Opioid Analgesics: Pharmacology, Uses, Adverse Effects & Dosing

Morphine: brand name

MS Contin / Kadian / Avinza / Duramorph

MS Contin: generic name

Morphine

Kadian: generic name

Morphine

Avinza: generic name

Morphine

Duramorph: generic name

Morphine

Morphine: drug class

Naturally occurring full mu agonist

Morphine: main use

Moderate-to-severe pain (the reference opioid)

Morphine: top 3 ADRs

Constipation, Respiratory depression, Pruritus (histamine release)

Morphine: How it is cleared

Glucuronidation (no CYP)

Morphine: Equianalgesic dose IV / PO

10 mg IV / 30 mg PO

Morphine: Is the itching an allergy

No, it is histamine release; treat with an antihistamine

Codeine: brand name

Tylenol #3 / Tylenol #4

Tylenol #3: generic name

Codeine

Tylenol #4: generic name

Codeine

Codeine: drug class

Naturally occurring opioid (prodrug)

Codeine: main use

Mild-to-moderate pain

Codeine: top 3 ADRs

Constipation, Pruritus, Nausea

Codeine: Enzyme that activates it

CYP2D6 (turns it into morphine)

Codeine: % of people it does not work in

About 10% (lack CYP2D6)

Codeine: Ceiling dose

60 mg per dose

Hydromorphone: brand name

Dilaudid

Dilaudid: generic name

Hydromorphone

Hydromorphone: drug class

Semisynthetic full mu agonist

Hydromorphone: main use

Severe pain; SC infusion

Hydromorphone: top 3 ADRs

Constipation, Respiratory depression, Sedation

Hydromorphone: How it is cleared

Glucuronidation (no CYP)

Hydromorphone: Why it suits SC infusion

High potency

Hydromorphone: Equianalgesic dose IV / PO

1.5 mg IV / 7.5 mg PO

Hydrocodone: brand name

Norco / Vicodin / Lortab / Lorcet

Norco: generic name

Hydrocodone

Vicodin: generic name

Hydrocodone

Lortab: generic name

Hydrocodone

Lorcet: generic name

Hydrocodone

Hydrocodone: drug class

Semisynthetic full mu agonist

Hydrocodone: main use

Moderate pain

Hydrocodone: top 3 ADRs

Constipation, Sedation, Nausea

Hydrocodone: What it always comes combined with

Acetaminophen or ibuprofen

Hydrocodone: What limits its daily dose

The acetaminophen/ibuprofen in the combination

Oxycodone: brand name

OxyContin / OxyIR / OxyFast / Roxicodone

OxyContin: generic name

Oxycodone

OxyIR: generic name

Oxycodone

OxyFast: generic name

Oxycodone

Roxicodone: generic name

Oxycodone

Oxycodone: drug class

Full mu agonist

Oxycodone: main use

Moderate-to-severe pain

Oxycodone: top 3 ADRs

Constipation, Respiratory depression, Sedation

Oxycodone: Effect of alcohol

Increases oxycodone bioavailability

Oxycodone: Active metabolite

Oxymorphone

Oxycodone: Organ disease needing caution

Liver disease

Oxycodone: Equianalgesic PO dose

20 mg

Oxymorphone: brand name

Opana / Numorphan

Opana: generic name

Oxymorphone

Numorphan: generic name

Oxymorphone

Oxymorphone: drug class

Full mu agonist

Oxymorphone: main use

Severe pain

Oxymorphone: top 3 ADRs

Constipation, Sedation, Respiratory depression

Oxymorphone: How to take it with food

1 hour before or 2 hours after eating

Oxymorphone: Drugs that increase its effect

Cimetidine and MAOIs

Fentanyl: brand name

Duragesic / Actiq

Duragesic: generic name

Fentanyl

Actiq: generic name

Fentanyl

Fentanyl: drug class

Synthetic full mu agonist

Fentanyl: main use

Chronic pain in opioid-tolerant patients; breakthrough cancer pain

Fentanyl: top 3 ADRs

Respiratory depression, Wooden chest syndrome, Hypotension

Fentanyl: Who must never get it

Opioid-naive patients

Fentanyl: Definition of opioid-tolerant

At least 60 mg oral morphine-equivalents/day for at least 1 week

Fentanyl: What the patch needs to work

Subcutaneous fat

Fentanyl: How it is metabolized

CYP3A4 (never given as an oral pill)

Fentanyl: Patch conversion to oral morphine

Patch strength x 2 = daily oral morphine (mg)

Fentanyl: Only use for buccal/lozenge form

Breakthrough cancer pain in opioid-tolerant patients

Methadone: brand name

Dolophine / Methadose

Dolophine: generic name

Methadone

Methadose: generic name

Methadone

Methadone: drug class

Synthetic mu agonist + NMDA antagonist + SNRI-like

Methadone: main use

Chronic pain and opioid use disorder

Methadone: top 3 ADRs

QT prolongation / torsades, Respiratory depression, Constipation

Methadone: Its 3 mechanisms

Mu agonist, NMDA antagonist, SNRI-like

Methadone: How it is metabolized

CYP3A4, no active metabolites

Levorphanol: brand name

Levo-Dromoran

Levo-Dromoran: generic name

Levorphanol

Levorphanol: drug class

Synthetic mu agonist

Levorphanol: main use

Chronic pain

Levorphanol: top 3 ADRs

Constipation, Sedation, Respiratory depression

Levorphanol: Which drug it is like

Methadone

Meperidine: brand name

Demerol

Demerol: generic name

Meperidine