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]])
  • Oxycodone + Acetaminophen (Percocet) (see Oxycodone + Acetaminophen, [[Oxycodone + Acetaminophen]])
• 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

Adverse Effects

Cardiovascular Adverse Effects

• Hypotension (see Hypotension, [[Hypotension]])

Gastrointestinal Adverse Effects

• Constipation (see Constipation, [[Constipation]])

Neurologic Adverse Effects

• Delirium (see Delirium, [[Delirium]])
• Obtundation-Coma (see Obtundation-Coma, [[Obtundation-Coma]])

Pulmonary Adverse Effects

• Respiratory Depression
  • Acute Hypoventilation (see Acute Hypoventilation, [[Acute Hypoventilation]])
  • Chronic Hypoventilation (see Chronic Hypoventilation, [[Chronic Hypoventilation]])

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

• Respiratory Depression (see Respiratory Failure, [[Respiratory Failure]])

Cardiac Manifestations

• Hypotension (see Hypotension, [[Hypotension]])

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

• Hypertension (see Hypertension, [[Hypertension]])
• Tachycardia (see Sinus Tachycardia, [[Sinus Tachycardia]])

Gastrointestinal Manifestations

• Abdominal Cramps (see Abdominal Pain, [[Abdominal Pain]])
• Diarrhea (see Diarrhea, [[Diarrhea]])
• Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])

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