Pain Management and Opioids

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Questions and Answers

What are the primary classes of analgesics mentioned in the text?

Antidepressants, antipsychotics, anxiolytics, anticonvulsants

Antibiotics, antivirals, antifungals, antiparasitics

Steroids, antihistamines, muscle relaxants, benzodiazepines

Acetaminophen, NSAIDs, opioids, medications for neuropathic pain (correct)

What is MAT in the context of opioid use disorder management?

Medication Analysis and Testing for drug abuse

Medication Application and Therapy for chronic pain

The use of medications to treat persons with opiate use disorder (correct)

Medication-Assisted Treatment for mental health disorders

What are the characteristic pharmacologic effects of different opioid receptors?

Bronchodilation, vasodilation, increased heart rate, and diuresis

Analgesia, respiratory depression, sedation, and euphoria (correct)

Muscle relaxation, anxiolysis, antiemesis, and cognitive impairment

Antipyresis, anti-inflammatory effects, platelet aggregation, and vasoconstriction

What is the goal of pain management according to the text?

To alleviate pain and improve quality of life Signup and view all the answers

What is the correct dosing strategy for managing breakthrough pain during around the clock (ATC) opioid dosing?

Increase the dose or decrease the interval of the scheduled pain medicine Signup and view all the answers

What is the recommended approach for managing end-of-dose pain during opioid medication?

Increasing the dose or decreasing the interval of the scheduled opioid medication Signup and view all the answers

What is the effect of parenteral administration of opioids within 2-4 hours of delivery on the neonate?

May lead to transient respiratory depression in the neonate Signup and view all the answers

What is the recommended approach for managing predictable incident pain in patients?

Using a short-acting opioid 30 to 45 minutes prior to activity Signup and view all the answers

Which medication is considered a first-line treatment for neuropathic pain?

Amitriptyline Signup and view all the answers

Which medication is considered a second-tier guideline therapy for neuropathic pain?

Carbamazepine Signup and view all the answers

What is the recommended approach for managing breakthrough pain with a neuropathic origin?

Consider nonopioid analgesics such as anticonvulsants Signup and view all the answers

What is the correct strategy for managing breakthrough pain in opioid-tolerant patients?

Start with the lowest dose and only use in opioid tolerant patients Signup and view all the answers

Which opioid receptor do opiate agonists primarily bind to?

Mu opioid receptor Signup and view all the answers

What is the main physiological effect of opiate/opioid agonists?

Respiratory depression Signup and view all the answers

Which opioid is derived from the opium poppy plant and is considered a prototypical full mu agonist?

Morphine Signup and view all the answers

What is the active metabolite of morphine that is formed in the liver?

Morphine 6-glucuronide Signup and view all the answers

Which opioid is known for its potency, being more potent than morphine?

Hydromorphone Signup and view all the answers

Which opioid is associated with the risk of accumulation of its active metabolite, normeperidine, leading to neuro excitation and seizures?

Meperidine Signup and view all the answers

Which opioid is a controlled-release formulation of oxycodone, dosed every 12 hours?

Oxycontin Signup and view all the answers

What is the main physiological effect of opioid overdose?

Respiratory depression Signup and view all the answers

What is the peak onset time for intrathecal administration of morphine?

90 minutes Signup and view all the answers

Which opioid is known for its potency and is available as a transdermal patch for continuous pain management?

Fentanyl Signup and view all the answers

What is the primary mechanism of action of opiate agonists in exerting analgesic effects?

Binding to mu opioid receptors Signup and view all the answers

Which opioid is commonly used for the treatment of diarrhea due to its antidiarrheal effects?

Loperamide Signup and view all the answers

Which type of pain is caused by nerve damage or persistent stimulation?

Neuropathic pain Signup and view all the answers

What is the main site of painful stimuli in nociceptive pain?

Peripheral nociceptive receptors Signup and view all the answers

What is the primary organ for the metabolism of acetaminophen?

Liver Signup and view all the answers

What is the mechanism of action of NSAIDs?

Decreasing prostaglandin synthesis Signup and view all the answers

What is a potential adverse effect of NSAIDs on the gastrointestinal system?

Gastritis Signup and view all the answers

Which receptors do opioids act on to provide analgesia?

Mu, delta, and kappa receptors Signup and view all the answers

What is the term for natural opioids such as heroin, morphine, and codeine?

Opiates Signup and view all the answers

What is the primary use of opioids in pain management?

Providing analgesia Signup and view all the answers

Which type of pain has different physiological and psychological components for acute and chronic forms?

