Chapter 8 - Drugs to Treat Pain: Opioid Analgesics

Because the potential risks and harms often outweigh the benefits in treating chronic pain.

Only for treating acute pain.

Binding to opioid receptors, primarily located in the central nervous system, the peripheral nervous system, and the gastrointestinal tract.

<p>It is the major analgesic opioid receptor, and its activation produces the analgesic, euphoric, and sedative effects associated with opioid addiction.</p> Signup and view all the answers

<p>Because of the first-pass effect, which reduces the bioavailability of the opioid.</p> Signup and view all the answers

<p>The onset is approximately 45 minutes, and the peak effect usually occurs 1 to 2 hours after administration.</p> Signup and view all the answers

<p>By avoiding first-pass metabolism, nasal insufflation directly delivers the opioid to the bloodstream, resulting in rapid absorption and therapeutic levels.</p> Signup and view all the answers

<p>Analgesia, euphoria, sedation, and respiratory depression.</p> Signup and view all the answers

<p>They relieve continuous dull pain more effectively than sharp, intermittent pain.</p> Signup and view all the answers

<p>Drowsiness, difficulty in mentation, apathy, and reduced physical activity.</p> Signup and view all the answers

<p>As the dose increases, the risk of fatal overdose increases.</p> Signup and view all the answers

<p>Establish and measure pain and function goals, discuss benefits and risks, recommend nonopioid therapies, start low and go slow, taper and discontinue if needed.</p> Signup and view all the answers

<p>The risk of overdose and adverse effects is higher with extended-release opioids, and they are not necessary for acute pain management.</p> Signup and view all the answers

<p>It reduces the bioavailability of opioids, meaning less of the drug reaches systemic circulation after oral administration.</p> Signup and view all the answers

<p>Physiological factors, such as blood flow and tissue permeability, and chemical factors, such as drug binding to specific receptors, all contribute to the distribution of opioids in the body.</p> Signup and view all the answers

<p>Opioids are used to provide effective pain relief after nonopioids and are categorized into low-potency and high-potency.</p> Signup and view all the answers

<p>Opioids refer to drugs or chemicals that interact with opioid receptors, while opiates are natural compounds derived from opium.</p> Signup and view all the answers

<p>Fentanyl is the opioid with extremely high potency associated with many trade names.</p> Signup and view all the answers

<p>Naloxone, marketed as Narcan, is an opioid antagonist used to reverse opioid overdoses.</p> Signup and view all the answers

<p>67.8% of drug overdose deaths involved opioids.</p> Signup and view all the answers

<p>Endogenous opioids are naturally occurring peptides that bind to opioid receptors, with beta-endorphin being a specific example.</p> Signup and view all the answers

<p>The rate increased from 6.0 to 21.7 deaths per 100,000 people.</p> Signup and view all the answers

<p>The term 'narcotic' comes from the Greek word 'narkotikos', meaning numbing or stupor.</p> Signup and view all the answers

<p>To enhance analgesic effects and achieve a synergistic outcome in certain pain states.</p> Signup and view all the answers

<p>Oxycodone and hydrocodone.</p> Signup and view all the answers

<p>8 tablets.</p> Signup and view all the answers

<p>To ensure consistent pain management and to prevent breakthrough pain episodes.</p> Signup and view all the answers

<p>Opioid-induced constipation.</p> Signup and view all the answers

<p>Addiction and life-threatening respiratory depression.</p> Signup and view all the answers

<p>They help evaluate pain complaints and identify risk factors for opioid misuse or abuse.</p> Signup and view all the answers

<p>Using the lowest effective dose for the shortest duration consistent with treatment goals.</p> Signup and view all the answers

<p>It lists characteristics of opioid addiction to help prescribers identify at-risk patients.</p> Signup and view all the answers

<p>NSAIDs and non-opioid analgesics.</p> Signup and view all the answers

<p>They should only be used for chronic pain management and not on an as-needed basis.</p> Signup and view all the answers

<p>They result from extended use, especially at higher dosages over time.</p> Signup and view all the answers

<p>Counseling on proper fluid and fiber intake to prevent constipation.</p> Signup and view all the answers

