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Questions and Answers
In which type of patients does morphine retain its normal analgesic efficacy?
In which type of patients does morphine retain its normal analgesic efficacy?
- Patients with opioid receptor mutations
- CYP2D6-deficient patients
- Extensive metabolizers (correct)
- Poor metabolizers
Which of the following opioids is known to be less effective in poor metabolizers?
Which of the following opioids is known to be less effective in poor metabolizers?
- Oxycodone
- Hydrocodone
- Codeine (correct)
- Morphine
What is the primary factor influencing the analgesic potency of opioids like morphine?
What is the primary factor influencing the analgesic potency of opioids like morphine?
- CYP2D6-mediated metabolism
- Blood-brain barrier permeability
- Liver enzyme activity
- Opioid receptor binding affinity (correct)
Which of the following is NOT a factor affecting the pharmacokinetics of morphine?
Which of the following is NOT a factor affecting the pharmacokinetics of morphine?
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What is the primary reason why codeine and morphine are effective in normal subjects?
What is the primary reason why codeine and morphine are effective in normal subjects?
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Study Notes
Opioid Metabolism and Efficacy
- Codeine is ineffective in patients who cannot convert it to morphine (poor metabolizers), as shown in a volunteer study (Fig. 17.15)
- Morphine retains its normal analgesic efficacy in poor metabolizers
- Codeine and morphine are effective in normal subjects (extensive metabolizers)
Dose-Effect Relationship
- Tolerance is characterized by a rightward shift in the dose-effect curve (Fig. 17.19)
- Hyperalgesia is characterized by a downward shift in the dose-effect curve (Fig. 17.19)
Opioid-Induced Hyperalgesia
- Opioid-induced hyperalgesia is distinct from tolerance
- Hyperalgesia is associated with a downward shift in the dose-effect curve (Fig. 17.19)
Meta-Analysis and Guidelines
- A recent meta-analysis confirmed the efficacy of opioids in pain management (108)
- Treatment guidelines regarding patient selection are still evolving (109)
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Description
This quiz covers the effects of fentanyl and codeine on pain relief in patients, including their pharmacokinetics and pharmacodynamics. It also discusses the differences between poor and extensive metabolizers.
