Preparation for Child Psych PRITE and Boards
Opioids are widely used, but often misused and underutilized in clinical practice. They are also widely abused.
- morphine (pure μ-agonist)
- hydromorphone (Dilaudid)
- oxymorphone (Opana)
- meperedine (Demerol)
- fentayl (Duragesic)
- tramadol (Ultram)
- PO dose is generally higher than the equivalent IV dose due to 1st pass effect (e.g. morphine, hydromorphone). PO dosing is also less predictable for the same reason.
- codeine and oxycodone have little 1st pass metabolism.
- opioids will accumulate in tissues in patients on frequent high dosing, or if lipophilic and slowly metabolized (fentanyl)
- morphine is metabolized to
- M6G (10%) - a potent analgesic
- M3G - a neuroexcitatory compound; can cause seizures if accumulated (e.g. renal failure)
- fentanyl has no active metabolites.