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Pharm 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Factors that accentuate ventilatory depression (6)

A

Older age >60 years
Occurrence of natural sleep/sleep disorders
Opioid naivety
Male
Chronic heart failure
Intra-articular morphine

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2
Q

Factor that attenuates ventilatory depression (1)

A

pain of surgery

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3
Q

Re-narcanization immediately post op (2 reasons)

A

1) Mobilization of opioids from other compartments (e.g., muscles, fat group) increased blood flow, increased movement, warming

2) Reduction in stimulation post-extubation

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4
Q

how large of a dose of fentanyl is required to blunt sympathetic response

A

5-8 mcg/kg: will totally blunt sympathetic response from laryngoscopy

Takes a massive amount to truly eliminate the autonomic response, but normal dose can help a little it (1-2 mcg/kg: analgesia)

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5
Q

Design two anesthetic techniques to provide reliable amnesia during an “opioid
anesthetic.”

A

volatile agents

benzodiazepine (such as versed)

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6
Q

neuraxial opioids, order the speed of ONSET (fastest to slowest) (morphine vs fentanyl)

A

fentanyl > morphine

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7
Q

what neuraxial drug can travel further cephalad and cause greater issues

A

morphine (low lipid solubility)

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8
Q

Lipid Solubility (most lipid > least lipid)

A

Sufentanil > Fentanyl > Alfentanil > Demerol > Morphine

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9
Q

neuraxial opioids, order the DURATION (shortest to longest) (morphine vs fentanyl)

A

Fentanyl (50-100 mcg) lasts 1-3 hours
Morphine (2-5 mg) lasts 4-24 hours

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10
Q

what drug can cause myocardial depression and what is the dose

A

Demerol
2 mg/kg (not much more than the max dose)

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11
Q

what 2 drugs can cause histamine release
(increased HR, bronchoconstriction (B2), decreased BP, decreased SVR, welts, itching)

A

morphine
demerol

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12
Q

what metabolite can cause seizures and what is the dose

A

Normeperidine (from demerol)
> 5 mg/kg can cause seizures

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13
Q

what 2 drugs cause direct relaxation of aortic (arterial) smooth muscle

A

sufentanil and alfentanil

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14
Q

what drug causes a weak alpha blockade

A

sufentanil

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15
Q

what opioid causes tachycardia (the only one!)
how does the tachycardia occur

A

demerol
similar in chemical structure to atropine

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16
Q

what is demerol equivalent to 10mg morphine*

A

100 mg
1/10th as potent

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17
Q

what is fentanyl equivalent to 10mg morphine

A

100 mcg
100x more potent

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18
Q

what is dilaudid equivalent to 10mg morphine

A

1.5 mg

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19
Q

what is sufentanil equivalent to 10mg morphine

A

10 mcg
1000x more potent

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20
Q

what is the semi-synthetic opioid

A

hydromorphone (dilaudid)

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21
Q

what is the naturally occurring opioid

A

morphine

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22
Q

what are 3 most common side effects of neuraxial opioids and treatment

A

pruritus (treat with gabapentin or 0.25 mcg/kg/hr Narcan)

resp depression (treat with physostigmine or 0.25 mcg/kg/hr Narcan)

urinary retention (NOT related to opioid dose size)
(treat with Narcan)

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23
Q

sufentanil is ____x more potent than fentanyl

A

10x more potent

50 mcg of fent= 5 mcg of sufentanil

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24
Q

sufentanil is ______ lipid soluble than fentanyl

A

sufentanil is more lipid soluble than fentanyl

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25
Q

what is CSHT of remifentanil

A

4 minutes always

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26
Q

what drug causes opioid induced hyperalgesia

A

remifentanil

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27
Q

what drug is indicated for

Neuro assessments
Craniotomy
Carotid endarterectomy
Procedures with significant pain
Laryngoscopy
Retrobulbar block
L&D

A

remifentanil

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28
Q

what drug is indicated for

infusions
TIVA

A

sufentanil

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29
Q

what drug is indicated for single, brief stimulus
Laryngoscopy
Retrobulbar block (cataract)

A

alfentanil

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30
Q

The degree of drug receptor interaction for a given drug (potency/attraction) differentiate between different agonists that activate the same receptor, can all produce the same maximal response, but at differing concentrations

A

affinity

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31
Q

Intrinsic activity, a drug’s ability to produce the desired response expected by stimulation of a given receptor, the maximum effect that can be achieved with the drug

A

efficacy

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32
Q

the ratio of LD50 (lethal dose) to ED50 (desired effect)

LD50: ED50

A

therapeutic index

the larger the number, the safer it is!

