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Spring '20/ L. PHARM TEST 2 - opioids, anticholinergics, cholinesterase > apex opioids > Flashcards

apex opioids Flashcards

1
Q

tolerance

A

associated with opioids. due to receptor desensitization and increased synthesis of cAMP.

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2
Q

tolerance does not develop

A

to mitosis or constipation

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3
Q

early signs of withdrawal

A

diaphoresis insomnia restlessness

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4
Q

late signs of withdrawal

A

abdominal cramping n/v

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5
Q

most potent opioid

A

sufentanil

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6
Q

least potent opioid

A

meperidine

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7
Q

which opioids have active metabolites

A

morphine and meperidein

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8
Q

remifentanil and dosing

A

lean body weight for dosin

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9
Q

methadone receptor

A

mu

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10
Q

meperidine receptor

A

mu and kappa

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11
Q

mu endogenous ligand

A

endorphin

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12
Q

delta endogenous ligand

A

enkephalin

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13
Q

kappa endogenous ligand

A

dynorphin

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14
Q

mu-3

A

immune suspression

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15
Q

morphine metabolism

A

morphine 6 glucuronide
very potent if it builds up it will create respiratory depression and toxicity after morphine
patients on dialysis are unable to excrete m6g and are more likely to experience respiratory depression and toxicity after morphine

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16
Q

meperidine metabolism

A

metabolite is normeperidine
half as potent
it reduces the seizure threshold and increases ins excitability. caution in elderly and dialysis.

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17
Q

remifentanil metabolism

A

hydrolyzed in the plasma by erythrocyte and tissue esterase’s. (not pseudocholinesterase)

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18
Q

what is meperidine structurally related to ?

A

atropine and exhibits anticholinergic effects such as tachycardia, mydriasis and dry mouth

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19
Q

which opioid does not get metabolized by the liver?

A

remifentanil

20
Q

which opioid can produce skeletal muscle rigidity

A

fentanyls

21
Q

what is the treatment for skeletal muscle rigidity

A

paralysis and intuabtion

22
Q

common characteristics of partial agonists

A

produce analgesia with a reduced risk of respiratory depression

have a ceiling effect beyond which additional analgesia is not possible

reduce the efficacy of previously administered opoids

can cause acute opioid withdrawal in the opioid dependent patient

can cause dysphoria reactions

carry a low risk of dependence

are used in patients who cannot tolerate a full opioid agonist

23
Q

naloxone (which receptors) which has the greatest affinity

A

mu has the greatest affinity
kappa
delta receptors.

24
Q

naloxone indications

A

acute reversal of opioid induced respiratory depression
reversal of respiratory depression in the neonate whose mother received an opioid
treatment of opioid overdose

25
Q

does naloxone cross the placenta

A

yes it does if giving it to an opioid abusing mother it can precipitate acute opioid with drawl in the neonate

26
Q

naloxone please remember

A

last 45 minutes- it may be shorter than the opioid you are reversing- remember to tell PACU you gave it. may need an infusion.

27
Q

naloxone side effects

A

pul edema tachycardia, cardiac death

28
Q

nalmefene who do we give it to?

A

can be used to maintain recovering opioid abusers.

29
Q

the experience of pain are divided into 4 steps. please name them

A

transduction
transmission
modulation
perception

30
Q

transduction

A

peripheral nerves are activated to organize the inflammation response so the brain can interpret
a delta fibers- fast sharp

c fibers- slow dull

31
Q

transmission

A

3 neuron pain pathway along the spinothalamic track
1-periphery-drg
2-drg-thalamus
3thalamus-cortex

32
Q

modulation

A

modulation is at substantial gelatinous in the dorsal horn

the descending inhibitory pain pathway begins in the periaqueductal gray and the rostroventral medulla it projects to the substantial gelatinous.

pain is inhibited when spinal neurons release gaba and glycine
the descending pain pathway releases NE, 5HT, and endorphins .

pain is augmented by central sensation and wind up

33
Q

perception

A

how we feel about pain

34
Q

allodynia

A

reduced threshold to pain stimulus

35
Q

hyperalgesia

A

increased response to pain stimulus.

36
Q

gender plays a role in pk/pd differences

how is morphine different for women

A

greater analgesic potency
slower onset of action
longer duration of action
lower post operative opioid consumption

37
Q

name the opioids most potent to least potent

A

sufentanil-fentanyl-remifentanil-alfentanil-hydromorphone-morphine-meperidine

38
Q

meperidine is structurally related to?

A

atropine

39
Q

meperidine is structurally related to atropine meaning it will exhibit what effects

A

tachycardia, mydriasis, and dry mouth

40
Q

name drugs that cause histamine release

A

meperidine, morphine, codeine, and oxycodone

41
Q

how quickly does alfentanil equilibrate?

A

1.4minutes

due to it being 90% unionized- readily crosses the BBB

42
Q

how quickly does fentanyl and sufentanil cross the blood brain barrier

A

6ish minutes

43
Q

methylnaltrexone

A

unable to cross the BBB
it does not reverse respiratory depression
helpful in reversing opioid induced bowl dysfunction

44
Q

nalmefene

A

used to maintain recovering opioid abusers last 10 hours

45
Q

naltrexone

A

last 24 hours- DOES NOT UNDERGO SIGNIFICANT FIRST PASS METABOLISM. used to maintain opioid abusers

Spring '20/ L. PHARM TEST 2 - opioids, anticholinergics, cholinesterase (8 decks)

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