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Flashcards in Opioid Basics Deck (29)
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1

Mild to moderate agonists

-Phenanthrenes --> Codeine; codeine + APAP, Hydrocodone

-Phenylpiperidines --> Diphenoxylate, Loperamide

2

Strong Agonists (All C-II)

-Phenanthrenes --> Morphine, oxycodone, oxymorphone, hydromorphone

-Phenylheptylamines/diphenylheptanes --> methadone

-Phenylpiperidines --> Meperidine, fentanyl

3

"Weak" Mu-agonist/SNRI

-Tramadol*

-Tapentadol (more potent cousin)

4

Mixed Agonist/Antagonist

-Nalbuphine

-Butophanol (C-IV)

-Pentazocine (C-IV)

-Buprenorphine** (C-III)

5

This drug is metabolized by 2D6 to become morphine and has increasing toxicity in ultra-rapid metabolizers 

 

 

 

-Codeine 

6

What are the ADR's of codeine to be aware of?

-BBW in peds d/t unpredictability 

-Non-immune hypersensitivity: N/V, pruritus, hives

 

(same reactions seen with morphine)

7

Codeine + APAP = ?

Hydrocodone + APAP = ?

-Tylenol

-Vicodin 

8

What enzyme is hydrocodone metabolized by? What is it metabolized to?

Hydrocodone --> 2D6 --> Hydromorphone 

 

-Hydromorphone is more potent 

9

What drug is first-line for severe pain and used in pediatrics due to its predictable response?

Morphine

10

Which drugs are first-line for severe pain?

Morphine

Oxycodone 

Hydromorphone 

11

Which drugs are first-line for mild-moderate pain?

-tramadol 

-hydrocodone

12

This drug is the active metabolite of oxycodone 

Oxymorphone (not used much)

13

This drug is a substrate of 3A4 and has a black-box warning regarding use with 3A4 inhibitors 

Oxycodone (OxyContin)

14

This drug has a short half-life and may cause less pruritus and nausea than morphine 

Hydromorphone

15

Which Strong Agonists are available in IV formulations?

-Morphine 

-Oxymorphone

-Hydromorphone 

-Methadone 

-Meperidine 

16

Which strong agonist has a long half-life, needs careful titration, has no active metabolites, and ADRs include QT prolongation and an increased risk of respiratory depression?

Methadone

17

What are the phenanthrenes?

Morphine

Oxycodone

Oxymorphone

Hydromorphone

18

What opioid falls in the phenylheptylamines family?

Methadone

19

When two meds fall in the phenylpiperidines family?

Meperidine

Fentanyl

20

This strong agonist is a potent 5-HT stimulator. It is ONLY for short-term acute pain, there is death associated with MAOI, and IM injectino can lead to muscle fibrosis. What am I?

Meperidine

21

I am second line for severe pain and should not be used in opioid naive patients. I am contraindicated with clarithromycin. If combined with a sertonin drug, there is risk of Serotonin Syndrome. I am a transdermal patch. What am ?

Fentanyl

22

What are the two u-AG/SNRIs?

Tramdadol

Tapentadol

23

This drug is first line for mild-mod pain. It is metabolized by 2D6 into active metabolite. CI includes history of seizures, stroke, head trauma, ETOH withdrawal, and clarithromycin. This sohuld be avoided in peds. What is it?

Tramadol

24

What are the CI of tramadol?

Hx of seizures, stroke, head trauma, ETOH withdrawal

Clarithromycin

25

This opioid is similar to tramdadol but stronger. Comparable to Oxycodone 10-15mg. ADR is seizures.

Tapentadol

26

What four opioids are mixed AG/AAG?

Nalbuphine

Butorphanol

Pentazocine

Buprenorphine

27

What 3 opioids have incomplete reversal with Naloxone, leading to an increased risk of harm?

Nalbuphine

Butorphanol

Pentazocine

28

This opioid binds with high affinity and slowly dissociates from u receptors. It acts as an AAG. It's a substrate of 3A4 and is CI with clarithromycin. It has a lower abuse potential and has fewer withdrawal symptoms. 

Buprenorphine

29

What drug should you give to reverse an opioid overdose?

Naloxone