Opiates

Opiate Agents

Benzomorphans

  • Dezocine (Dalgan)
  • Pentazocine (Talwin) (see Pentazocine, [[Pentazocine]])

Morphinans

  • Butorphanol (Stadol)
  • Levorphanol (Levo-Dromoran)

Phenanthrenes

  • Buprenorphine (Buprenex, Subutex, Suboxone, Butrans): semi-synthetic, mixed opioid receptor agonist–antagonist
  • Codeine (see Codeine, [[Codeine]])
  • Heroin (see Heroin, [[Heroin]])
  • Hydrocodone (see Hydrocodone, [[Hydrocodone]])
    • Hydrocodone + Acetaminophen (Vicodin, Lortab, Lorcet, Lorcet Plus, Norco, Zydone) (see Hydrocodone + Acetaminophen, [[Hydrocodone + Acetaminophen]])
  • Hydromorphone (Dilaudid) (see Hydromorphone, [[Hydromorphone]])
  • Morphine (see Morphine, [[Morphine]])
  • Nalbuphine
  • Oxycodone (Roxicodone, Oxycontin, Oxecta, OxyIR, Endone, Oxynorm) (see Oxycodone, [[Oxycodone]])
  • Oxymorphone (Numorphan)

Phenylheptylamines

  • Levomethadyl Acetate (L-Acetylmethadol) (OrLAAM)
  • Methadone (Dolophone) (see Methadone, [[Methadone]])
  • Propoxyphene (Darvon) (see Propoxyphene, [[Propoxyphene]])

Phenylpiperidines

  • Alfentanil (Alfenta)
  • Diphenoxylate (Lomotil) (see Diphenoxylate, [[Diphenoxylate]])
  • Fentanyl (Sublimaze) (see Fentanyl, [[Fentanyl]])
  • Loperamide (Imodium) (see Loperamide, [[Loperamide]])
  • Meperidine (Demerol) (see Meperidine, [[Meperidine]])
  • Remifentanil (Ultiva)
  • Sufentanil (Sufenta)

Other

  • Dextromethorphan (Robitussin, Delsym, DexAlone, Duract, Mucinex DM, NyQuil, Vicks, Dimetapp, TheraFlu, Coricidin) (see Dextromethorphan, [[Dextromethorphan]]): acts as μ, δ, and κ-opioid receptor agonist (as well as multiple other pharmacologic effects)
  • Tramadol (Ultram) (see Tramadol, [[Tramadol]])
    • Pharmacology
      • Weak mu opioid receptor agonist
      • Norepinephrine and serotonin reuptake Inhibitor

Opiate Comparison

OPIATE COMPARISON


Adverse Effects

Cardiovascular Adverse Effects

Gastrointestinal Adverse Effects

Neurologic Adverse Effects

Pulmonary Adverse Effects

Other Adverse Effects

  • Serotonin Syndrome (see Serotonin Syndrome, [[Serotonin Syndrome]])
    • Opiates with Serotonergic Activity
      • Dextromethorphan (see Dextromethorphan, [[Dextromethorphan]]): increases serotonin release from stored vesicles and serotonin reuptake inhibitor
      • Fentanyl (see Fentanyl, [[Fentanyl]]): serotonin reuptake inhibitor
      • Meperidine (Demerol) (see Meperidine, [[Meperidine]]): serotonin reuptake inhibitor
      • Methadone (see Methadone, [[Methadone]]): serotonin reuptake inhibitor
      • Propoxyphene (Darvon) (see Propoxyphene, [[Propoxyphene]]): serotonin reuptake inhibitor
      • Tramadol (see Tramadol, [[Tramadol]]): serotonin reuptake inhibitor

Opiate Intoxication

Diagnosis

  • Urine Tox Screen: methadone can give false-negative urine tox for opiates

Clinical

Neuro Manifestations

  • Miosis (see Miosis, [[Miosis]])
  • Sedation
  • xxx

Pulmonary Manifestations

Cardiac Manifestations

Treatment

  • Naloxone (Narcan) (see Naloxone, [[Naloxone]]): 1 amp (0.4 mg) IV push, may repeat PRN or start drip at 0.4 mg/hr

Opiate Withdrawal

Clinical Manifestations

Cardiovascular Manifestations

Gastrointestinal Manifestations

Neurologic Manifestations

  • Anxiety (see Anxiety, [[Anxiety]])
  • Generalized Weakness (see Weakness, [[Weakness]])
  • Hyperreflexia (see Hyperreflexia, [[Hyperreflexia]]): in neonates
  • Irritability
  • Restlessness
  • Seizures (see Seizures, [[Seizures]]): in neonates
  • Shivering/Trembling

Other Manifestations

  • Fever (see Fever, [[Fever]])
  • Diaphoresis
  • Myalgias (see Myalgias, [[Myalgias]]
  • Piloerection
  • Rhinorrhea
  • Sneezing

References

  • xxx