Nagelhout Pharm 1-Exam 3 Cause of urinary retention with opioids - ANSWER-Smooth muscle spasm Antidiuretic effect
First drug choice for anti-shivering? - ANSWER-Meperidine (Demerol)
Acute skeletal muscle effects of opioids - ANSWER-Muscle rigidity of chest wall, contraction of pharyngeal and laryngeal muscles
Cause of skeletal muscle rigidity with opioids - ANSWER-1. Large doses
- Given rapidly
- Concurrent use of N2O
- Older age
- Absence of muscle relaxants
Associated with: *Alfentanil, *Remifentanil, Sufentanil, Fentanyl
Treatment for chest wall rigidity - ANSWER-Neuromuscular blocker
Acute dermatologic effects of opioids - ANSWER-Rash, itching, warmth R/t mu receptors more than histamine release
Cause of tolerance in opioids - ANSWER-Down regulation (starts within 24 hours)
Analgesic mechanism of action of opioids - ANSWER-Actives opioid receptors on pre- synaptic "pain pathway" nerve → prevents release of substance P (or bradykinin/acetylcholine) to post-synaptic nerve
Analgesic mechanism of action of endogenous endorphins - ANSWER-Endorphins released from pre-synaptic "pain relieving" nerve → pre-synaptic "pain producing nerve" → prevents release of substance P (or bradykinin/acetylcholine) to post-synaptic nerve
- classes of opiate receptors - ANSWER-1. Mu µ
- Kappa κ
- Delta δ
Mu receptors effects (11) - ANSWER-1. Analgesia (supraspinal and spinal) (Mu-1 in animals)
- Euphoria & sedation
- Physical dependence
- Depression of respirations (Mu-2 in animals) 1 / 2
- Miosis
- Constipation
- Urinary retention
- Bradycardia
- Pruritus
- Skeletal rigidity
- Biliary spasm
Kappa receptor effects (6) - ANSWER-1. Analgesia (spinal & supraspinal)
2. DYSPHORIA
- Sedation
- Low abuse potential
- Miosis
6. ANTI-SHIVERING
General Cardiac Effects of Opiates - ANSWER-Little to no effect Minimal bradycardia Effects more pronounced in shock or ambulating patients
Groups of Endogenous Opioid Peptides (5) - ANSWER-1. Enkephalins
- Leu-enkephalin
- Met-enkephalin
- β -Endorphin
- Dynorphins
- Dynorphin
- α-Neoendorphin
- Endomorphin 1 and Endomorphin 2
- Nociceptin
Precursor to Enkephalins - ANSWER-Proenkephalin A
Precursor to β-Endophins - ANSWER-Pro-opiomelanocortin (Pro-OMC)
Precursor to Dynorphins - ANSWER-Prodynorphin
Precursor to Endomorpins 1 & 2 - ANSWER-Unknown
Precursor to Nociceptin - ANSWER-Pronociceptin
Location of endogenous opioid peptides - ANSWER-Brain & Spinal cord (second highest concentration in GI)
Delta receptor effects (5) - ANSWER-(AUGMENTS MU & KAPPA EFFECTS)
- Analgesia (supraspinal and spinal)
- Physical dependence
- / 2