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\author{shanvjx}
\pdfinfo{
  /Title (opioids-pharmacology.pdf)
  /Creator (Cheatography)
  /Author (shanvjx)
  /Subject (Opioids(pharmacology) Cheat Sheet)
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Opioids(pharmacology) Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{shanvjx} via \textcolor{DarkBackground}{\uline{cheatography.com/156376/cs/33242/}}}
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}shanvjx \\
  \uline{cheatography.com/shanvjx} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 19th July, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Introduction to pain}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Definition of pain}} & An unpleasant sensory \& emotional experience associated with actual/potential tissue damage \tn 
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% Row 1
\SetRowColor{white}
{\bf{Purpose of pain}} & 1. As a protective mechanism \tn 
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% Row 2
\SetRowColor{LightBackground}
 & 2. Cause individual to react to remove  pain stimulus \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.55618 cm} x{1.51041 cm} x{1.51041 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Nociceptive pain mechanism}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & Wide spread in superficial layers of skin \& certain internal tissues &  \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
 & Excited by 3 different stimuli : mechanial, thermal, chemical &  \tn 
% Row Count 11 (+ 5)
% Row 2
\SetRowColor{LightBackground}
 & Pain is related to degree of receptor stimulation by processes causing tissue injury (more receptor \seqsplit{stimulated=more} pain) &  \tn 
% Row Count 21 (+ 10)
% Row 3
\SetRowColor{white}
{\bf{2 nociceptor systems}} & 1. A delta fibres (faster) &  \tn 
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% Row 4
\SetRowColor{LightBackground}
 & 2. C fibres (slower) &  \tn 
% Row Count 25 (+ 2)
% Row 5
\SetRowColor{white}
{\bf{Chemicals that stimulate nociceptors}} & Histamine &  \tn 
% Row Count 29 (+ 4)
% Row 6
\SetRowColor{LightBackground}
 & Bradykinins &  \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.55618 cm} x{1.51041 cm} x{1.51041 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Nociceptive pain mechanism (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
 & 5-HT (serotonin) &  \tn 
% Row Count 2 (+ 2)
% Row 8
\SetRowColor{white}
 & some metabolic substances released from damaged cells (lactic acid,ATP) &  \tn 
% Row Count 8 (+ 6)
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\SetRowColor{LightBackground}
{\bf{Sources of nociceptive pain}} & Somatic pain &  \tn 
% Row Count 11 (+ 3)
% Row 10
\SetRowColor{white}
 & Visceral pain & Pain from internal structures, poorly localised, often radiates or referred to other areas \tn 
% Row Count 18 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Neuropathic pain}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & Pain resulting from pathophysiologic changes in peripheral or CNS \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & A state of chronic pain is sustained \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Idiopathic pain}}  \tn
% Row 0
\SetRowColor{LightBackground}
Patient's psychological state contribute to pain & May be due to anzxiety,depression, other psychological disorders \tn 
% Row Count 4 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pharmacotherapy in management of pain}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{1. Opioid analegesics} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{2. NSAIDs} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{3. Local anaesthetics} \tn 
% Row Count 3 (+ 1)
% Row 3
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\mymulticolumn{2}{x{5.377cm}}{4. Alpha 2 agonists} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{x{1.19002 cm} x{1.69349 cm} x{1.69349 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Opioids}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{MOA}} & Binds to opioid receptors and inhibit action on neurons &  \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Type of opioid receptors}} & 1. Mu receptors & effects: analgesia,respiratory\&physical depression,miosis,reduced GI motility \tn 
% Row Count 10 (+ 6)
% Row 2
\SetRowColor{LightBackground}
 & 2. Kappa receptors & effects: sedation,miosis \tn 
% Row Count 12 (+ 2)
% Row 3
\SetRowColor{white}
 & 3. Delta receptors & effects: dysphoria,hallucinations \tn 
% Row Count 15 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
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\begin{tabularx}{5.377cm}{x{2.93643 cm} x{2.04057 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Classification of opioids}}  \tn
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\SetRowColor{LightBackground}
{\bf{Strong agonists}} & Morphine \tn 
% Row Count 1 (+ 1)
% Row 1
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 & Pethidine \tn 
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 & Methadone \tn 
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% Row 3
\SetRowColor{white}
 & Fentanyl \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & \seqsplit{Sufentanil/Alfentanil} \tn 
% Row Count 6 (+ 2)
% Row 5
\SetRowColor{white}
{\bf{Mild to moderate agonists}} & Codeine \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
{\bf{Mixed agonist-anatagonists}} & Pentazocine \tn 
% Row Count 10 (+ 2)
% Row 7
\SetRowColor{white}
 & Buprenorphine \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.94103 cm} x{3.03597 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Strong agonist opioid's desirable effects}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Analgesia}} & Centrally mediated \tn 
% Row Count 1 (+ 1)
% Row 1
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 & Alters emotional perception of pain \tn 
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% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Sedation}}} \tn 