<p>Percocet.</p> Signup and view all the answers

<p>Cytochrome P450 enzymes facilitate metabolic reactions necessary for opioid metabolism in the liver.</p> Signup and view all the answers

<p>Inability to control opioid use and uncontrollable cravings are two key symptoms of OUD.</p> Signup and view all the answers

<p>Adipose tissue can accumulate opioids, especially after frequent high-dose administration, acting as a reservoir even with its lower perfusion.</p> Signup and view all the answers

<p>The WHO 3-step pain relief ladder promotes the use of conservative therapies before initiating opioid therapy.</p> Signup and view all the answers

<p>Patients with renal insufficiency risk sedation and respiratory depression when given high-potency opioids.</p> Signup and view all the answers

<p>As-needed dosing can cause fluctuations in analgesic plasma concentrations, leading to uncontrolled pain and sedation.</p> Signup and view all the answers

<p>Antidepressants may enhance morphine-induced analgesia by augmenting its effects in chronic neuropathic pain contexts.</p> Signup and view all the answers

<p>Patients with high pain tolerance may transition from opioids following surgery to anti-inflammatory medications safely.</p> Signup and view all the answers

<p>A vicious cycle occurs when wide swings in analgesic plasma concentrations necessitate increasing amounts of medication for relief.</p> Signup and view all the answers

<p>Combining opioids with drugs that have the same mechanism may lead to unnecessary increased risks without added benefit.</p> Signup and view all the answers

<p>Endogenous opioids are naturally occurring peptide ligands for opioid receptors; an example is beta-endorphin.</p> Signup and view all the answers

<p>The age-adjusted drug overdose death rate significantly increased from 6.0 deaths per 100,000 in 1999 to 21.7 in 2017.</p> Signup and view all the answers

<p>Synthetic opioids, particularly illicitly manufactured fentanyl, were involved in a significant number of overdose deaths, illustrating their potency and danger.</p> Signup and view all the answers

<p>The practice is controversial due to rising overdose rates and concerns about addiction, despite potential effectiveness for pain relief.</p> Signup and view all the answers

<p>The term 'narcotic' originates from the Greek word for 'numbing' and is often legally associated with opioids and drugs that pose addiction risks.</p> Signup and view all the answers

<p>Naloxone is an opioid antagonist used to reverse the effects of opioid overdose, providing a critical safety measure for individuals using opioid medications.</p> Signup and view all the answers

<p>Physical dependence and tolerance develop as the body adapts to the presence of opioids, requiring higher doses to achieve the same effect and leading to withdrawal symptoms upon cessation.</p> Signup and view all the answers

<p>The ladder prioritizes nonopioids first and escalates to low- then high-potency opioids, guiding clinicians to promote safer, stepwise pain management.</p> Signup and view all the answers

<p>8 tablets.</p> Signup and view all the answers

<p>Profound sedation, respiratory depression, coma, and death.</p> Signup and view all the answers

<p>Amitriptyline.</p> Signup and view all the answers

<p>It impacts patient quality of life and may necessitate additional treatments.</p> Signup and view all the answers

<p>To minimize the risk of addiction, abuse, and overdose.</p> Signup and view all the answers

<p>Every 3 to 6 hours.</p> Signup and view all the answers

<p>They should only be used for chronic pain on an around-the-clock basis.</p> Signup and view all the answers

<p>Intake of fluids and fiber, and possibly using a laxative.</p> Signup and view all the answers

<p>12 tablets, if taken as 1 tablet every 6 hours.</p> Signup and view all the answers

<p>Assessment of pain, functionality goals, and risk factors for misuse.</p> Signup and view all the answers

<p>Behavioral changes such as increased tolerance or secretive drug-seeking behavior.</p> Signup and view all the answers

<p>Tramadol and certain antidepressants.</p> Signup and view all the answers

<p>Constipation.</p> Signup and view all the answers

<p>For acute pain management.</p> Signup and view all the answers

<p>Norco.</p> Signup and view all the answers

<p>Opioid concentration in tissues is influenced by blood flow, tissue perfusion rate, and the lipophilicity of the drug.</p> Signup and view all the answers

