NSGvj533vjOpioidvjQuiz
1. Endogenousvjopioidvjpeptides:vjSmallvjmoleculesvjthatvjarevjnaturallyvjproducedvjinvjthevjCNSvjandvjinvjvariousvjgla
ndsvjthroughoutvjthevjbody,vjsuchvjasvjthevjpituitaryvjandvjadrenalvjglands.vjConsistsvjofvjendorphins,vjenkephalins,vjdynorphins,vja
ndvjnociceptins.
2. Mechanismvjofvjactionvjforvjopioids:vjStimulatingvjopioidvju-receptorsvjinvjthevjCNS.vjPurevjagonistsvj(mor-
vjphine)vjbindvjtovju-
receptorsvjtovjproducevjanalgesiavjthatvjincreasesvjwithvjdosevjwithoutvjavjceilingvjettect.vjPartialvjagonistsvjatvjthevju-
receptorvj(Buprenorphine,vjtramadol)vjcausevjlessvjconformationalvjchangevjandvjreceptorvjactivationvjthanvjfullvjagonists.
3. Indicationsvjforvjinitiatingvjopioidvjtherapy:vjUsedvjwhenvjbenefitsvjoutweighvjrisksvjassociatedvjwithvj
opioidsvjsuchvjasvjabuse.vjUsedvjforvjacutevjpainvj(includingvjpost-surgical)vjfromvjundervjavjmonth,vjandvjchronicvjpain.
4. Tolerance:v j thevjdiminishingvjettectvjwithvjregularvjusevjofvjthevjsamevjdosevjofvjavjdrug,vjrequiringvjthevjuservjtovjtakevjlargerv
j andvjlargervjdosesvjbeforevjexperiencingvjthevjdrug'svjettect
5. Dependence:vjthevjconditionvjthatvjresultsvjwhenvjthevjbrainvjdevelopsvjavjchemicalvjneedvjforvjavjdrugvjandvjcannotvj
functionvjnormallyvjwithoutvjit
6. Addiction:vjAvjphysiologicalvjorvjpsychologicalvjdependencevjonvjavjdrug
7. Neuralgia:v j nervevjpain
8. Analgesia:v j Painvjrelief;vjinabilityvjtovjfeelvjpain
9. Allodynia:vjPainvjduevjtovjavjstimulusvjthatvjdoesvjnotvjnormallyvjprovokevjpain
10. Whenvjtovjinitiatevjlong-actingvjopioids:vjIfvjthevjshort-
actingvjopioidsvjarevjnotvjworkingvjasvjwellvjinvjchronicvjpainvjorvjend-of-
lifevjpain,vjorvjthevjpatientvjfeelsvjasvjthoughvjtheirvjregularvjdosevjisvjnotvjasvjettective.
11. Abusevjdeterrentvjopioids:vjDesignedvjtovjpreventvjthesevjalteredvjroutesvjofvjadministration,vjwhilevjretainingvj
eflcacyvjwithvjoralvjadministrationvjforvjlegitimatevjpainvjrelief.vjHydrocodone,vjoxycontin
12. Breakthroughv j painv j management:v j Adjuvantvjmedications,vjimmediate-releasevjopioidsvjifvjnecessary
13. Howvjshouldvjavjpropervjdosevjofvjopioidvjbevjdetermined:vjConvertvjeachvjdosevjofvjopioidvjtovjMMEvj
byvjmultiplyingvjthevjdailyvjdosagevjforvjeachvjopioidvjbyvjitsvjconversionvjfactor.
14. Neuropathicvjpainvjmanagement:vjGabapentinvjorvjpregabalin,vjtransdermalvjlidocaine,vjTCA's,vjSNRI'sv
j(Duloxetine),vjgenerallyvjnovjopioids..
15. Adjunctvjandvj"other"vjmedicationsvjtovjmanagevjpain:vjAcetaminophen,vjNSAIDsvj(ifvjcanvjbevj
tolerated),vjgabapentin,vjpregabalin,vjduloxetine,vjlidocaine,vjanticonvulsants,vjcorticosteroids
16. Recommendedvjguidelinesvjforvjprescribingvjopioids:vjPrescribevjatvjthevjlowestvjettectivevjdose,v
jtaperingvjottvjwhenvjdone,vjevaluatevjrisksvjandvjbenefitsvjofvjtherapy,vjmaximizevjusevjofvjnonopioidvjtherapy,vjmonitorvjopioidsvj
andvjcountvjofvjopioids,vjeducatevjthevjpatient,vjinvolvevjptvjinvjcare
1. Endogenousvjopioidvjpeptides:vjSmallvjmoleculesvjthatvjarevjnaturallyvjproducedvjinvjthevjCNSvjandvjinvjvariousvjgla
ndsvjthroughoutvjthevjbody,vjsuchvjasvjthevjpituitaryvjandvjadrenalvjglands.vjConsistsvjofvjendorphins,vjenkephalins,vjdynorphins,vja
ndvjnociceptins.
