Opioids

Opioids - effects

RS, CVS, GI, Eye, CNS

RS - Cough suppressant

CVS - Brady

GI - Spasm(increase tone)

Eye - Miosis (EW nucleus)

CNS - sedation , seizures

Exceptions of opioid CVS effects

(Mn - TRAMpoline MEla PEN)

Cause tachycardia

TRAMadol

MEperidine

PENtazocaine

Opioid tolerance

& Exceptions (Mn- Mi > C A S E )

Tolerance - rapid to Euphoria

Mi-osis

Constipation, Convulsions

Analgesia

Sedation

Emesis

Reverse opioid tolerance

Ketamine

Rx to post anaesthetic/ infusion related shivering

Meperidine/ pathidine

Fentanyl analogies

(SU R AL - “fentanyl” )

SUfentanyl

REMIfentanyl

ALfentanyl

Fentanyl - effects on RS CVS , Hep & renal

RS - minimal histamine release : ✅ Br. As.

CVS - minimal cardiac depression : ✅ cardiac / hemodynamically unstable pt

Hep & renal : ✅ failures

Wooden chest syndrome

High dose of FENTANYL

Chest wall rigidity

Ventilation difficulty

Rx: NM blockers, Opioid ant.

Mu opioid based agonist ( less ADR)

GPCR with beta arresting pathway

OLICERIDINE

Buprenorphine - MOA

Partial agonist @ Mu

Antagonist @ kappa , delta

Opioid withdrawl syndrome - Rx

Opioid use disorder - Rx

(Mn - BU M)

Buprenorphine

Methadone - full Mu agonist

(Reduce cravings)

Safe opioids in Biliary colic / Abd pain

Buprenorphine

Pentazocaine

NMDA receptor antagonist & GABA - A enchancer

(Receptors ends with ‘A’ drug starts with ‘A’ )

Acamprostate