T5 Flashcards
morphine
Strong Analgesic (μ agonist) 10mg subQ -good for sev. pain IV doses lower sedation/mental clouding (OD) anxiety relief euphoria nausea (stim. CRTZ) resp. depression *death* (can tx resp. distress in pulm. edema) pupil constriction anti-cough histamine rel. (use benadryl, naloxone) lower seizure threshold endocrine disturbs. sm. musc effects (constipa., reten, bronchoconstr., inc. biliary press.) CV effects (hypotension, cut. vasodilation, inc. CSF press.) skel musc. regidity immunosuppression
codeine
Strong Analgesic (μ agonist) weaker than morphine antitussive (lower dose) *but can rel. histamine-->aggrav. asthma, etc.
fentanyl (Sublimaze)
Strong Analgesic (μ agonist)
patch or IV
short-term, fx
stronger than morphine-100 ug is typ. dose
(Duragesic) for chronic pain
fentanyl plus droperidol (Innovar): neuroleptic analgesia
heroin
Strong Analgesic (μ agonist)
acetylated morphine-more potent and euphoric (4-6 hrs)
today much higher purity
inj., snorting, smoking (easier for novice DU)
Afghanistan
“black tar” from Mexico
hydrocodone (Vicodin, Lortab, Norco, Zohydro ER, others)
Strong Analgesic (μ agonist) exs are vicodin: hydrocodone + acetaminophen(inhib. PG prod) problem: can OD, tox. doses of acetomin. 1st -Zohydro ER: just hydrocodone, no acetomin. -antitussive (lower dose) was Schedule 3-->*now Sch. 2*
hydromorphone (Dilaudid, Palladone)
Strong Analgesic (μ agonist)
like morphine, more potent
IV, oral
meperidine (demerol)
Strong Analgesic (μ agonist)
-almost discarded, still around
1/10th potency of morphine, will see doses up to 100 mg
oral, IV
mod-sev. pain, obstetrics (dec. resp depression? NO)
“urban legend” advantages: less sm. musc effects? NO
short-acting buildup of normeperidine–>seizures w/ repetitive tx, NOT for chronic pain
methadone (dolophine)
Strong Analgesic (μ agonist)
less euphoric and longer duration (12-24 hrs) than heroin or morphine
can be taken orally
-tx of heroin addxn
tricky dosing
“methadone substitution”: for drug pt is dependent on, then tapered
“methadone maintenance”: addiction tx as disease, medicated chronically w. methadone
-can function, just switching?
-can only be dispensed by licensed methadone clinics! not readily available for heroin tx
-good pain relieving drug but underused bc of stigma
Schedule 2: can prescribe for pain
oxycodone (Percodan, Percocet, OxyContin, Oxecta)
Strong Analgesic (μ agonist) more powerful than hydrocodone combo prod. w/ acetomin. (percocet) or w/ ASA Oxycontin: sustained release just opioid for chronic sev. pain (12-24 hrs) used to get high-snort "hilbilly heroin": appalachia, reformulated so "gummy mess" can't grind up w/ etOH: "dose dumping"-->OD
oxymorphone (opana)
Strong Analgesic (μ agonist) -pulled in 70s (drug users) marked as having lower abuse potential-false
pentazocine (talwin)
Partial Agonist and Mixed Agonist/Antagonist Analgesic
not full u activity, k agonist, some pain relief, not as much for severe pain
less abuse potential (still there!)
u antagonists at high doses–>w.drawal symptoms
dysphoric rxns
Talwin NX: form. w/ nalaxone (antag!) to reduce chance of IV abuse
nalaxone metabolized on 1st pass in liver-doesn’t reach systemic
if injected, both in system
buprenorphine (Buprenex, Sabutrex, Suboxone)
Partial Agonist and Mixed Agonist/Antagonist Analgesic
-replacement for methadone for opioid addxn, more readily available, less abuse potential
Suboxone: + nalaxone
maintenance: “office based” tx of opioid dependence not enrolled in methadone clinic, doc is certified
butorphanol (Stadol)
Partial Agonist and Mixed Agonist/Antagonist Analgesic
tramadol (Ultram)
Partial Agonist and Mixed Agonist/Antagonist Analgesic
-weak u agonist, less intense “buzz”, no high, dec. abuse pot.(still abused, Schedule 4)
inhibits reup. of NE and serotonin, (like tricycl. antidepr)
neuropathic pain
apentadol (Nucynta)
Partial Agonist and Mixed Agonist/Antagonist Analgesic