<p>First-pass metabolism in the liver can significantly reduce the amount of active drug entering systemic circulation, potentially requiring higher doses for effect.</p> Signup and view all the answers

<p>Polar metabolites are water-soluble, allowing for their efficient elimination through the kidneys into the urine.</p> Signup and view all the answers

<p>Patients with renal insufficiency may have impaired drug clearance, which increases the risk of sedation and respiratory depression from opioids.</p> Signup and view all the answers

<p>The WHO ladder advocates for using milder analgesics before escalating to opioids, ensuring pain management starts with the least invasive treatments.</p> Signup and view all the answers

<p>Patients with high pain tolerance may effectively transition to non-opioid medications sooner, reducing reliance on opioids for pain management.</p> Signup and view all the answers

<p>A diagnosis of OUD requires at least 2 of 11 specified symptoms to be present within a 1-year period.</p> Signup and view all the answers

<p>Combination therapy can provide enhanced pain relief by pairing opioids with non-opioid analgesics while avoiding overlapping effects.</p> Signup and view all the answers

<p>'Vicious cycle' refers to the scenario where alternating pain and sedation lead to increased medication requirements and dependency.</p> Signup and view all the answers

<p>Changes in exercise habits and hygiene can indicate the impact of opioid use on a patient's overall health and lifestyle.</p> Signup and view all the answers

<p>Combining opioid therapy with nonpharmacologic interventions can enhance pain relief and improve functional outcomes while potentially reducing the required dosage of opioids.</p> Signup and view all the answers

<p>Measuring pain and functional goals prior to treatment helps clinicians tailor therapy to individual patient needs and assess treatment efficacy over time.</p> Signup and view all the answers

<p>Starting with the lowest effective dosage minimizes the risk of adverse effects and overdose while allowing for gradual adjustments based on patient response.</p> Signup and view all the answers

<p>Opioids are considered second-line therapy because nonpharmacologic and nonopioid pharmacologic treatments are generally preferred due to their lower risk of dependency and side effects.</p> Signup and view all the answers

<p>The delay, which is approximately 45 minutes for onset and 1-2 hours for peak effect, necessitates alternative routes or medications for immediate pain relief in acute situations.</p> Signup and view all the answers

<p>The CDC recommends regular follow-up to reevaluate patient risks, adjust dosages, and potentially taper or discontinue opioids if risks outweigh benefits.</p> Signup and view all the answers

<p>Psychoactive effects, such as euphoria and sedation, increase the potential for misuse and addiction as patients may seek these effects alongside pain relief.</p> Signup and view all the answers

<p>The mu-opioid receptor mediates the analgesic, euphoric, and sedative effects of opioids, and its activation is crucial for their therapeutic action.</p> Signup and view all the answers

<p>Immediate-release opioids should be prescribed only to manage acute pain, ensuring they are not used for chronic pain management or routine therapy.</p> Signup and view all the answers

<p>Reevaluation is essential to ensure that the treatment remains effective, to monitor for adverse effects, and to adjust or discontinue therapy as necessary.</p> Signup and view all the answers

<p>Pharmacokinetics, such as absorption and distribution, vary by route of administration, impacting onset and duration of pain relief and necessitating individualized treatment plans.</p> Signup and view all the answers

<p>The first-pass effect can significantly reduce bioavailability of orally administered opioids, necessitating higher doses compared to parenteral routes to achieve therapeutic effects.</p> Signup and view all the answers

<p>Prescribing extended-release or long-acting opioids for acute pain can increase the risk of overdose and dependency due to prolonged drug exposure without necessary monitoring.</p> Signup and view all the answers

<p>Combining opioids with non-opioid medications can provide more effective pain relief while reducing the dosage requirements and side effects associated with opioids.</p> Signup and view all the answers

<p>Opiate (D)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>beta-endorphin</p> Signup and view all the answers

<p>opioid receptors</p> Signup and view all the answers

<p>Synthetic opioids other than methadone (D)</p> Signup and view all the answers

<p>Codeine = Opioid, low potency Morphine = Opioid, medium potency Fentanyl = Opioid, extremely high potency Naloxone = Opioid, antagonist</p> Signup and view all the answers

