NR293- Pharmacology- Week 2/Unit 3- Pain: Opioid Analgesics
| UPDATED Questions with 100% Verified Answers
Nightingale College • BSN 315
Q1: Opioids are classified under which category related to their mechanism of action? Anti-infectives
Agonists Immunosuppressants Antagonists
A: Agonists The classification of opioids is agonist because they compete with endogenously occurring opioid peptides
to alter the perception of, and response to, pain. Opioids are not antagonists, immunosuppressants, or anti-infectives.
Q2: When an opioid overdose occurs, which medication should be administered first? Activated charcoal
Naloxone Atropine Aspirin
A: Naloxone Naloxone should be administered first with an opioid overdose. Naloxone is a reversal agent for opioids
that works quickly when administered nasally or by injection. Activated charcoal works in the gastrointestinal system
to absorb harmful substances and may be used after naloxone to bind any ingested opioids that have not been
absorbed. Atropine and aspirin will not offset the effects of an opioid overdose and should not be administered.
Q3: The therapeutic effects of opioid analgesics include which items? Select all that apply.
A: Pain relief Altered pain perception
Q4: Decreased inflammation Diarrhea prevention Fever reduction Pain relief Altered pain perception
A: Opioid analgesics provide pain relief and alter the perception of pain. Opioid analgesics do not decrease
inflammation, reduce fever, or prevent diarrhea; however, the mechanism of action of an opiate does slow GI motility,
making them an option for treating diarrhea.
Q5: How Opioids Work
A: Opioid Mechanism of Action: -Agonists that bind to opiate receptors in the central nervous system (CNS). -Block
naturally occurring opioid peptides (enkephalins and endorphins) to alter pain perception and response. Additional
Action: -Opioids interfere with sodium and calcium transmission at nerve endings, reducing the strength of the pain
signal sent to the brain.
, Q6: Use, Effect, and Administration
A: Primary Use: -Moderate to severe pain management. Other Uses: -Cough suppression (e.g., codeine) -Stopping
diarrhea (e.g., loperamide) -General anesthesia (e.g., fentanyl) Addictive Nature: -Use opioids only when other pain
relief options (e.g., topical, OTC) are ineffective. Administration Routes: -Oral, subcutaneous, intramuscular,
intravenous, rectal, and epidural. -Most common: Oral, intramuscular, intravenous. SEE IMAGE: Visual
representation of the order in which pain medications should be prescribed, starting with topical analgesics, then
adding over-the-counter medications (acetaminophen and non-steroidal anti-inflammatory drugs [NSAIDs]), and
finally opioid analgesics. The goal is to treat pain with the least invasive and safest medications first.
Q7: Mechanism of Action
A: Opioid analgesics are further classified by their mechanism of action of agonists, which bind to opioid pain receptors
in the central nervous system (CNS) to alter and reduce the sensation of pain. Opioids act as an agonist of opioid
peptides of enkephalins and endorphins to alter and reduce the sensation of pain.
Q8: Contraindications and Adverse Effects
A: Contraindications - Do Not Use If: -Known drug allergy -Severe asthma or respiratory insufficiency (alterations in
breathing) Use With Caution If: -Respiratory insufficiency -Elevated intracranial pressure (altered cognition) -Obesity
or sleep apnea -Undiagnosed abdominal pain -Liver disease (altered metabolism) -History of addiction -Older adults
-Paralytic ileus -Pregnancy Adverse Effects: -CNS depression -Respiratory depression -Nausea and vomiting
-Urinary retention -Pupil constriction -Constipation -Itching
Q9: Drug-to-Drug Interactions
A: Increased CNS Depression: -CNS depression is increased when opioids are taken with: ---Alcohol ---Antihistamines
---Antidepressants ---Sedatives/hypnotics ---Phenothiazines ---Monoamine oxidase inhibitors (MAOIs) Precipitate
Opioid Withdrawal: -Partial-antagonist opioids can cause withdrawal symptoms in clients with opioid dependence.
These include: ---Buprenorphine ---Butorphanol ---Nalbuphine (also decreases the analgesic effect of opioids)
Caution! -Concurrent use of opioids with MAOIs and procarbazine can lead to paradoxical or fatal reactions. -Clients
using MAOIs must wait 14 days after their last opioid dose before taking these drugs.
Q10: Opioid Medications: Fentanyl
A: Indication -Used to supplement anesthesia and control pain. Available Forms -Parenteral (Intramuscular,
Intravenous) -Transdermal patch -Transmucosal (Buccal tablet, Sublingual spray, Lozenge) Metabolism -Metabolized
by the liver, primarily by CYP3A4 enzyme. -10-25% excreted unchanged by the kidneys. -Crosses the placenta and
found in breast milk—Not recommended during pregnancy or lactation. Pharmacokinetics/Dosing Info -Intramuscular
(IM): ---Onset: 7–15 minutes ---Peak: 20–30 minutes ---Duration: 1–2 hours -(Pre-op) Dosing: ---Dose: 50–100 mcg
---Frequency: Once ---Note: IM not routinely used for pain management -Intravenous (IV): ---Onset: 10–15 minutes
---Peak: 30–50 minutes ---Duration: 2–4 hours -(Analgesia) Dosing: ---Dose: 0.5–1 mcg/kg/dose ---Frequency: As
needed, may repeat after 30–60 minutes -Transdermal: ---Onset: 6 hours ---Peak: 12–24 hours ---Duration: 72 hours
-Dosing: ---Initial Dose: 25 mcg/hr ---Frequency: 48–72 hours -Buccal tablet: ---Onset: 15 minutes
| UPDATED Questions with 100% Verified Answers
Nightingale College • BSN 315
Q1: Opioids are classified under which category related to their mechanism of action? Anti-infectives
Agonists Immunosuppressants Antagonists
A: Agonists The classification of opioids is agonist because they compete with endogenously occurring opioid peptides
to alter the perception of, and response to, pain. Opioids are not antagonists, immunosuppressants, or anti-infectives.
