Pain - Opioids

14 important questions on Pain - Opioids

What type of pain are opioids most appropriate for?

Moderate-severe pain

How do opioids work?

Mu receptor agonists
Result in pain relief, euphoria and respiratory depression 

Which opioid is a partial mu-opioid agonist? It acts as an agonist at low doses and an antagonist and higher doses.

Buprenorphine
lower doses: treat pain
higher doses: treat opioid use disorder
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What schedule are most opioids?

C-II

What type of patients can the fentanyl patch and lozenge NOT be used in?

Opioid-naive patients

What patient can be converted to a fentanyl patch?

If using equivalent to morphine 60 mg/day or more for at least 7 days

Fentanyl patch counseling

Apply 1 patch q72h (can be q48)
D/c all around the clock opioids when applied
Only 1 at a time, to hairless skin
Only cover with Bioclusive or Tegaderm
Do not cover with heating pad or other bandage
Flush down toilet and keep away from kids and pets

Buprenorphine buccal film

Belbuca
Insert between gum and cheek tissue. Do not eat/drink for 30 minutes.

Why is methadone hard to dose safely?

It has a variable half life

What type of substrate is Methadone and what can it do to testosterone?

Major CYP3A4 substrate [avoid use with inhibitors or decrease methadone dose]
Can decrease testosterone -> sexual dysfunction

Why is Meperidine (Demerol) no longer recommended as an analgesic?

CNS toxicity is a risk for renally impaired and elderly.
Use for short term or single use.

Why can the metabolite of Meperidine cause CNS toxicity?

Normeperidine- renally cleared and can accumulate to cause CNS tox (including seizures)

What can be given to block the histamine-induced pruritis caused by morphine?

Diphenhydramine

Oxycodone BBW and main side effects

Starting CYP3A4 inhibitors can cause fatal overdose.
Pruritis, dry mouth, hyperhidrosis

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