<p>Naloxone (B)</p> Signup and view all the answers

<p>opium</p> Signup and view all the answers

<p>Skeletal muscle (A)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>cytochrome P450 enzymes</p> Signup and view all the answers

<p>one year</p> Signup and view all the answers

<p>Lipophilic = Able to cross cell membranes First-pass metabolism = Processing of a drug by the liver before systemic circulation Enterohepatic circulation = Reabsorption of drugs from bile back into circulation PRN dosing = Administering medication as needed</p> Signup and view all the answers

<p>Weight gain (C)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>a starting dose</p> Signup and view all the answers

<p>rapid-onset</p> Signup and view all the answers

<p>Alternating states of uncontrolled pain and sedation (A)</p> Signup and view all the answers

<p>Increased alertness (B)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>oral</p> Signup and view all the answers

<p>opioid</p> Signup and view all the answers

<p>Analgesia = Reduction or disappearance of pain Euphoria = A sense of intense well-being and pleasure Sedation = A state of calm or drowsiness Respiratory depression = Decrease in the rate and depth of breathing</p> Signup and view all the answers

<p>Start low and go slow, using the lowest effective dosage. (D)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>mu-opioid receptor (MOR)</p> Signup and view all the answers

<p>45</p> Signup and view all the answers

<p>Oral = Slower onset of effect (45 min), preferred route when possible Intravenous (IV) = Rapid onset of effect, used when oral is not feasible Intranasal (IN) = Rapid therapeutic blood levels due to avoiding first-pass metabolism Intramuscular (IM) = Moderate absorption rate, useful when IV is not available</p> Signup and view all the answers

<p>Nonpharmacologic and nonopioid pharmacologic therapies are preferred. (B)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>first-pass effect</p> Signup and view all the answers

<p>MOR</p> Signup and view all the answers

<p>Analgesic = A drug that relieves pain Agonist = A drug that binds to a receptor and produces a response Bioavailability = The extent to which a drug is absorbed and reaches the systemic circulation First-pass effect = Metabolism of a drug before it reaches the systemic circulation</p> Signup and view all the answers

<p>Norco (B)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>opioid-induced constipation</p> Signup and view all the answers

<p>ineffective</p> Signup and view all the answers

<p>Demerol = Meperidine Dilaudid = Hypromorphone Vicoprofen = Hydrocodone and ibuprofen Ultram = Tramadol</p> Signup and view all the answers

<p>Increased appetite and weight gain (A)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>antidepressants and anticonvulsants</p> Signup and view all the answers

<p>dose</p> Signup and view all the answers

<p>Meperidine = Demerol Hypromorphone = Dilaudid Oxycodone = Oxycontin Tramadol = Ultram</p> Signup and view all the answers

<p>Benzodiazepines (A)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>Tramadol</p> Signup and view all the answers

<p>fiber</p> Signup and view all the answers

<p>Hydrocodone and acetaminophen = Norco, Lortab, Vicodin Oxycodone and acetaminophen = Percocet Codeine and acetaminophen = Tylenol with codeine Hydrocodone and ibuprofen = Vicoprofen</p> Signup and view all the answers

<p>Opiate (D)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>naloxone</p> Signup and view all the answers

<p>narkotikos</p> Signup and view all the answers

<p>Opioid, low potency = Codeine Opioid, medium potency = Morphine Opioid, extremely high potency = Fentanyl Opioid, antagonist = Naloxone</p> Signup and view all the answers

<p>Synthetic opioids other than methadone (A)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>opium poppy</p> Signup and view all the answers

<p>Liver (A)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>Inability to control opioid use</p> Signup and view all the answers

<p>renal insufficiency</p> Signup and view all the answers

<p>Morphine = Chronic pain management Methadone = Pain management and opioid addiction treatment Oxycodone = Moderate to severe pain relief Fentanyl = Severe pain management</p> Signup and view all the answers

<p>To avoid withdrawal symptoms (A), To minimize side effects (C)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>They facilitate metabolic reactions.</p> Signup and view all the answers

<p>inflammatory</p> Signup and view all the answers

<p>Respiratory depression (B)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>Demerol</p> Signup and view all the answers

