect with some antagonist activity
• ex. pentazocine (talwin)
• butorphanol (stadol)

Question 5

what are pure antagonists/blockers (opioids)

Answer 5

• inhibit both Mu and Kappa receptors
• no analgesic effects; used in opioid overdose
• ex. naloxone, naltrexone (revia)

Question 6

what are some opiate agonists with moderate efficacy

Answer 6

• codeine
• hydrocodone (hycodan)
• oxycodone (oxycontin)
• combined with acetaminophen = Percocet
• combined with ASA = percodan

Question 7

what are some opioid agonists with high efficacy

Answer 7

• hydromorphone (dilaudid)
• meperidine (demerol)
• morphine

Question 8

what are some other effects of opioids besides analgesia

Answer 8

• suppress cough reflex
• slow GI motility
• depress CNS
• sedation
• euphoria

Question 9

what are some adverse effects of opioids on the CNS

Answer 9

• respiratory depression
• cough suppression
• nausea/vomiting

Question 10

what is an adverse effect of opioids in the GI tract

Answer 10

• constipation

Question 11

what are some other adverse effects of opioids in general

Answer 11

• tolerance can develop

- physical and psychological dependence

Question 12

what drugs will interact poorly with opioids

Answer 12

• antihistamines, sedative/hypnotics, alcohol and psychotropics
• increased CNS effects (e.g. sedation)

Question 13

at what dose will morphine reduce severe pain or eliminate pain

Answer 13

• 5-10 mg

Question 14

what are the central actions or morphine (and some other opioids)

Answer 14

• analgesia
• drowsiness and sleep
• cough suppression
• vomiting (due to stimulation of chemoreceptor trigger zone in the brain)
• hypotension
• miosis (papillary constriction)
• respiratory depression (high doses): major toxic effect and cause of death because no tolerance is developed to respiratory depression
• euphoria (ecstacy; develop tolerance rapidly to euphoric actions)
• increased release of ADH (antidiuretic hormone), which causes urinary retention

Question 15

what are some other minor activities (peripheral actions) caused by morphine and some other opioids

Answer 15

• constipation (due to slowing of peristalsis)

- body warmth/flushing/itching (due to histamine release)

Question 16

when is morphine used

Answer 16

• severe pain due to trauma, cancer, or heart attack
• severe and chronic pain
• pre-anaesthetic medication

Question 17

what does morphine do (pharmacodynamically)

Answer 17

• binds with mu and kappa receptor sites
• analgesia, euphoria, constriction of pupils, stimulation of cardiac muscle
• relieves SOB with heart failure and pulmonary edema
• for relief of chest pain due to heart attack

Question 18

what are some side effects of morphine

Answer 18

• dysphoria (restlessness, depression, anxiety)
• hallucinations
• nausea
• constipation
• dizziness
• itching sensation
• in cases of overdose, respiratory depression, cardiac arrest
• do not take with alcohol -> both are CNS depressants
• tolerance and cross tolerance can develop, as well as physical and psychological dependence

Question 19

what is methadone

Answer 19

• long-acting synthetic morphine derivative used orally in the treatment of opioid (usually heroin) addiction
• used to ‘wean’ patients off narcotics because it does not produce euphoria
• it is still abused

Question 20

what is meperidine

Answer 20

• also called demerol
• less effective analgesic than morphine with half the duration of action (75 mg meperidine IM = 10 mg morphine IM)
• used for moderate to severe pain

Question 21

what is oxycodone and hydrocodone

Answer 21

• semisynthetic morphine derivatives
• respiratory depression, antitussive, constipation and dependence
• moderate to severe dental pain
• it is most effective when combined with NSAIDs, aspirin, or acetaminophen (eg Percocet, percodan)

Question 22

what is codeine

Answer 22

• naturally occurring narcotic agonist obtained from the opium poppy but in lesser amounts than morphine
• less potent analgesic than morphine (120 mg of codeine phosphate IM = 20 mg morphine IM; 200 mg codeine oral = 30-60 mg morphine orally)
• less respiratory depressant and constipation and has less dependance potential

