CHE 360 - Opioids

Analgesia

Pain relief

Antitussant

Cough suppressant

Reduced GI motility

Preventing diarrhea

Respiratory depression

Negative side effect of opiod use and can lead to death

Miosis

Pinpoint pupils

PCA

Patient controlled analgesia machines, administered through IV and allows more patinet control and less hassle for nurses

Morphine

Used for severe pain like post surgery or terminal cancer, availible orally IV IM and rectal suppository, schedule II, given q 4hrs

MS-contin

Sustained release form of morphine, has 12 hr half life

Heroin

More lipophilic than morphine entering the brain faster when smoked or given through IV, schedule I in US

Withdrawal causes diarrhea, stomach cramping, vomiting, and nausea, and cold sweats

Hydromorphone (Dilaudid)

Has higher potency than morphine and may have less side effects (nausea, vomiting, diarrhea) for some patients, can be given PO, SC, IM, IV

Codeine

Prodrug metabolized into morphine, classified as moderate opioid, give good dental pain control, good antitussive

CYP 2D6

Enzyme responsible for converting codeine to morphine, 7% of the population lack this enzyme

Tylenol II, III, IV

Codeine combined with acetaminophen, synergistic effects acheived because of different methods of pain control, nausea and allergy somewhat common

Hydrocodone (Norco, Vicodin)

Combines with APAP or hematropine as antitussive, available as tablets or syrup, also metabolized by CYP 2D6 but turned into more potent form hydromorphone

Oxycodone (Percocet, Oxycontin)

Lower frequency of nausea and vomiting compared to morphine, Schedule II drug by itself, oxycodone + aspirin = Percocet, oxyconton = long acting bid form of oxycodone

Fentanyl (Duragesic)

Available in 3 day transdermal patches used for people who experience vomiting or cant swallow a bill, IV _____ common drug used to manage pain during childbirth, short half life so exposure to drug can be kept to a minimum

Naloxone (Narcan)

Pure opioid receptor antagonist, on someone with opiods in their system it wont cause an effect bur for frequent opiod uses it will cause instant cold turkey, available IV SC MI or nasal inhaler, effects last less than an hour

Methadone

Used to suppress withdrawal symptoms in opioid dependent individuals, still produces euphoria and physical dependence but acts slowly, since action is slow it is causing people to take repeat doses increasing respiratory depression potentially leading to death

Buprenorphine (Suboxone)

Partial mu-opiod agonist used to suppress withdrawal symptoms, binds to same receptors as other opioids but has agonist and antagonistic effects so wont stimulate to the same level, slightly more productive in treating abuse over methadone, most commonly taken as a sublingual strip Suboxone which also contains naloxone, buprenorphine used only with medical supervision, Suboxone used at home

Dextromethorphan (Robitussin)

Moderate cough suppressant without analgesic effects, low abuse potential and available OTC, can produce hallucinations in large doses

Loperamide (Imodium)

OTC anti-diarrheal, absorbed in the GI tract so generally limited to the GI tract, however in some cases if a large dose is taken they can get other effects out of it and is termed the poor mans methadone

Benzocaine

Strictly topical anesthetic, used before injections, can be found OTC as Solarcaine to help pain from sunburns, and vagisil for vaginal itching

Cocaine

Schedule II drug but is rarely prescribed, combined action as a anesthetic and vasoconstrictor make it useful in nasal and oral surgery, vasoconstriction of the nose can lead to necrosis of the issue, stimulatory effects may be due to preventing dopamine reuptake increasing levels of dopamine in the brain

Articaine

Becoming and increasingly used anesthetic in dental procedures

Epinephrine

Added to anesthetics to as a vasoconstrictor which extends duration of the numbness and causes less bleeding

Lidocaine

Local anesthetic of choice in dental offices but is getting competition from articaine