<p>8</p> Signup and view all the answers

<p>Oxycodone = Oxycontin Hydrocodone and acetaminophen = Percocet Codeine and acetaminophen = Tylenol with codeine Tramadol = Ultram</p> Signup and view all the answers

<p>Tolerance to opioids cannot develop. (A)</p> Signup and view all the answers

<p>True (A)</p> Signup and view all the answers

<p>Respiratory depression</p> Signup and view all the answers

<p>treatment</p> Signup and view all the answers

<p>Opioid-induced constipation (B)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>Profound sedation</p> Signup and view all the answers

<p>Opioids (C)</p> Signup and view all the answers

<p>alternative</p> Signup and view all the answers

<p>Risk of misuse</p> Signup and view all the answers

<p>Opioids should be first-line or routine therapy for chronic pain. (A)</p> Signup and view all the answers

<p>True (A)</p> Signup and view all the answers

<p>Analgesia (pain relief)</p> Signup and view all the answers

<p>opioid</p> Signup and view all the answers

<p>Analgesia = The reduction or absence of pain Euphoria = A state of euphoria or feeling of well-being Sedation = A state of calmness or drowsiness Respiratory depression = Reduced breathing rate First-pass effect = The metabolism of a drug by the liver before it reaches systemic circulation</p> Signup and view all the answers

<p>Binding to mu-opioid receptors (A)</p> Signup and view all the answers

<p>True (A)</p> Signup and view all the answers

<p>It reduces the bioavailability of the drug, often requiring a higher oral dose to achieve a therapeutic effect.</p> Signup and view all the answers

<p>Gabapentin (A)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>reduce</p> Signup and view all the answers

<p>Intravenous = IV Intramuscular = IM Subcutaneous = SQ Intranasal = IN Oral = PO</p> Signup and view all the answers

<p>Oxycodone and Hydrocodone</p> Signup and view all the answers

<p>Prescribe only the lowest effective dosage and for the shortest duration necessary. (D)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>Skeletal Muscle (D)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>liver</p> Signup and view all the answers

<p>cytochrome P450</p> Signup and view all the answers

<p>Increased libido (B)</p> Signup and view all the answers

<p>Lipophilic = Allows crossing of cell membranes to reach target tissues Polar metabolites = Excreted mainly in the urine First-pass metabolism = Occurs extensively in the liver Highly perfused tissues = Where opioids concentrate most densely</p> Signup and view all the answers

<p>Moderate and severe pain is not relieved by weaker options (D)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>as-needed (PRN)</p> Signup and view all the answers

<p>rapid-onset</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>β-endorphin</p> Signup and view all the answers

<p>narkotikos</p> Signup and view all the answers

<p>Opioid, low potency = Codeine Opioid, medium potency = Morphine Opioid, extremely high potency = Fentanyl Opioid antagonist = Naloxone</p> Signup and view all the answers

<p>67.8% (D)</p> Signup and view all the answers

<p>illicitly manufactured fentanyl</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>oral</p> Signup and view all the answers

<p>psychoactive</p> Signup and view all the answers

<p>Analgesia = Pain Relief Euphoria = Feeling of intense happiness Sedation = Calming effect, reduction of alertness Respiratory depression = Decreased rate and depth of breathing</p> Signup and view all the answers

<p>The benefits must outweigh the risks to the patient (C)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>MOR activation</p> Signup and view all the answers

<p>first-pass</p> Signup and view all the answers

<p>Oral = 45 minutes Intravenous = Rapid Intranasal = Rapid Subcutaneous = Variable</p> Signup and view all the answers

<p>Start low and go slow (A)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>natural and semisynthetic opioids and methadone</p> Signup and view all the answers

<p>opioid receptors</p> Signup and view all the answers

<p>First-pass effect = Reduces bioavailability of oral medications Delayed onset of oral medication = Not ideal when immediate relief is needed High oral dose requirement = Needed due to first-pass metabolism Risk of overdose = Increases with dose escalation</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>opioid-induced constipation</p> Signup and view all the answers

<p>ineffective</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>Shortest duration consistent with patient goals</p> Signup and view all the answers

<p>appropriate</p> Signup and view all the answers

<p>Stimulant laxatives (C)</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>Tramadol</p> Signup and view all the answers

<p>analgesic</p> Signup and view all the answers

<p>Oxycodone = Oxycodone and acetaminophen Hydrocodone = Hydrocodone and acetaminophen Tramadol = Tramadol extended release Codeine = Codeine and acetaminophen</p> Signup and view all the answers

<p>8 tablets (B)</p> Signup and view all the answers

Drugs that interact with opioid receptors in the body.