2. Mechanismvjofvjactionvjforvjopioids:vjStimulatingvjopioidvju-receptorsvjinvjthevjCNS.vjPurevjagonistsvj(mor-
vjphine)vjbindvjtovju-
receptorsvjtovjproducevjanalgesiavjthatvjincreasesvjwithvjdosevjwithoutvjavjceilingvjettect.vjPartialvjagonistsvjatvjthevju-
receptorvj(Buprenorphine,vjtramadol)vjcausevjlessvjconformationalvjchangevjandvjreceptorvjactivationvjthanvjfullvjagonists.
3. Indicationsvjforvjinitiatingvjopioidvjtherapy:vjUsedvjwhenvjbenefitsvjoutweighvjrisksvjassociatedvjwithvj
opioidsvjsuchvjasvjabuse.vjUsedvjforvjacutevjpainvj(includingvjpost-surgical)vjfromvjundervjavjmonth,vjandvjchronicvjpain.
4. Tolerance:v j thevjdiminishingvjettectvjwithvjregularvjusevjofvjthevjsamevjdosevjofvjavjdrug,vjrequiringvjthevjuservjtovjtakevjlargerv
j andvjlargervjdosesvjbeforevjexperiencingvjthevjdrug'svjettect
5. Dependence:vjthevjconditionvjthatvjresultsvjwhenvjthevjbrainvjdevelopsvjavjchemicalvjneedvjforvjavjdrugvjandvjcannotvj
functionvjnormallyvjwithoutvjit
6. Addiction:vjAvjphysiologicalvjorvjpsychologicalvjdependencevjonvjavjdrug
7. Neuralgia:v j nervevjpain
8. Analgesia:v j Painvjrelief;vjinabilityvjtovjfeelvjpain
9. Allodynia:vjPainvjduevjtovjavjstimulusvjthatvjdoesvjnotvjnormallyvjprovokevjpain
10. Whenvjtovjinitiatevjlong-actingvjopioids:vjIfvjthevjshort-
actingvjopioidsvjarevjnotvjworkingvjasvjwellvjinvjchronicvjpainvjorvjend-of-
lifevjpain,vjorvjthevjpatientvjfeelsvjasvjthoughvjtheirvjregularvjdosevjisvjnotvjasvjettective.
11. Abusevjdeterrentvjopioids:vjDesignedvjtovjpreventvjthesevjalteredvjroutesvjofvjadministration,vjwhilevjretainingvj
eflcacyvjwithvjoralvjadministrationvjforvjlegitimatevjpainvjrelief.vjHydrocodone,vjoxycontin
12. Breakthroughv j painv j management:v j Adjuvantvjmedications,vjimmediate-releasevjopioidsvjifvjnecessary
13. Howvjshouldvjavjpropervjdosevjofvjopioidvjbevjdetermined:vjConvertvjeachvjdosevjofvjopioidvjtovjMMEvj
byvjmultiplyingvjthevjdailyvjdosagevjforvjeachvjopioidvjbyvjitsvjconversionvjfactor.
14. Neuropathicvjpainvjmanagement:vjGabapentinvjorvjpregabalin,vjtransdermalvjlidocaine,vjTCA's,vjSNRI'sv
j(Duloxetine),vjgenerallyvjnovjopioids..
15. Adjunctvjandvj"other"vjmedicationsvjtovjmanagevjpain:vjAcetaminophen,vjNSAIDsvj(ifvjcanvjbevj
tolerated),vjgabapentin,vjpregabalin,vjduloxetine,vjlidocaine,vjanticonvulsants,vjcorticosteroids
16. Recommendedvjguidelinesvjforvjprescribingvjopioids:vjPrescribevjatvjthevjlowestvjettectivevjdose,v
jtaperingvjottvjwhenvjdone,vjevaluatevjrisksvjandvjbenefitsvjofvjtherapy,vjmaximizevjusevjofvjnonopioidvjtherapy,vjmonitorvjopioidsvj
andvjcountvjofvjopioids,vjeducatevjthevjpatient,vjinvolvevjptvjinvjcare
