Opioid

Chapter 29:  Pain Management

 

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Table of Contents:Opioids

Organ Systems

Clinical Use: Opioid Analgesics

Specific Drugs

Opioids

Morphine

 

Codeine and Oxycodone (methylated at C3)

Pharmacokinetics

Way, W.L., Fields, H.L. and Way, E. L. Opioid Analgesics and Antagonists, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 496-515.
Coda, B.A. Opioids, In Clinical Anesthesia, 3rd Edition (Barash, P.G., Cullen, B.F. and Stoelting, R.K.,eds) Lippincott-Ravin Publishers, Philadelphia, New York, 1997, pp 329-358.
Schuckit, M.A. and Segal D.S., Opioid Drug Abuse and Dependence, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 2508-2512.

Pharmacodynamics

Opioid Receptor Subtype

Drug

Mu (m) Delta (d) Kappa (k)
Opioid Peptides      
Enkephalins Antagonist Agonist  
beta-endorphin Agonist Agonist  
Dynorphin Weak Agonist   Agonist
Agonists      
Codeine Weak Agonist Weak Agonist  
etorphine Agonist Agonist Agonist
fentanyl (Sublimaze) Agonist    
meperidine (Demerol) Agonist    
methadone (Dolophine) Agonist    
Morphine Agonist Weak Agonist  
Agonist-antagonists      
Buprenorphine Partial Agonist    
dezocine (Dalgan) Partial Agonist Agonist  
nalbuphine (Nubain) Antagonist   Agonist
pentazocine (Talwain) Antagonist or Partial Agonist   Agonist
Antagonist: naloxone (Narcan) Antagonist Antagonist Antagonist
Spinal Cord Sites of Opioid Action

courtesy of Roxane Pain Institute used with permission http://pain.roxane.com/sitemap.html

Way, W.L., Fields, H.L. and Way, E. L. Opioid Analgesics and Antagonists, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 496-515.
Schuckit, M.A. and Segal D.S., Opioid Drug Abuse and Dependence, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 2508-2512.
Coda, B.A. Opioids, In Clinical Anesthesia, 3rd Edition (Barash, P.G., Cullen, B.F. and Stoelting, R.K.,eds) Lippincott-Ravin Publishers, Philadelphia, New York, 1997, pp 329-358.

Opioid Effects: Degree of Tolerance Developed
High Intermediate Limited/None
analgesia bradycardia miosis
euphoria, dysphoria   constipation
mental clouding   convulsions
 sedation   antagonist actions
respiratory depression    
antidiuresis    
nausea/vomiting    
cough suppression    
adapted from Figure 31-4: Way, W.L., Fields, H.L. and Way, E. L. Opioid Analgesics and Antagonists, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, p. 505.

 

 

 

Abuse of Opioid
 
Some Symptoms of Opioid Withdrawal
rhinorrhea lacrimation chills hyperventilation muscular aches vomiting
anxiety diarrhea hostility piloerection yawning hyperventilation
 

 

 

Opioid Drug Listing
  • alfentanil (Alfenta)

  • butorphanol (Stadol)

  • Codeine

  • dezocine (Dalgan)

  • fentanyl (Sublimaze)

  • hydromorphone (Dilaudid)

  • levorphanol (Levo-dromoran)

  • meperidine (Demerol)

  • methadone (Dolophine)

  • morphine

  • nalbuphine

  • oxycodone (Roxicodone)

  • oxymorphone (Numorphan)

  • pentazocine (Talwain)

  • propoxyphene (Darvon)

  • sufentanil (Sufenta)

 

Combinations
  • Codeine/acetaminophen

  • Codeine/aspirin

  • Propoxyphene/aspirin

  • Codone/acetaminophen

  • Oxycodone/aspirin

 

Antitussives
  • Codeine

  • Dextromethorphan

  • Delsym

 

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