Question 23

what type of drug is codeine

Answer 23

• prodrug (its analgesic activity is the result of a conversion to morphine by cytochrome P450 liver enzymes)
• usually combined with other non-narcotic drugs such as acetaminophen (Tylenol) for the relief of acute nociceptive mild to moderate dental pain
• also used as an antitussive in cough syrups

Question 24

dental hygiene guidelines for patients taking codeine

Answer 24

• monitor patient for dry mouth; fluoride rinses if indicated
• monitor vital signs due to effects on the heart and respiratory system
• causes drowsiness/sedation

Question 25

what is propoxyphene

Answer 25

- also called Darvon - related to methadone with less analgesic activity than codeine - abused

Question 26

what is destromethorphan

Answer 26

- agonist opioid without any analgesic activity | - high antitussive effects (used in cough medicines)

Question 27

what is loperamide

Answer 27

- agonist opioid without analgesic effects | - increases smooth muscle tone in the GI tract and is used as an antidiarrheal

Question 28

what is diphenoxylate

Answer 28

- agonist opioid/anticholinergic - antidiarrheal - combined with atropine in a product called lomotil (can cause severe respiratory depression, coma and death after overdose in children)

Question 29

what is tramadol

Answer 29

- also called ultram - agonist, unique analgesic quality having both opiate and central acting adrenergic qualities - not a controlled substance; not narcotic - approved for moderate to moderately severe pain - can cause serious neurotoxicity and is not the first-line drug of choice

Question 30

what is naloxone

Answer 30

- opioid antagonist - block both mu and kappa receptors - complete or partial reversal of opioid effects - reverse opioid symptoms of respiratory depression and CNS depression within minutes

Question 31

what are some side effects of naloxone

Answer 31

- rapid loss of analgesia - increased blood pressure - tremors - hyperventilation - nausea/vomiting - drowsiness

Question 32

what are signs of withdrawal

Answer 32

- chills, abdominal and muscle cramps - severe itching, sweating, restlessness - anxiety, yawning, drug-seeking behaviour

Question 33

what is substance abuse

Answer 33

- the use, by self-administration, of a drug that does not conform to the medical or social norms within the client's given culture or society

Question 34

what are some reasons for substance abuse

Answer 34

- increase performance - assist in relaxation - alter psychological state - fit in with the crowd/peer pressure

Question 35

what are the 3 structures of society substance abuse has an impact on

Answer 35

- economic, social and public health

Question 36

what are some legal substances that are often abused

Answer 36

- alcohol - nicotine - volatile inhalants (aerosols, paint thinners) - narcotics - marijuana

Question 37

what are some illegal substances that are often abused

Answer 37

- stimulants - hallucinogens (LSD, PCP, psilocybin aka magic mushrooms) - narcotics

Question 38

what is addiction

Answer 38

- an overwhelming feeling to take - continued use of a substance despite its negative health and social consequences - legal prescription drugs rarely cause addiction

Question 39

what is dependence

Answer 39

- overwhelming desire to take drug and cannot stop | - 2 types: physical, psychological

Question 40

what is physical dependence

Answer 40

- the condition of experiencing unpleasant withdrawal symptoms when the substance is discontinued - altered physical condition caused by the nervous system adapting to repeated drug use - withdrawal symptoms when discontinued

Question 41

what are some drugs that can cause physical dependence

Answer 41

- narcotics - alcohol - CNS depressants - some stimulants - nicotine

Question 42

what is psychological dependence

Answer 42

- an unpleasant intense craving for a drug after it has been withdrawn - no physical signs

Question 43

what are some drugs that can cause psychological dependence

Answer 43

- marijuana - anti anxiety drugs - crack cocaine

Question 44

what is classic withdrawal

Answer 44

- unpleasant symptoms experienced when a physically dependent client discontinues use of an abused drug - prescription drugs used to reduce severity of symptoms

Question 45

what is conditioned withdrawal

Answer 45

- environment and social contacts contribute to relapse after addict is no longer abusing substance - treatment: stop association with past social contacts or relationships

Question 46

what is tolerance

Answer 46

- the individual adapts to the drug over time - higher and higher doses needed to produce the same initial effect - common with drugs that affect the nervous system - does not develop at the same rate for all actions of a drug