Drugs

What factors contribute to a patients risk of opioid induced respiratory depression? The RIOSORD analysis that is mentioned in the previous question is helpful in assessing risk for OIRD. The RIOSORD score is intended to determine probability of an overdose of serious opioid-induced respiratory depression. Each variable contributes a certain percentage to the score, and …

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What tools are available to risk stratify patients prior to initiating opioid therapy? Several screening tools are available to help providers assess a patient’s risk prior to initiating opioid therapy or determining misuse/abuse of an opioid medication. Some include the Opioid Risk Tool (ORT), Diagnosis Intractability Risk Efficacy (DIRE) Score, Prescription Drug Use Questionnaire (PDUQ), …

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“opioid rotation.” What is the rationale behind it and what is meant by dose reduction for cross-tolerance? Opioid rotation is a concept that takes advantage of the fact that there is incomplete cross-tolerance between the opioids. Periodically switching between opioids may benefit patients who inadequately respond to high doses of opioids due to tolerance, who …

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Is hyperalgesia a real thing? Hyperalgesia is a phenomenon in which patients treated with opioids for pain or drug abusers using opiates for euphoria paradoxically become more sensitive to certain nociceptive stimuli. It typically occurs at high doses, so it may be more common in drug abusers using excessive doses than in legitimate patients using …

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What is the role of the NMDA receptor? Which opioids block the NMDA receptors? Methadone, levorphanol, and ketamine are three opioids that block the NMDA receptor. The role of the NMDA receptor is to cause sensitization of the neuron and heightened responses following glutamate activation. This sensitization is what can lead to spontaneous pain and …

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Which opioid has a ceiling effect of accumulation of Carbon Dioxide? Due to the unique pharmacology (partial mu-agonist, as discussed in Question 5), buprenorphine provides analgesia at therapeutic doses but also has a suggested “ceiling effect” on respiratory depression. As the medication dose increases, the activity that buprenorphine exhibits as a partial agonist plateaus regardless …

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Which opioid is contraindicated within 14 days of use of an monoamine oxidase inhibitor? Tapentadol is contraindicated within 14 days of an MAOI. While use of MAOIs for depression is now uncommon, the antibiotic linezolid has MAOI activity. Serotonin syndrome is one reason for this concern. However, the larger concern with the combination is additive …

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