Q2: When an opioid overdose occurs, which medication should be administered first? Activated charcoal
Naloxone Atropine Aspirin
A: Naloxone Naloxone should be administered first with an opioid overdose. Naloxone is a reversal agent for opioids
that works quickly when administered nasally or by injection. Activated charcoal works in the gastrointestinal system
to absorb harmful substances and may be used after naloxone to bind any ingested opioids that have not been
absorbed. Atropine and aspirin will not offset the effects of an opioid overdose and should not be administered.
Q3: The therapeutic effects of opioid analgesics include which items? Select all that apply.
A: Pain relief Altered pain perception
Q4: Decreased inflammation Diarrhea prevention Fever reduction Pain relief Altered pain perception
A: Opioid analgesics provide pain relief and alter the perception of pain. Opioid analgesics do not decrease
inflammation, reduce fever, or prevent diarrhea; however, the mechanism of action of an opiate does slow GI motility,
making them an option for treating diarrhea.
Q5: How Opioids Work
A: Opioid Mechanism of Action: -Agonists that bind to opiate receptors in the central nervous system (CNS). -Block
naturally occurring opioid peptides (enkephalins and endorphins) to alter pain perception and response. Additional
Action: -Opioids interfere with sodium and calcium transmission at nerve endings, reducing the strength of the pain
signal sent to the brain.
, Q6: Use, Effect, and Administration
A: Primary Use: -Moderate to severe pain management. Other Uses: -Cough suppression (e.g., codeine) -Stopping
diarrhea (e.g., loperamide) -General anesthesia (e.g., fentanyl) Addictive Nature: -Use opioids only when other pain
relief options (e.g., topical, OTC) are ineffective. Administration Routes: -Oral, subcutaneous, intramuscular,
intravenous, rectal, and epidural. -Most common: Oral, intramuscular, intravenous. SEE IMAGE: Visual
representation of the order in which pain medications should be prescribed, starting with topical analgesics, then
adding over-the-counter medications (acetaminophen and non-steroidal anti-inflammatory drugs [NSAIDs]), and
finally opioid analgesics. The goal is to treat pain with the least invasive and safest medications first.
Q7: Mechanism of Action
A: Opioid analgesics are further classified by their mechanism of action of agonists, which bind to opioid pain receptors
in the central nervous system (CNS) to alter and reduce the sensation of pain. Opioids act as an agonist of opioid
peptides of enkephalins and endorphins to alter and reduce the sensation of pain.
Q8: Contraindications and Adverse Effects
A: Contraindications - Do Not Use If: -Known drug allergy -Severe asthma or respiratory insufficiency (alterations in
breathing) Use With Caution If: -Respiratory insufficiency -Elevated intracranial pressure (altered cognition) -Obesity
or sleep apnea -Undiagnosed abdominal pain -Liver disease (altered metabolism) -History of addiction -Older adults
-Paralytic ileus -Pregnancy Adverse Effects: -CNS depression -Respiratory depression -Nausea and vomiting
-Urinary retention -Pupil constriction -Constipation -Itching
Q9: Drug-to-Drug Interactions
A: Increased CNS Depression: -CNS depression is increased when opioids are taken with: ---Alcohol ---Antihistamines
---Antidepressants ---Sedatives/hypnotics ---Phenothiazines ---Monoamine oxidase inhibitors (MAOIs) Precipitate
Opioid Withdrawal: -Partial-antagonist opioids can cause withdrawal symptoms in clients with opioid dependence.
These include: ---Buprenorphine ---Butorphanol ---Nalbuphine (also decreases the analgesic effect of opioids)
Caution! -Concurrent use of opioids with MAOIs and procarbazine can lead to paradoxical or fatal reactions. -Clients
using MAOIs must wait 14 days after their last opioid dose before taking these drugs.
Q10: Opioid Medications: Fentanyl
A: Indication -Used to supplement anesthesia and control pain. Available Forms -Parenteral (Intramuscular,
Intravenous) -Transdermal patch -Transmucosal (Buccal tablet, Sublingual spray, Lozenge) Metabolism -Metabolized
by the liver, primarily by CYP3A4 enzyme. -10-25% excreted unchanged by the kidneys. -Crosses the placenta and
found in breast milk—Not recommended during pregnancy or lactation. Pharmacokinetics/Dosing Info -Intramuscular
(IM): ---Onset: 7–15 minutes ---Peak: 20–30 minutes ---Duration: 1–2 hours -(Pre-op) Dosing: ---Dose: 50–100 mcg
---Frequency: Once ---Note: IM not routinely used for pain management -Intravenous (IV): ---Onset: 10–15 minutes
---Peak: 30–50 minutes ---Duration: 2–4 hours -(Analgesia) Dosing: ---Dose: 0.5–1 mcg/kg/dose ---Frequency: As
needed, may repeat after 30–60 minutes -Transdermal: ---Onset: 6 hours ---Peak: 12–24 hours ---Duration: 72 hours
-Dosing: ---Initial Dose: 25 mcg/hr ---Frequency: 48–72 hours -Buccal tablet: ---Onset: 15 minutes
