Pharm Opioids- Nagelhout
What is a reported serious S/E related to dexamethasone? - CORRECT ANSWER--
avascular necrosis of femoral head
-at risk pts: DM, peptic ulcer dx, immunocompromised pts
(ONE DOSE SHOULD BE HARMLESS)
Does one dose of dexamethasone have an effect on wound healing or increase blood
sugar? - CORRECT ANSWER-NO
What is the biggest cardiac effect of opioids? - CORRECT ANSWER-bradycardia due to
medullary vagal stimulation
Do opioids have an effect on BP? - CORRECT ANSWER--no effect on BP ... EXCEPT
postural hypotension (especially with histamine release) **Fentanyl = no histamine
release
-pts who are well-hydrated should have no change in BP
-decreased BP with relief of pain is secondary effect of decreased catecholamines, NOT
directly caused by opioids
What side effects of opioids do pts never develop a tolerance to? - CORRECT
ANSWER-1) miosis
2) constipation
What is analgesic potency directly correlated with? - CORRECT ANSWER-respiratory
depression
What effect do opioids have on C02 response curve? - CORRECT ANSWER--shift it to
the RIGHT
-respiratory depression occurs due to DECREASED sensitivity to C02 in respiratory
center
-takes increased amount of C02 to drive same amount of respiration
What are the two mixed opioids? (synthetic phenanthrenes) - CORRECT ANSWER-1)
nalbuphine - can antagonize respiratory depression and pruritus, but maintain analgesia
2) butorphanol
MU antagonists, Kappa partial agonists, and Delta agonists
What are the 6 piperidines? (all are referred to as phenylpiperidines even though this
isn't technically correct) - CORRECT ANSWER-1) meperidine --> HISTAMINE
2) loperamide
3) Fentanyl
4) Sufentanil
5) Alfentanil
, 6) Remifentanil
What is the only diphenylheptane? - CORRECT ANSWER-methadone
Which are the 3 specific drugs that are MOST likely to stimulate histamine release? -
CORRECT ANSWER-1) codeine
2) morphine
3) meperidine
-general rule = phenanthrines and demerol
Are there cross allergies between classes? - CORRECT ANSWER-NO
-just AMONG classes
1) If someone is allergic to Vicodin can they have oxycodone?
2) If someone is allergic to morphine can they have dilaudid?
3) If someone is allergic to codeine can they have demerol?
4) If someone is allergic to fentanyl can they have morphine? - CORRECT ANSWER-1)
NO
2) NO
3) YES
4) YES
Why do opioids cause analgesia? - CORRECT ANSWER--suppress release of pain
chemicals
-PRESYNAPTIC AGONISTS THAT CAUSE INHIBITION OF RELEASE OF
SUBSTANCE P and other neurotransmitters
What class includes the drugs of choice for asthmatics? - CORRECT ANSWER--
phenylpiperidines EXCEPT demerol
-ex: FENTANYL is safe
Opioid with equal potency to fentanyl - CORRECT ANSWER-remifentanil
Opioid with weakest potency - CORRECT ANSWER-codeine
Opioid with strongest potency - CORRECT ANSWER-Sufentanil (MU agonist)
What are the 4 endogenous opioid peptides? - CORRECT ANSWER-1) enkephalins
2) B-endorphins
3) Dynorphins
4) Endomorphins
What are the 3 naturally occurring phenanthrenes? - CORRECT ANSWER-1) Morphine
--> HISTAMINE
2) Codeine ---> HISTAMINE
3) Thebaine
What is a reported serious S/E related to dexamethasone? - CORRECT ANSWER--
avascular necrosis of femoral head
-at risk pts: DM, peptic ulcer dx, immunocompromised pts
(ONE DOSE SHOULD BE HARMLESS)
Does one dose of dexamethasone have an effect on wound healing or increase blood
sugar? - CORRECT ANSWER-NO
What is the biggest cardiac effect of opioids? - CORRECT ANSWER-bradycardia due to
medullary vagal stimulation
Do opioids have an effect on BP? - CORRECT ANSWER--no effect on BP ... EXCEPT
postural hypotension (especially with histamine release) **Fentanyl = no histamine
release
-pts who are well-hydrated should have no change in BP
-decreased BP with relief of pain is secondary effect of decreased catecholamines, NOT
directly caused by opioids
What side effects of opioids do pts never develop a tolerance to? - CORRECT
ANSWER-1) miosis
2) constipation
What is analgesic potency directly correlated with? - CORRECT ANSWER-respiratory
depression
What effect do opioids have on C02 response curve? - CORRECT ANSWER--shift it to
the RIGHT
-respiratory depression occurs due to DECREASED sensitivity to C02 in respiratory
center
-takes increased amount of C02 to drive same amount of respiration
What are the two mixed opioids? (synthetic phenanthrenes) - CORRECT ANSWER-1)
nalbuphine - can antagonize respiratory depression and pruritus, but maintain analgesia
2) butorphanol
MU antagonists, Kappa partial agonists, and Delta agonists
What are the 6 piperidines? (all are referred to as phenylpiperidines even though this
isn't technically correct) - CORRECT ANSWER-1) meperidine --> HISTAMINE
2) loperamide
3) Fentanyl
4) Sufentanil
5) Alfentanil
, 6) Remifentanil
What is the only diphenylheptane? - CORRECT ANSWER-methadone
Which are the 3 specific drugs that are MOST likely to stimulate histamine release? -
CORRECT ANSWER-1) codeine
2) morphine
3) meperidine
-general rule = phenanthrines and demerol
Are there cross allergies between classes? - CORRECT ANSWER-NO
-just AMONG classes
1) If someone is allergic to Vicodin can they have oxycodone?
2) If someone is allergic to morphine can they have dilaudid?
3) If someone is allergic to codeine can they have demerol?
4) If someone is allergic to fentanyl can they have morphine? - CORRECT ANSWER-1)
NO
2) NO
3) YES
4) YES
Why do opioids cause analgesia? - CORRECT ANSWER--suppress release of pain
chemicals
-PRESYNAPTIC AGONISTS THAT CAUSE INHIBITION OF RELEASE OF
SUBSTANCE P and other neurotransmitters
What class includes the drugs of choice for asthmatics? - CORRECT ANSWER--
phenylpiperidines EXCEPT demerol
-ex: FENTANYL is safe
Opioid with equal potency to fentanyl - CORRECT ANSWER-remifentanil
Opioid with weakest potency - CORRECT ANSWER-codeine
Opioid with strongest potency - CORRECT ANSWER-Sufentanil (MU agonist)
What are the 4 endogenous opioid peptides? - CORRECT ANSWER-1) enkephalins
2) B-endorphins
3) Dynorphins
4) Endomorphins
What are the 3 naturally occurring phenanthrenes? - CORRECT ANSWER-1) Morphine
--> HISTAMINE
2) Codeine ---> HISTAMINE
3) Thebaine
