Opioid Treatment

strong opioid agonistIVundergoes significant first pass metabolism when taken orally

= constrictionexception: Meperidine

increased tone

cause "serotonin syndrome"

strong opioid agonistrapid onset, short durationIV100x more potent than morphineused during labor, as preanesthetic, and for pre-, intra-, post-op, & breakthru paincan use for "balanced anesthesia" (ie to supplement the analgesia and sedative-hypnotic effects of NO and halothane)Fentanyl + droperidol = Innovar (induces neuroleptanalgesia, permitting wakeful state when cooperation is needed during surgery)can be given in transdermal patch or lollipop for breakthru pain

on rapid IV administration

weak opioid agonistalso Oxycodone, Hydrocodone, Dihydrocodeinegets its analgesic activity from conversion to morphine (10% is converted)good oral bioavailability (unlike morphine)less respiratory depression than morphinehydrocodone + acetaminophen = Vicodin/Lortaboxycodone + acetaminophen = Percocetoxycodone + aspirin = Percodan

less than morphine

strong opioid agonistno effect on cough reflexlargely replaced by other opioids

due to formation of N-demethylated metabolite (normeperidine) -- no analgesic activity

less than with morphine

less than with morphine

d/t weak anticholinergic activitynote: this is OPPOSITE from what you would expect with an opioid!

"serotonin syndrome"severe restlessnessexcitementfeverseizuresdelirium

for neuropathic painenhances 5-HT and NE neurotransmission by blocking reuptake (makes you happier)actions partially reversed by naloxoneNO effect on respiration

CONTRAINDICATED IN PATIENTS WITH EPILEPSY OR PATIENTS TAKING MAOI'S (lower seizure threshold)

for moderate pain (has analgesic ceiling)resistant to naloxone reversal

CONTRAINDICATED FOR MI's

for moderate pain (has analgesic ceiling)resistant to naloxone reversal

very high dose

less constipating effect than codeineno analgesic activityno dependence riskAE:dizzinessnauseadrowsiness

less constipating than codeineno analgesic activityno dependence risk

weak opioid agonistminimal dependence riskcombined with atropine to decrease misuse by IV route

weak opioid agonistminimal dependence riskpoorly absorbeddoesn't cross BBB

for dyspnea associated with acute pulmonary edema secondary to acute left ventricular failure

morphine's ability to relieve SOB is due to:1) decreased peripheral RESISTANCE2) slowing of RESPIRATION3) relief from ANXIETY

both are pure competitive opioid antagonists --> can preciptate opioid withdrawal

to reverse opiod overdose and toxicityshort duration of action (so you need to maintain vigilance around the patient - they might go back into opioid-induced respiratory depression)only partially reverses tramadoldoesn't reverse pentazocine or buphrenorphine at all

to dx opioid dependencecan also reduce craving for alcoholNaltrexone + Clonidine or Buprenorphine = rapid opioid detox

strong opioid agonistorallong duration, so less severe withdrawal syndromealso has good analgesia for cancer and neuropathic paincross tolerance decreases heroin's reinforcing propertiesno euphoria

in addition to analgesia, also tx opioid addictionsafer and as effective as methodonealso used to tx depresion and in smoking cessation programs

strong opioid agonistmore lipid soluble and faster acting than morphineeuphoria