Chronic pain Signup and view all the answers

What is the primary class of drugs used for severe pain in pain management?

Opioids Signup and view all the answers

What is the potential consequence of high doses of acetaminophen?

Hepatotoxicity Signup and view all the answers

What is a characteristic of chronic nociceptive pain?

Often caused by nerve damage Signup and view all the answers

What is the long half-life of methadone?

24 hours Signup and view all the answers

Which opioid is used for acute pain but increases cardiac work, requiring caution in CHF patients?

Butorphanol Signup and view all the answers

What are Sublocade and Probuphine?

Long-acting buprenorphine products for OUD Signup and view all the answers

What is the main use of naloxone and naltrexone?

Opioid dependence treatment Signup and view all the answers

What are abuse deterrent formulations of opioids designed to deter?

Misuse Signup and view all the answers

What is a potential consequence of high doses of acetaminophen?

Hepatotoxicity Signup and view all the answers

What are the distinct phenomena related to opioids?

Tolerance, dependence, and addiction Signup and view all the answers

What is the primary goal of NPs and PAs prescribing buprenorphine for OUD?

Prescribe for up to 30 patients Signup and view all the answers

What is the main concern with recent use of buprenorphine as Suboxone?

Dental decay and cavities Signup and view all the answers

What are the potential adverse effects of opioids?

Respiratory depression and opioid-induced constipation Signup and view all the answers

What is the primary use of tramadol, tapentadol, and dextromethorphan?

Analgesia and antitussive purposes Signup and view all the answers

What are the primary uses of naloxone and naltrexone?

Opioid overdose and addiction treatment Signup and view all the answers

Study Notes

Pain Management Overview

Types of pain include nociceptive, neuropathic, acute, and chronic
Nociceptive pain can be somatic or visceral, with painful stimuli at the site of injury stimulating peripheral nociceptive receptors
Neuropathic pain is difficult to treat and often chronic, caused by nerve damage or persistent stimulation
Acute and chronic pain have different physiological and psychological components
Pain management involves the use of analgesics, including nonopioids like acetaminophen and NSAIDs, as well as opioids for severe pain
Acetaminophen is metabolized in the liver, has a ceiling dose for analgesia, and can cause hepatotoxicity in high doses
NSAIDs decrease prostaglandin synthesis and are used for multiple types of pain, with various drugs and dosages available
NSAIDs have adverse effects including gastritis, ulceration, and decreased renal blood flow, and can interact with other medications
NSAIDs carry FDA warnings for potential serious adverse cardiovascular and gastrointestinal events
Opioids act on mu, delta, and kappa receptors, providing analgesia, euphoria, and respiratory depression
Opioids include natural, synthetic, or semi-synthetic chemicals that interact with opioid receptors
Opiates refer to natural opioids such as heroin, morphine, and codeine, while opioids encompass natural, synthetic, and semi-synthetic chemicals

Opioids Overview

Fentanyl is 100 times more potent than morphine and is a leading cause of opioid overdose deaths.
Sufentanil, 1000 times more potent than morphine, is used in anesthesia and peaks quicker than meperidine/morphine.
Methadone is used for opioid use disorder (OUD) and pain management, with a long half-life of 23hrs and potential for drug interactions.
Butorphanol, available in nasal, IM, and IV formulations, is used for acute pain but increases cardiac work, requiring caution in CHF patients.
Buprenorphine, used for opioid dependence, is available alone or in combination with naloxone as Suboxone, with recent issues of dental decay and cavities.
NPs and PAs can now prescribe buprenorphine for OUD after completing the required training and can apply to prescribe for up to 30 patients.
Sublocade, a once-monthly subcutaneous injection, and Probuphine, a 6-month implant, are long-acting buprenorphine products for OUD.
Naloxone and Naltrexone are opiate antagonists used for the treatment of opioid overdosage and addiction.
Abuse deterrent formulations of opioids, such as oxycodone and hydrocodone, are designed to deter misuse through physical or chemical barriers.
Opioids have dose-limiting adverse effects, including respiratory depression, and can cause opioid-induced constipation (OIC), managed with stool softeners and other interventions.
Opioid tolerance, dependence, and addiction are distinct phenomena with different implications for medication management and patient outcomes.
Tramadol, tapentadol, and dextromethorphan are opioids used for analgesia and antitussive purposes, with their own unique properties and indications.

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Description

Test your knowledge of pain management and opioids with this comprehensive quiz. Explore different types of pain, analgesic medications, opioid classifications, and the use of opioids in pain management and opioid use disorder. This quiz covers important concepts and considerations for healthcare professionals involved in pain management and opioid prescribing.