Opioids

This is a brief summary of medicines that target the opioid receptors.
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ADDITIONAL TAGS
Opioids
Drug
Mechanism of action
Indication
Notes
Heroin
Strong μ agonist
Manage pain, suppress cough, antimotility for diarrhea
Contraindication: phenothiazine, MAO inhibitors, and tricyclic antidepressants (depressant effects); alcohol and benzodiazepine (respiratory effects); hepatic metabolism
Often abused IV; not legal in US;
Morphine
Strong μ agonist
Prototypical opioid; various routes of admin
Fentanyl
Strong μ agonist
Rapid onset and offset with small doses; CV stability; 100x more potent than morphine
Methadone
Strong μ agonist
Also used for opioid/heroin withdrawal; racemic mixture of NMDA antagonist and mu agonist
Meperidine
Strong μ agonist
No biliary SE, doesn't constrict sphincter of Oddi; seizures
Codeine
Moderate μ agonist
Less potent morphine
Hydrocodone
Moderate μ agonist
Most prescribed opiate; often combined with NSAIDs/acetaminophen
Oxycodone
Moderate μ agonist
Similar to hydrocodone
Tramadol
Weak μ agonist
Synthetic codeine; lower addiction risk; can cause seizures and serotonin syndrome
Buprenorphine
μ agonist; κ antagonist
Analgesic; deterrent, detoxification
High affinity, low efficacy at mu receptor → partial agonist
Nalbuphine
κ agonist; μ antagonist
Treats opioid-induced pruritus
Originally hoped to be less addictive, less side effects than other opioids → no
Naloxone
μ antagonist (short acting)
Treat opioid addiction, overdose, and toxicity; reverses mu agonist effects; increases respiratory rate within 1-2 min
Better for opioid overdose; half-life is 1 hour
Naltrexone
μ antagonist (long acting)
Treats alcoholism; lasts 24 hours after moderate dose

[@Craigdna]

Thank you for putting together a list and sharing it. Much appreciated.

[@jaumepp1975]

Damn, this channel’s amazing. Congratulations!!!

[@kiddor909gmail]

tramadol was given to my sister last year to ween her off oxycodone. Her Dr said she wouldn't go thru w/drawls since its an opiate. She went thru major w/drawls & fibromyalgia pain, it almost killed her.
Turns out tramadol has only ☝ one opiate molecule.
She sought help, going to emergency, where she was neglected, & treated like a criminal. Her Dr never explained why he abruptly cut her off her medicine.
It was almost unbearable to watch her suffer. I think she shouldve taken legal action, since she had no history of addiction.
Tramadol shouldn't be on this chart. ppl should be educated on how to deal with pain, not just given pills, than treated with bad judgement.

[@con-man6919]

Tramadol is just used for moderate pain, sorry for what your sister has gone through, but tramadol shouldn't be used for withdrawal I think, as a med student that's my take.

[@coreyvalenzi9328]

Taking 150mg tramdol aday to try wean off oxycodone.its giving me insomnia ,not a good drug for me.very high levels of seretonin release. i totally agree with you.

[@jenburtwell]

yes, thank you. This is awesome

[@blank.9301]

I'm not a med student but this table (and your explanation), is perfect. I was curious to know which drugs were the strongest. (Not for my use of course, lol). But in terms of pain killer's/treatment. Such as the green whistle.

[@kitten_purrrs73]

where is hydromorph _ (dilauded) on the chart ?

[@OpurplejazO]

short and sweet thank you!!

[@mamaoluwatobi]

Great videos, please do you have lecture notes on this video? Thanks

[@NoToPCBS]

So if you had to pull your own tooth. would codeine be an effective at blocking the pain?

[@jayfrank1913]

You left out hydromorphone (Dilauldid) and oxymorphone, which are still widely used in the US.

[@jigglygrandmama]

Interesting, I have been wondering why codeine and morphine give me horrid side effects and the pain intensifies yet the one time I had Fentanyl I didn't seem to have any issues.

[@AllahHumaAjirniMinunNar]

Thank you. Very nice.

[@melissarowan1866]

Tramadol sent me to Er with seratonin (storm) syndrome, scary that they would give this over a simple time tested, proven medication.

[@norinori5101]

You probably took a large quantity while you're on another antidepressant

[@bharathiraja3233]

thank u

[@youcanbesober9693]

Sir what is cure nalbuphine addiction . I am nalbuphine addicted 11 Month

[@MikeyBAAZ]

LORTABS 10/500 Watson 540 were the best for pain

[@denawalters176]

Fentynol suxs lol had after surgery felt like I had no pain. Meds then they gave me diluadid felt way better after that..

[@kitten_purrrs73]

Dena Walters I'm not having good results with dilauded... I was on oxy 40mg morn and night and then pure oxy ( no tylonal) 5mg when needed but sometimes I'd take 15 mg cuz my pain was so bad at times. And now I'm on 18mg dilauded extended release morn and night and 2mg fast acting dilaudid and it does nothing ? Happy your having pain control tho ...

[@norinori5101]

Isn't oxycodone stronger than oral morphine?

[@ianmangham4570]

Oral is stronger

[@dottorkemiko9641]

I use 160 mg/12 Hours of oxy is like 60 mg of methad/24 Hours

[@ClientsMusic]

Where is Hydromorphone?

[@travisbull2152]

Caelan James dialysis is what it is

[@bibanu28dumitru24]

Tramadol stronger 225 mg

[@joellemay1109]

Hydromorphone

[@jenburtwell]

can you email me that chart please

[@MedLecturesMadeEasy]

Let me know if this doesn't work:
drive.google.com/open?id=18c6HJvMkw39EodOCfmlxZbEftCZBhA53nLGvvK6usdA

[@rencyj.7872]

MedLecturesMadeEasy may I get this email as well?!

[@MedLecturesMadeEasy]

drive.google.com/open?id=18c6HJvMkw39EodOCfmlxZbEftCZBhA53nLGvvK6usdA&pageId=116666287976619899750

[@waulpall]

Why is any of this worthy of making a video over? Be careful of your dose comparisons, ie "100x more powerful"