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Mu receptor agonist Crosses BBB - CNS effects in brain Poor lipid solubility, 60% charged Slow onset (4hours), 2hr half life Accentuates inhibitory system Analgesia, euphoria, RR depression, sedation, urinary retention Metabolism: M-6 glucuronide - 10x active M-3 glucuronide - inactive Liver disease has little effect RENAL effects are significant due to M-6 3xOral = IV dosage Can dose into spinal cord - side effects are dampened |
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5x more potent than morphine, faster onset IV or oral H-6 glucuronide is less active than M-6 H-3 is still inactive Greater euphoria, greater risk of abuse |
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CYP2D6 metabolism in liver (prodrug) Prodrug metabolized to hydromorphone Given w/ acetamenophin (Vicodin/Lortab) |
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CYP2D6 metabolism in liver (prodrug) Prodrug metabolized to oxymorphone Given w/ acetamenophin (Percocet) Available in extended release |
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CYP2D6 metabolism in liver to morphine (prodrug) Given with acetaminophen Weak/mild analgesia |
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DO NOT USE Prodrug converted to morphine W/ acetaminophen (Darvocet) |
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Diacetyl Morphine Very lipid soluble Converted to morphine in the brain and monoacetyl morphine via deacetylation Rapid onset |
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Oral - nonactive half metabolite VERY long half life - 15-60 hrs Drug addiction treatment, mild pain management |
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Oral/IV (Demerol) - active metabolite Lipid soluble, fast onset 10x less potent than morphine (7.5mg morphine = 75 meperidine) Liver -> nor-meperidine (CNS/convulsions) Nor-meperidine - severe effects with KIDNEYS Side effects with MAOIs - seretonin syndrome (clonus, hyperactive autonomics, mental status effect) |
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Patch for chronic pain Oral - lollipop or sublingual Epidural Non-active metabolite |
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Mixed agnoist/antagonist Partial mu agonist and monoamine (seretonin/NE) uptake inhibitor w/ acetaminophen Mild/moderate pain |
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Mixed agnoist/antagonist at mu receptors kappa agnoist mu agnoist/antagonist opioid NOT for chronic pain, only short term and managing side effects |
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Mixed agnoist/antagonist at mu receptors kappa agnoist mu agnoist/antagonist opioid NOT for chronic pain, only short term and managing side effects |
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Mixed agnoist/antagonist at mu receptors kappa agnoist mu agnoist/antagonist opioid NOT for chronic pain, only short term and managing side effects |
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Mixed mu agonist/antagonist High agonist affinity for mu, some for kappa Used for addiction: difficult to reverse agonist, inhibits analgesia for surgery |
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Opioid agnoist Antidiarrheal |
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Opioid agonist antidiarrheal (imodium) |
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Opioid antagonist - save lives Parenteral |
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Opioid antagonist - save lives Oral |
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Opioid antagonist - Oral Poorly absorbed - good for GI side effects of opioids |
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