% Row Count 4 (+ 1)
% Row 3
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\mymulticolumn{2}{x{5.377cm}}{{\bf{Sense of well being}}} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Cough supression}}} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
{\bf{Reduce GI motility}} & Can help with diarrhoea \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.09034 cm} x{2.88666 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Strong agonist opioid's adverse effects}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Respiratory depression}} & Dose related \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & Most important side effect which limits clinical use \tn 
% Row Count 5 (+ 3)
% Row 2
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{\bf{Miosis}} & Constriction of pupil \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
 & Decreases ability to see in dim light \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Orthostatic hypotension}}} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Nausea \& vomiting}}} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Constipation}}} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Anorexia}}} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Sedation}}} \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
{\bf{Development of dependence}} & Cause addiction \tn 
% Row Count 15 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Caution:  \newline *Eldery are more prone to adverse effects of narcotic analgescis, thus lower dose is required}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Tolerance of strong agonist opioids}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Due to \seqsplit{regular/intermittent} use}} & Regular administration of fixed dose of drug give rise to progressively decreasing effect \tn 
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% Row 1
\SetRowColor{white}
 & Progressively higher dose has to be administered to achieve the same effect \tn 
% Row Count 9 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Develops gradually}}} \tn 
% Row Count 10 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{Cross tolerance between opioids}} & Will develop tolerance to drugs of similar pharmacological action \tn 
% Row Count 14 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.24425 cm} x{3.73275 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Clinical uses of strong agonists opioids}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Severe pain}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Pre-medication for anaesthesia}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{Methadone}} & Substitution therapy in drug dependence clinics \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
 & Chronic use: long term treatment in terminal cancer patients \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{0.96117 cm} x{1.14425 cm} x{2.47158 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Mild-moderate agonists (CODEINE)}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Indications}} & \seqsplit{Mild-moderate} pain & Usually in combination with non-opioid analgesics \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & Cough \seqsplit{supression} & At lower dose than that for analgesia \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Mixed agonist-antagonist opioids}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Opioids with full agonist activity at one receptor subtype but behaves like an antagonist or partial agonist at another receptor subtype} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
Examples: & Pentazocine \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Buprenorphine \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{Clinical uses}} & Chronic severe pain \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Drug abusers \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Advantages of mixed agonist-antagonist}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Less adverse effects mediated by specific receptors}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Less prone to cause dependence and abuse}}} \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Caution: \newline *Should not be given to patients that are already on treatment with pure strong agonist as it may precipate severe withdrawal syndrome}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{0.86963 cm} x{1.87657 cm} x{1.8308 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Tramadol}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{5.377cm}}{Chemically unrelated to other opioid drugs} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{MOA}} & Partial mu agonist & Less affinity than morphine \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Inhibition of serotonin and noradrenaline reuptake & Levels of \seqsplit{serotonin\&noradrenaline} increase \tn 
% Row Count 7 (+ 4)
% Row 3
\SetRowColor{white}
 & Block nociceptor impulse at spinal level &  \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Clinical use}} & Mild to moderate pain &  \tn 
% Row Count 13 (+ 3)
% Row 5
\SetRowColor{white}
{\bf{Adverse effects}} & Less constipation,less respiratory depression,less dependence than opioids &  \tn 
% Row Count 18 (+ 5)
% Row 6
\SetRowColor{LightBackground}
 & Dizziness,sedation,nausea,vomiting &  \tn 
% Row Count 21 (+ 3)
% Row 7
\SetRowColor{white}
 & Constipation,headache &  \tn 
% Row Count 23 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Counselling points for opioids}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Drug may cause drowsiness,dizziness,blurring of vision}} & Do not drive or operate heavy machinery \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Avoid alcohol}}} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{If patient experience GI effects}} & Drug can be taken with food \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Seek medical attention if}} & Experience severe nausea,vomiting,constipation \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}