Module 14.3 - Opioid Toxicology - Lecture

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Welcome to our comprehensive exploration of opioids! As aspiring and practicing pharmacy professionals, a deep understanding of this multifaceted class of xenobiotics is paramount for delivering safe and effective patient care.
In this module, we embark on a journey through the rich history of opioids, from their ancient medicinal roots to the complexities of the current public health crisis, including pivotal legislative responses like the Harrison Narcotics Tax Act. We'll clarify essential terminology, precisely differentiating between "opiates," "opioids," and the broader, often-misused term "narcotics".
Dive into the intricate world of opioid pharmacology, where we dissect the pharmacodynamics of key opioid receptor subtypes—mu (µ), kappa (κ), and delta (δ)—and their signal transduction mechanisms. You'll learn how activation of these receptors correlates with both therapeutic effects and critical adverse events like respiratory depression.
We'll also spotlight the unique pharmacological properties and associated toxicities of specific opioid agents such as meperidine (proconvulsant, serotonin toxicity), tramadol (seizures), and fentanyl (potency, chest wall rigidity), alongside essential agents like methadone and buprenorphine. You’ll learn to recognize the hallmark signs and symptoms of the opioid toxic syndrome, including mental status depression, respiratory depression, and miosis.
A critical focus is placed on opioid antagonists. We'll compare and contrast the pharmacokinetic profiles of naloxone and naltrexone, explaining their distinct roles: naloxone as the cornerstone for acute overdose reversal and naltrexone for long-term relapse prevention. You’ll gain insights into formulating appropriate naloxone dosing strategies, understanding the nuances for patient opioid dependence and specific opioids like buprenorphine and fentanyl.
Finally, we underscore the pivotal role of pharmacists in prevention and harm reduction strategies. This includes advocating for responsible prescribing, promoting naloxone distribution to laypersons, and understanding medication-assisted treatment (MAT) for Opioid Use Disorder (OUD) with agents like methadone and buprenorphine, recognizing their distinguishing characteristics, safety profiles, and administrative requirements.
Join us to deepen your understanding and contribute effectively to patient care and public health in the ongoing opioid crisis.