NU 578
Unit 2 Study Guide
Key Concepts & Exam Review
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help students reinforce
understanding, identify weak areas, and prepare confidently for
the assessment.
, Unit 2 Study Guide
Chapters 18-35
Opioids/Pain Relief
« SE and ADRs of opioids, monitoring
« Treatment of Opioid induced constipation
« Use of opioids (when are they initiated?)
« Tables on p 184-185 are useful
Tables on interactions between opioids and other drugs, MSO4- and fentanyl preparations,
and pharmacology/PK of pure opioid agonists (think duration, onset, excretion, metabolism
« Morphine pg 184 – strong opioid agonist
Therapeutic use: relief of pain
- Principal indication for MSO4- is moderate to severe pain (post-op pain, L&D, chronic pain
from ca/other conditions)
- MSO4- is more effective against constant, dull pain than sharp, intermittent pain.
SEs
- Mental clouding, sedation, euphoria, anxiety reduction
ADRs pg 184
- Respiratory depression (monitor very pts young/old/resp dz/tolerance). Resp dep
increased by concurrent use of other drugs with CNS depressant actions (ETOH, barbs,
benzos). Reverse with naloxone.
- Constipation d/t actions of CNS and GI tract by activating the mu receptors in gut. Can
lead to impation, bowel perf, rectal tearing, hemorrhoids. Treat with fiber, fluids, laxative
(senna), enemas, polyethylene glycol, or methylnaltrexone/Relistor (PO drug that blocks
mu receptors in intestine, cannot block BBB so no reversal of analgesia).
- Orthostatic hypotension d/t blunting of baroreceptor reflex and dilation of arterioles and
veins. MSO4- causes vasodilation due to histamine.
- Urinary retention, drugs with anticholinergic properties (TCAs, antihistamines) can
exacerbate the problem
- Emesis d/t triggering of chemoreceptor trigger zone of medulla
- Neurotoxicity d/t delirium, agitation. Risk factors of renal impairment, cognitive
impairment, prolonged use (do an opioid rotation)
- Toxicity: coma, respiratory depression, pinpoint pupils. Tx with ventilatory support and
naloxone.
« Fentanyl pg 187 – strong opioid agonist
Regardless of route, it has the same ADRs as other opioids: resp dep, sedation, constipation,
urinary retention, nausea.
Metabolized by CYP3A4 so fentanyl levels can be increased by CYP3A4 inhibitors (ritonavir,
ketoconazole)
Transdermal system (Duragesic) allows drugs to be absorbed through skin. Reaches optimal
levels in 24 hours and remain steady for 48 hours. Only available for persistent pain patients
, Unit 2 Study Guide
who are already opiate tolerant as use in nontolerant patients can cause fatal resp dep. If it
occurs, it can persist after patch removal d/t absorption from skin.
« Methadone pg 187 – strong opioid agonist
Has pharmacologic properties similar to morphine. Effective by PO and has long duration of
action. Used to treat pain and opiod addiction.
BBW: Can cause QT prolongation so ECG needs to be completed before treatment, 30 days
later, and annually. If QT exceeds 500ms, methadone should be stopped or decreased.
Torsades is possible outcome. Can also cause resp dep.
Methadone toxicity can be achieved by taking more than prescribed amount or with other
CNS depressants.
« Hydrocodone/APA pg 188 – moderate to strong opioid agonist
Relieve pain and suppress cough.
The usual instant release (IR) dosage is 5 mg Extended-release (ER) products (Zohydro ER,
Hysingla ER) contain only hydrocodone and are taken every 12 to 24 hours. IR hydrocodone is
combined with acetaminophen or ibuprofen. For cough suppression, the drug is combined
with antihistamines and nasal decongestants. See Table 24.8
BBW: Products that contain acetaminophen (Vicodin) are associated with hepatotoxicity. The
extended-release forms of hydrocodone can cause fatal respiratory depression and should
only be prescribed by providers with additional education regarding chronic pain.
« Oxycodone pg 188 – moderate to strong opioid agonist
Schedule II
BBW: Like oxymorphone and hydromorphone, oxycodone has a high potential for abuse and
can cause fatal respiratory depression. Long-acting forms of oxycodone should be prescribed
only by providers with additional education regarding chronic pain.
« Buprenorphine pg 189 – opioid agonist-antagonist
Schedule III
Table 24.9, pg 189 for pharmacology/onset/duration
Table 24.10, pg 189 for formulations
Partial agonist at mu receptor and antagonist at kappa receptor
Analgesic effects like morphine but no significant tolerance observed.
Physical dependence on buprenorphine develops, but symptoms of abstinence are delayed:
Peak responses may not occur until 2 weeks after the final dose was taken. Although
pretreatment with naloxone can prevent toxicity from buprenorphine, naloxone cannot
readily reverse toxicity that has already developed.
SE: non-severe respiratory depression
ADR: if given to person dependent on pure opioid agonist, can cause withdrawal. Can prolong
QT interval. Risk for ADRs may be increase by psychosis, ETOHism, adrenocortical
insufficiency, liver/renal impairment
« Naloxone pg 190 – opioid antagonist
Unit 2 Study Guide
Key Concepts & Exam Review
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help students reinforce
understanding, identify weak areas, and prepare confidently for
the assessment.