Compounds related to products found in opium.

Naturally occurring peptides in the brain that bind to opioid receptors.

A specific type of endogenous opioid peptide.

Initially referred to any drug inducing sleep, now often linked to opioids.

An extremely high potency opioid, often used in severe pain.

An opioid antagonist used to reverse opioid overdoses.

A guideline for pain management starting with nonopioids then opioids.

Most opioids undergo extensive first-pass metabolism in the liver before entering circulation.

Opioids are typically lipophilic, allowing them to cross cell membranes.

Polar metabolites of opioids are primarily excreted in urine; small amounts may remain unchanged.

Patients with renal issues should be evaluated carefully before high-potency opioids are given.

Diagnosis requires at least 2 of 11 criteria within a year for Opioid Use Disorder.

Inability to control use, cravings, drowsiness, and changes in habits are signs of OUD.

Initiate therapy based on factors like patient's renal or liver function and pain level.

Combining opioids with other analgesics can be beneficial for certain pain types.

Opioid dosing begins with a starting dose, adjusted based on pain and side effects.

Utilize rapid-onset formulations for acute pain in chronic pain patients already on opioids.

Opioids prescribed for pain relief include natural and semisynthetic types.

Recommendations by the CDC for safe opioid prescribing for chronic pain.

Opioids should not be the primary treatment for chronic pain.

Clinicians must set and evaluate goals related to pain level and functional ability.

Prescribed only for acute pain and not for chronic use.

Initiate opioid treatment with the lowest effective dose, then adjust as needed.

Opioids can produce feelings of intense happiness or euphoria.

Proteins in the CNS and body that opioids bind to for pain and pleasure effects.

The main receptor that opioid drugs activate for their analgesic effects.

Methods by which opioids can be given, including oral, IV, and others.

The reduction in bioavailability of oral opioids because of liver metabolism.

The reduction or elimination of pain experienced after opioid use.

A serious side effect of opioids where breathing becomes slower or weaker.

Acute pain is sudden and severe; chronic pain lasts longer and may be ongoing.

The effects of opioids on the body, including pain relief and side effects.

Medications that can enhance analgesic effects by blocking amine reuptake.

Drugs like gabapentin that may augment pain relief effects.

Mixing different pain medications for better efficacy.

Trade name for Meperidine, an opioid pain reliever.

Trade name for Hypromorphone, a potent opioid analgesic.

Combination of hydrocodone and acetaminophen for pain relief.

Time-released formulation of Oxycodone for acute pain management.

Combination of oxycodone and acetaminophen for pain relief.

A mix of codeine and acetaminophen for mild to moderate pain.

Specific dosing limits and schedules for opioid medications like Norco.

Sudden increase in pain despite ongoing pain management.

A common side effect of opioid use, decreasing bowel movement frequency.

Three main risks associated with opioid use: addiction, respiratory depression, and CNS depression.

The smallest dose necessary to achieve the desired therapeutic effect.

Long-term treatment involving careful opioid prescription and patient monitoring.

Opioids used in the first step of WHO's pain management ladder.

Includes opioids like Morphine, used for moderate pain.

Opioids used for severe pain; includes drugs like Oxycodone.

An illegal opioid that is highly addictive.

Tissues with high blood flow where opioids concentrate, like brain and liver.

Skeletal muscle is a reservoir for opioids but has lower concentrations.

Process in the liver that reduces the concentration of opioids before they enter circulation.

Enzymes necessary for metabolizing opioids in the liver.

Drug byproducts excreted mainly in urine after opioid use.

A condition requiring at least 2 of 11 criteria showing addiction-like symptoms.

Includes drowsiness, cravings, and isolation from loved ones.

Guideline suggesting starting with non-opioids before strong opioids for pain management.

