Opioids by Ashish Holkar https://padlet.com/holkar74/ziqo2fck282ci6jx Highlighting the use and effects of the main 4 opioids en-us 2022-01-13 21:37:58 UTC 2026-01-30 21:34:34 UTC hello@padlet.com CNS Side Effects holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991277912
  • Analgesia
  • Euphoria → particularly with iv administration
  • Sedation
  • Pupillary Constriction –> stimulation of oculomotor nucleus brainstem

    • ]]>     2022-01-13 21:41:29 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991277912     Gi Side effects holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991278444
  • Nausea and vomiting → chemoreceptor trigger zone in medulla
  • Constipation → from reduced motility and muscle tightening

    • ]]>     2022-01-13 21:42:04 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991278444     Respiratory Effects holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991278797
  • Resp depression → inhibit respiratory centres in the brain → lead to hypoxia
  • Suppression of the cough reflex

    • ]]>     2022-01-13 21:42:26 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991278797     Safety Concerns: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991280603 Acute use:
    • sedation, respiratory depression, vomiting
    Chronic use:
    • Constipation
    ]]>     2022-01-13 21:44:16 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991280603     Most important opioid for severe pain, particularly by injection holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991281235 2022-01-13 21:44:54 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991281235 4 Pharmokinetic Problems: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991282720
  • Oral absorption is relatively slow and inconsistent requires a higher dose than injection
  • Short half-life - broken down by liver in 3-4 hours
  • Active metabolite morphine-6-glucuronide eliminated by the kidney
  • Both breakdowns mean in renal or kidney failure it will remain in the blood and be toxic

    • ]]>     2022-01-13 21:46:09 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991282720     Often prescribed with: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991283065
  • Anti-emetic e.g. metoclopramide, ondansetron → to stop nausea and vomiting
  • Laxatives if long-term use → to allow for constipation

    • ]]>     2022-01-13 21:46:30 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991283065     More potent and soluble therfore you only require half the dose holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991283705 2022-01-13 21:47:13 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991283705 Mainly used in palliative care holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991283977 2022-01-13 21:47:30 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991283977 Structural Advantages: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991284683
  • Is pro-drug –> converted in the body to 6-monoacetylmorphine and morphine
  • Crosses blood-brain barrier easily –> rapid ‘high’ favoured by iv users

    • ]]>     2022-01-13 21:48:17 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991284683     Pro drug demethylated in the liver by CYP2D6 to become morphine holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991286326
  • Genetic variation in liver CYP enzymes – less predictable response 
    • Serious toxicity noted in susceptible children
    • Other patients – poor analgesic benefit

    • ]]>     2022-01-13 21:49:34 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991286326     Well-absorbed orally but only limited fraction converted to morphine, thus cannot provide strong analgesia holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991286737 2022-01-13 21:50:01 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991286737 Used in: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991287176
  • Mild-moderate pain (sometimes in combination of co-codamol - when nsaids are not available as they may have ulcers
  • Chronic diarrhoea

    • ]]>     2022-01-13 21:50:29 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991287176     Synthetic opioid - good oral absorption holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991288082 2022-01-13 21:51:26 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991288082 Half life exceeds 24 hours: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991288659 Caution: highly toxic in overdose because of very long half-life]]> 2022-01-13 21:51:56 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991288659 Used as an alternative to morphine holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991289200
  • Used as substitution therapy to reduce iv drug abuse
  • Often part of supervised regime where community patients go to local pharmacy to pick up methadone

    • ]]>     2022-01-13 21:52:28 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991289200     Moderate to severe actue pain: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991290262 Morphine 5-10(mg)]]> 2022-01-13 21:53:33 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991290262 Chronic Pain/Palliative Care: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991290791
  • Morphine or diamorphine (5-10mg)
    • ]]>     2022-01-13 21:54:06 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991290791     Mild Pain: holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991291269
  • Codeine for mild pain, particularly when paracetamol/ NSAID are not effective or suitable
    • ]]>     2022-01-13 21:54:32 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991291269     holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991292116
  • Neuropathic pain- tingling/shock in peripheral nerves
  • Headache/migraine

    • ]]>     2022-01-13 21:55:24 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991292116     holkar74 https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991294425
  • 10-30 mg  starting dose if the patient has been regularly having other strong opioids
  • If the patient has no response to initial dose - increase by 30-50% 
    • ]]>     2022-01-13 21:57:48 UTC https://padlet.com/holkar74/ziqo2fck282ci6jx/wish/1991294425