, Unit 2 Study Guide
Chapters 18-35
Opioids/Pain Relief
« SE and ADRs of opioids, monitoring
« Treatment of Opioid induced constipation
« Use of opioids (when are they initiated?)
« Tables on p 184-185 are useful
Tables on interactions between opioids and other drugs, MSO4- and fentanyl preparations,
and pharmacology/PK of pure opioid agonists (think duration, onset, excretion, metabolism
« Morphine pg 184 – strong opioid agonist
Therapeutic use: relief of pain
- Principal indication for MSO4- is moderate to severe pain (post-op pain, L&D, chronic pain
from ca/other conditions)
- MSO4- is more effective against constant, dull pain than sharp, intermittent pain.
SEs
- Mental clouding, sedation, euphoria, anxiety reduction
ADRs pg 184
- Respiratory depression (monitor very pts young/old/resp dz/tolerance). Resp dep
increased by concurrent use of other drugs with CNS depressant actions (ETOH, barbs,
benzos). Reverse with naloxone.
- Constipation d/t actions of CNS and GI tract by activating the mu receptors in gut. Can
lead to impation, bowel perf, rectal tearing, hemorrhoids. Treat with fiber, fluids, laxative
(senna), enemas, polyethylene glycol, or methylnaltrexone/Relistor (PO drug that blocks
mu receptors in intestine, cannot block BBB so no reversal of analgesia).
- Orthostatic hypotension d/t blunting of baroreceptor reflex and dilation of arterioles and
veins. MSO4- causes vasodilation due to histamine.
- Urinary retention, drugs with anticholinergic properties (TCAs, antihistamines) can
exacerbate the problem
- Emesis d/t triggering of chemoreceptor trigger zone of medulla
- Neurotoxicity d/t delirium, agitation. Risk factors of renal impairment, cognitive
impairment, prolonged use (do an opioid rotation)
- Toxicity: coma, respiratory depression, pinpoint pupils. Tx with ventilatory support and
naloxone.
« Fentanyl pg 187 – strong opioid agonist
Regardless of route, it has the same ADRs as other opioids: resp dep, sedation, constipation,
urinary retention, nausea.
Metabolized by CYP3A4 so fentanyl levels can be increased by CYP3A4 inhibitors (ritonavir,
ketoconazole)
Transdermal system (Duragesic) allows drugs to be absorbed through skin. Reaches optimal
levels in 24 hours and remain steady for 48 hours. Only available for persistent pain patients
, Unit 2 Study Guide
who are already opiate tolerant as use in nontolerant patients can cause fatal resp dep. If it
occurs, it can persist after patch removal d/t absorption from skin.
« Methadone pg 187 – strong opioid agonist
Has pharmacologic properties similar to morphine. Effective by PO and has long duration of
action. Used to treat pain and opiod addiction.
BBW: Can cause QT prolongation so ECG needs to be completed before treatment, 30 days
later, and annually. If QT exceeds 500ms, methadone should be stopped or decreased.
Torsades is possible outcome. Can also cause resp dep.
Methadone toxicity can be achieved by taking more than prescribed amount or with other
CNS depressants.
« Hydrocodone/APA pg 188 – moderate to strong opioid agonist
Relieve pain and suppress cough.
The usual instant release (IR) dosage is 5 mg Extended-release (ER) products (Zohydro ER,
Hysingla ER) contain only hydrocodone and are taken every 12 to 24 hours. IR hydrocodone is
combined with acetaminophen or ibuprofen. For cough suppression, the drug is combined
with antihistamines and nasal decongestants. See Table 24.8
BBW: Products that contain acetaminophen (Vicodin) are associated with hepatotoxicity. The
extended-release forms of hydrocodone can cause fatal respiratory depression and should
only be prescribed by providers with additional education regarding chronic pain.
« Oxycodone pg 188 – moderate to strong opioid agonist
Schedule II
BBW: Like oxymorphone and hydromorphone, oxycodone has a high potential for abuse and
can cause fatal respiratory depression. Long-acting forms of oxycodone should be prescribed
only by providers with additional education regarding chronic pain.
« Buprenorphine pg 189 – opioid agonist-antagonist
Schedule III
Table 24.9, pg 189 for pharmacology/onset/duration
Table 24.10, pg 189 for formulations
Partial agonist at mu receptor and antagonist at kappa receptor
Analgesic effects like morphine but no significant tolerance observed.
Physical dependence on buprenorphine develops, but symptoms of abstinence are delayed:
Peak responses may not occur until 2 weeks after the final dose was taken. Although
pretreatment with naloxone can prevent toxicity from buprenorphine, naloxone cannot
readily reverse toxicity that has already developed.
SE: non-severe respiratory depression
ADR: if given to person dependent on pure opioid agonist, can cause withdrawal. Can prolong
QT interval. Risk for ADRs may be increase by psychosis, ETOHism, adrenocortical
insufficiency, liver/renal impairment
« Naloxone pg 190 – opioid antagonist
