Therapeutics Of Pain Practice Exam

What class of drug treats opioid-induced constipation without reversing analgesia?

Central analgesic receptor antagonists Nonsteroidal anti-inflammatory drugs Peripherally acting mu-opioid receptor antagonists (PAMORAs) Antidepressants

Correct Answer:

Peripherally acting mu-opioid receptor antagonists (PAMORAs)

Explanation:

Blocking opioid receptors in the gut while keeping the brain unaffected treats opioid-induced constipation. Peripherally acting mu-opioid receptor antagonists do exactly this: they block mu receptors in the GI tract to restore motility and relieve constipation, but they don’t significantly cross the blood-brain barrier, so they don’t reverse the central analgesic effects of opioids. Examples include methylnaltrexone, naldemedine, and alvimopan. Central opioid receptor antagonists would reverse analgesia, and NSAIDs or antidepressants don’t target the peripheral GI effects of opioids.

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