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Chapter 53. Acute Pain Management in the Opioid-Dependent Patient

Which statement is true regarding opioid-dependent patients?

A. Diarrhea is not a symptom of withdrawal.

B. Tolerance is a physiologic adaptation in which decreasing amounts of a drug are required to achieve the same pharmacologic effects after prolonged use.

C. Withdrawal refers to physiologic symptoms resulting from the abrupt discontinuation of chronically administered opioids.

D. Withdrawal is often life threatening.

C is correct. Withdrawal refers to physiologic symptoms resulting from the abrupt discontinuation of chronically administered opioids.

A is incorrect. The symptoms of opioid withdrawal include abdominal cramps, anxiety, diarrhea, disturbed sleep, irritability, dysphoria, nausea and vomiting, rhinorrhea, urinary frequency, twitching, lacrimation, and increased muscle spasms.

B is incorrect. Tolerance is a physiologic adaptation in which increasing amounts of a drug are required to achieve the same pharmacologic effects after prolonged use.

D is incorrect. Although withdrawal from opioids is rarely life threatening, it can be very uncomfortable.

Tolerance does not develop to which effect of opioids?

A. Analgesia

B. Respiratory depression

C. Nausea

D. Constipation

D is correct. Tolerance does not develop to miosis or constipation.1

A, B, and C are incorrect. Tolerance develops to most effects of opioids, including analgesia, euphoria, sedation, respiratory depression, and nausea.

Which opioid has the longest half-life?

A. Heroin

B. Morphine

C. Methadone

D. Remifentanyl

C is correct. The onset and time course of opioid withdrawal are determined by the half-life of the drug (Figure 53–1).

Figure 53–1

Symptoms and duration of heroin and methadone withdrawal.

A, B, and D are incorrect. Withdrawal symptoms of short-acting opioids such as heroin and morphine typically begin more rapidly than long-acting agonist opioids such as methadone. The half-life of remifentanyl, heroine, morphine and methadone is respectively 3 to 10 minutes, 7 to 8 minutes, 2 to 6 hours, and 15 to 60 hours (www.bcfi.be).2

Withdrawal symptoms can be elicited by:

A. Abrupt discontinuation

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