Opioids analgesics

Patients receiving opioid analgesics opioid-dependent patients patients in acute opioid withdrawal failed naloxone challenge positive urine screen for opioids history of sensitivity to naltrexone acute hepatitis or liver failure. 

Tramadol Acute intoxication with alcohol, hypnotics, narcotics, centrally acting analgesics, opioids, or psychotropic drugs. 

Morphine Liposomal (DepoDur) [Analgesic/Opioid Agonist]... 

Endogenous opioid peptides. Extensive processing is also involved in formation of analgesic opioid peptides, which are present naturally in the brain (see also Section B). Tire formation of (1-endorphin in the hypothalamus from prepro-opiomelanocortin (Fig. 30-2) has already been mentioned. Prior to the discovery of P-endorphin, the pentapeptides Met-enkephalin and Leu-enkephalin (Table 30-4) were discovered and were found to compete with opiate drugs for receptors in the brain. Tire larger P-endorphin, which contains the Met-enkephalin sequence at its N terminus, is a far more potent opiate antagonist than are the enkephalins. Since the Met-enkephalin sequence within P-endorphin is not flanked by basic residues, it apparently is normally not released. Two other recently discovered brain peptides are endomorphin-1 (YPWF-NH2) and endomorphin-2 (YPFF-NH2). They are also potent agonists for the opioid receptors, especially the p receptor (see Section B,10).,61a,61b... 

Transcutaneous electrical nerve stimulation [TENS] Decreased pain Opioid and nonopioid analgesics Opioid antagonists (naloxone) -... 

Preparations Available1 Analgesic Opioids Alfentanil (Alfenta)... 

Opioids are compounds that bind one or more of the many different opioid receptors in the body. Opioids act primarily on the central nervous system. The selectivity of a given opioid for the various opioid receptors determines its characteristic activity. While many opioids are powerful analgesics, opioids often cause physical dependence and have tolerance issues. Sedation and decreased rate of breathing are also side effects associated with opioids. Despite their problems, opioids are generally the drug of choice for treating severe, acute pain. 

PROCAINAMIDE ANALGESICS-OPIOIDS Methadone may t flecainide levels Methadone inhibits CYP2D6-mediated metabolism of flecainide Monitor PR and BP closely... 

BARBITURATES ANALGESICS - OPIOIDS 1. Barbiturates t sedative effects of opioids 2.1 efficacy of fentanyl and methadone with phenobarbital and primidone 1. Additive sedative effect. 2. t hepatic metabolism of fentanyl and methadone 1. Monitor respiratory rate and conscious levels 2. Be aware that the dose of fentanyl and methadone may need to t... 

SODIUM OXYBATE 1. ALCOHOL 2. ANALGESICS - opioids 3. ANTIDEPRESSANTS-TCAs 4. ANTIEPILEPTICS-barbiturates 5. ANTIHISTAMINES 6. ANTIPSYCHOTICS 7. ANXIOLYTICS AND HYPNOTICS-BZDs, buspirone Risk of CNS depression - coma, respiratory depression Additive depression of CNS Avoid co-administration. Caution even with relatively non-sedating antihistamines (cetrizine, desloratidine, fexofenadine, levocetirizine, loratidine, mizolastine) as they can impair the performance of skilled tasks... 

IMATINIB ANALGESICS-OPIOIDS May cause t plasma concentrations, with a risk of toxic effects of codeine, dextromethorphan, hydroxycodone, methadone, morphine, oxycodone, pethidine and tramadol Inhibition of CYP2D6-mediated metabolism of these opioids Monitor for clinical efficacy and toxicity. Warn patients to report t drowsiness, malaise or anorexia. Measure amylase and lipase levels if toxicity is suspected. Tramadol causes less respiratory depression than other opiates, but need to monitor BP and blood counts, and advise patients to report wheezing, loss of appetite and fainting attacks. Need to consider 1 dose. Methadone may cause Q-T prolongation the CHM has recommended that patients with heart and liver disease who are on methadone should be carefully monitored for heart conduction abnormalities such as Q-T prolongation on ECG as they may lead to sudden death. Also need to monitor patients on more than 100 mg methadone daily and thus an t in plasma concentrations necessitates close monitoring of cardiac and respiratory function... 

PROCARBAZINE ANALGESICS-OPIOIDS Unpredictable reactions may occur associated with hypotension and respiratory depression when procarbazine is co-administered with alfentanil, fentanyl, sufentanil or morphine Opioids cause hypotension due to arterial and venous vasodilatation, negative inotropic effects and a vagally induced bradycardia. Procarbazine can cause postural hypotension. Also attributed to an accumulation of serotonin due to inhibition of MAO Recommended that a small test dose (one-quarter of the usual dose) be administered in initially to assess the response... 

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