Adjusting opioid doses based on patient pain levels and side effects.

Using opioids with other analgesics for better pain control, especially for breakthrough pain.

Treatment methods that do not involve medications, such as physical therapy or acupuncture.

Ongoing pain that lasts for months or years, often resistant to treatment.

Evaluating if the benefits of opioid therapy outweigh the potential risks.

Recommendations by the CDC to promote safe prescribing of opioids.

Regular assessments to evaluate the effectiveness and risks of opioid therapy.

Gradually reducing opioid dosage to lower dependence and manage side effects.

Feelings of happiness or pleasure that can occur with opioid use.

How the body absorbs, distributes, metabolizes, and excretes opioid medications.

Decreased breathing rate and effectiveness, a serious side effect of opioids.

Process by which opioids attach to receptors in the body to exert effects.

Formulations designed to release medication over a longer period for chronic pain.

Assessment for undesirable side effects from opioid use, essential for patient safety.

Combining medications like antidepressants and anticonvulsants enhances pain relief.

Regular opioid dosing schedule to manage persistent pain effectively.

Opioids dosed consistently for chronic pain, not as needed.

A significant decrease in bowel movement due to opioid use.

Severe safety warnings on opioid medications due to risks.

Prior assessment of a patient's history before prescribing opioids.

Using the smallest dose needed to achieve the desired pain relief.

Regular checks on patients for signs of opioid misuse or addiction.

Opioids may be prescribed cautiously for chronic pain not linked to cancer.

Thorough evaluation of pain complaints before opioid prescriptions.

Customizing opioid doses based on patient's past treatments and risks.

Risks when using opioids with CNS depressants or benzodiazepines.

Evaluating patients’ goals regarding pain and functionality before treatment.

Comprehensive approaches for treating long-term pain, including opioids.

A low potency opioid used for mild pain relief.

A medium potency opioid used for moderate to severe pain.

Opioids can accumulate in fatty tissues, especially with frequent high doses.

Signs include inability to control use, cravings, and isolation.

Guideline recommending stepwise treatment from non-opioids to opioids based on pain severity.

Opioids mixed with other analgesics for better pain management.

Considerations of a patient’s history to prevent abuse of opioids.

Potential for addiction and physical dependence on opioid medications.

Total daily dosage of Norco should not exceed 8 tablets.

The use of opioids to treat pain when benefits outweigh risks.

Intense feelings of happiness that can occur with opioid use.

A method of delivering opioids in the lower body through the epidural space.

Using opioids alongside nonopioid therapies for comprehensive pain management.

A medium potency opioid used for pain relief.

A medium potency opioid, often used in hospitals for pain.

Natural opioid peptides produced by the brain that help relieve pain.

Recommendations promoting safe opioid prescribing for chronic pain management.

Opioids should not be the primary treatment for chronic pain.

Utilizing opioids for immediate pain relief in short-term situations.

Opioids can build up in adipose tissue, affecting drug effects over time.

Caution is needed when prescribing high-potency opioids to patients with kidney issues.

Dosing starts low and is adjusted based on pain relief and side effects such as sedation.

Using opioids with other analgesics to enhance pain relief, especially for chronic pain.

Adjusting the opioid dose based on individual patient pain levels and side effects.

Antidepressants can enhance the analgesic effects of opioids for better chronic pain management.

A narcotic analgesic used for moderate to severe pain management.

Usual adult dosage of Norco is 1-2 tablets every 4-6 hours, with limits.

Man-made opioids, often more potent, e.g., Fentanyl.

Skeletal muscle serves as a major reservoir for opioids despite lower concentrations.

Starts with a dose that is adjusted based on the patient's pain and side effects.

Dosing schedule where medication is taken only when needed for pain relief.

Recommendations for safer opioid prescribing in chronic pain.

Potential harms include addiction and overdose.

Includes analgesia, euphoria, sedation, and respiratory depression.

Methods include oral, IV, IN, SQ, and others.

Clinicians should regularly reassess pain management and risks.

Evaluate patient's history for tailored opioid dosage.

Regular checks for undesirable side effects from opioid use.

Goals set for pain management and functional ability.

Using opioids with other analgesics to enhance pain control.