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Questions and Answers
Which of the following conditions is a contraindication for opioid use?
What syndrome can occur in a neonate as a result of opioid exposure in utero?
Which opioid is categorized as a partial agonist?
Which of the following is a precaution when prescribing opioids?
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Which symptom is NOT associated with neonatal withdrawal syndrome?
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In which situation can opioids be administered to comatose patients?
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Which opioid is NOT listed as a full agonist?
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What is a major risk associated with opioid exposure during pregnancy?
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What is the primary mechanism through which opioids provide cough suppression?
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Which side effect of opioids is unlikely to develop tolerance over time?
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What is the therapeutic approach regarding opioid dosing for achieving maximum effectiveness?
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Which of the following is a potential severe adverse effect associated with opioid use?
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What should be avoided when prescribing immediate release opioids?
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Pupillary constriction in opioid users is a result of which central effect?
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What is a true allergy to opioids characterized by?
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The lowest effective dose of opioids should be utilized for what reason?
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What is the pediatric dosing range for codeine per dose?
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What is the primary pathway for codeine's metabolism into morphine?
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Which of the following opioids has the longest half-life in adults?
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How long does it typically take for oral morphine to reach onset of action?
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Which opioid is primarily categorized under phenanthrenes?
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What is the recommended adult dose of codeine per administration?
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What is the duration of action for codeine after administration?
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Which of the following forms of codeine is available as a prescription medication?
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What is the proposed mechanism of action for acetaminophen?
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Which of the following is NOT a type of analgesic?
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What is the maximum recommended dose of acetaminophen for adults?
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What type of pain is acetaminophen generally used to treat?
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Which of the following is a common adverse effect of acetaminophen?
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In what form is acetaminophen NOT available?
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How is the pediatric dosage of acetaminophen generally calculated?
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Those with cirrhosis should be cautious and limit acetaminophen intake to how much maximum per day?
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What is one requirement that Opioid Treatment Programs (OTPs) must meet to provide services for patients with opioid use disorder?
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Which agency shifted regulation from the FDA to ensure compliance in opioid use disorder treatment?
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What does the Connecticut Prescription Monitoring Program (PMP) specifically track?
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What protection is provided to licensed healthcare professionals when administering an opioid antagonist?
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What action must prescribers take before prescribing a controlled substance in Connecticut?
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What does the Health Assistance InterVention Education Network (HAVEN) provide?
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What is a key purpose of the Prescription Monitoring Program (PMP)?
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When must a prescriber review a patient's records in the Connecticut PMP during prolonged treatment?
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What does Public Act 15-198 mandate regarding controlled substances?
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What new flexibility regarding opioid use disorder treatment was introduced with the Consolidated Appropriations Act 2023?
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Study Notes
Types of Analgesics
- Acetaminophen: Also known as APAP, effective for mild to moderate pain and fever reduction.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Provide pain relief and inflammation reduction.
- Adjuvants: Includes antidepressants, antiepileptics, and topical agents, used to enhance pain management.
- Antimigraine medications: Specifically target migraine-related pain.
- Opioids: Potent pain relievers that act on the central nervous system but carry a risk of dependence.
Acetaminophen (Tylenol®)
- Proposed mechanism: Weakly inhibits COX-1 and COX-2 and may activate central serotonergic pathways.
- Provides analgesic and antipyretic properties but lacks anti-inflammatory effects.
- First-line treatment for osteoarthritis and safe for treating fever in children.
Dosing and Administration
- Adults: 325-1000 mg every 4-6 hours, with a maximum dose of 4 grams per day; 2 grams for those with cirrhosis.
- Pediatrics: 10-15 mg/kg/dose, max 5 doses/day in various formulations like oral, rectal, or IV.
- Combination products common; some may contain allergens like benzyl alcohol or polysorbate 80.
Adverse Effects of Acetaminophen
- Generally well tolerated, with risks increasing primarily with overdose.
- Occasional rashes or hypersensitivity reactions may occur.
Opioids: Therapeutic Effects
- Analgesia achieved through dose-dependent effects without causing unconsciousness.
- Codeine is more frequently used for cough suppression due to its action on the cough reflex center.
Opioids: Adverse Effects
- Pupillary Miosis: Constricted pupils are common with therapeutic use.
- Itching: Histamine release may cause pruritus.
- Constipation: Reduced gastrointestinal motility; tolerance does not develop.
- Nausea/Vomiting: Common side effects of opioid use.
Severe Adverse Effects of Opioids
- Respiratory Depression: Dose-dependent and potentially life-threatening.
- Hypotension: Caused by vasodilation due to histamine release.
- Bradycardia: Results from direct effects on cardiac pacemaker cells.
- Allergic Reactions: IgE mediated reactions can lead to severe outcomes like bronchospasm and shock.
Opioid Use Guidelines
- Use of opioids should be cautious, with consideration of risks and benefits.
- Start with immediate-release opioids at the lowest effective dose for a short duration.
- Avoid concurrent benzodiazepine prescribing unless necessary.
Contraindications and Precautions for Opioids
- Contraindications include significant respiratory disease and hypersensitivity to similar opioids.
- Caution advised in patients with bowel obstructions, CNS depression, head trauma, renal impairment, and respiratory diseases.
Opioids: Pregnancy and Lactation
- Fetal dependence can occur; neonates may experience withdrawal symptoms.
- Opioids are excreted in breast milk and may require monitoring.
Opioid Functional Classes
- Full Agonists: Morphine, Hydromorphone, Oxycodone.
- Partial Agonists: Buprenorphine.
- Antagonists: Naloxone.
Opioid Use Disorder Treatment
- Recent legislation removed federal prescription waivers for treating opioid use disorder.
- Treatment programs must comply with certification and accreditation requirements.
- Expands access to care and transfers regulation from FDA to SAMHSA.
Prescription Monitoring Program (PMP)
- An online database that records controlled substance prescriptions.
- Intended to improve patient care quality and combat misuse and overdose.
- All states have some form of PMP; communication between state programs varies.
Connecticut Specific Legislation
- Healthcare providers administering opioid antagonists during overdoses are protected from liability.
- Prior to prescribing controlled substances exceeding three days’ supply, providers must review patient records in the CPMRS every 90 days.
Health Assistance InterVention Education Network (HAVEN)
- Provides confidential support for healthcare professionals experiencing physical or mental health issues.
- Offers early intervention and referrals for treatment as needed.
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Description
Explore the different types of analgesics, including acetaminophen, NSAIDs, opioids, and adjuvants like antidepressants and antiepileptics. This quiz covers their mechanisms, classifications, and uses in pain management. Perfect for students of basic and clinical pharmacology.