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33
Q

rank therapuetic index (from safest to least safe)

A

safest:

remifentanil > sufentanil > alfentanil > fentanyl > morphine

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34
Q

The time for the plasma drug concentration to decrease by 50% after discontinuing a continuous infusion of a specific duration

Considers distribution, metabolism, and duration of infusion

A

context sensitive half time

the longer the CSHT, the longer the recovery! (fentanyl has long CSHT, remifentanil has shortest at 4 minutes)

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35
Q

The half-time between drug concentration in the blood and the drug effect

A

Effect Site Equilibration Time

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36
Q

what drug is quicker onset
sufentanil or alfentanil

A

alfentanil

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37
Q

what drug has a shorter CSHT and effect site concentration
sufentanil or alfentanil

A

sufentanil!

this is related to larger Vd, greater redistribution, so it is NOT in the plasma

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38
Q

which drug has the SHORTEST CSHT and effect site concentration

A

remifentanil

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39
Q

what is pre-emptive doses of opioids

A

Prophylactic opioids given before the pain starts

Pre-emptive doses of opioids may decrease the chance of sympathetic response to stimulation

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40
Q

G protein coupled receptors result in a __________ in intracellular cAMP

A

decrease

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41
Q

Opioids act like these 3 endogenous peptides/ligands that normally activate receptors***

A

enkaphalins
endorphins
dynorphins

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42
Q

Opioid Agonist: binds to opioid receptors at ______ the ____synaptic and ___synaptic sites in the CNS and peripheral sites (primary __fferent neurons)***

A

Opioid Agonist: binds to opioid receptors at both the PREsynaptic and POSTsynaptic sites in the CNS and peripheral sites (primary AFferent neurons)

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43
Q

The principal effect of opioids binding to specific G protein-coupled receptors is a ____________ in neurotransmission

A

decrease in neurotransmission

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44
Q

Activation of the opioid receptor (OR) causes:
________ of Ca2+ channels: presynaptic
________ of K+ channels: postsynaptic

A

closing Calcium (reduction in neurotransmitters)

opening K channels (potassium LEAVES the cell; hyperpolarizes the cell, inhibition occurs)

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45
Q

what receptors work presynaptically

A

mu, kappa, delta

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46
Q

what receptors work postsynaptically

A

mu

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47
Q

what occurs with the decrease in cAMP

A

closes voltage-gated calcium channels (decreased neurotransmitters)

opens potassium channels (hyperpolarization), resulting in decreased neuronal activity

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48
Q

what is the opioid analgesic effect (2 things)

A

1) Directly inhibit the ascending transmission of nociception information from the spinal cord dorsal horn to the midbrain

2) Modulation: activate pain control pathways that descend from the midbrain, via the rostral ventromedial medulla to the spinal cord dorsal horn
o Altering pain transmission

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49
Q

opioids directly inhibit the ___________ transmission of nociception information from the spinal cord _______ ________ to the ___________

A

directly inhibit the ascending transmission of nociception information from the spinal cord dorsal horn to the midbrain

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50
Q

Modulation: activate pain control pathways that ___________ from the __________, via the rostral ventromedial medulla to the spinal cord dorsal horn

A

Modulation: activate pain control pathways that descend from the midbrain, via the rostral ventromedial medulla to the spinal cord dorsal horn

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51
Q

noxious stimuli (chemical, thermal, mechanical energy) is converted to an electrical impulse in sensory nerve endings

A

transduction of pain (1st)

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52
Q

conduction of electrical impulses (action potential propagation) to the CNS: major connections for these nerves in dorsal horn of the spinal cord (signal transmitted along myelinated __–____ fibers and unmyelinated ___ fibers)

A

transmission of pain (2nd)

myelinated A-delta fibers and unmyelinated C fibers

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53
Q

altering pain transmission

A

Modulation of pain (3rd)

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54
Q

occurs at the thalamus with the cortex important for discrimination of specific sensory experiences

A

perception of pain (4th)

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55
Q

what receptor is found in the spinal cord only

A

mu 2

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56
Q

what receptor is known for the worst respiratory depression

A

mu 2

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57
Q

what receptor has dynorphins and agonists/antagonists

A

kappa

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58
Q

what receptor has endorphins, morphine, and synthetic opioids

A

mu 1 and mu 2

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59
Q

what receptor has enkephalins

A

delta

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60
Q

what receptor creates analgesia AND euphoria

A

mu 1

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61
Q

what receptors cause resp depression (3)

A

mu 2*, kappa, delta

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62
Q

what receptor causes psychotomimetic, dysphoria, and dissociation

A

kappa

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63
Q

what receptor causes hypothermia

A

mu 1

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64
Q

what receptor causes bradycardia

A

mu 1

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65
Q

what receptors cause urinary retention (3)

A

mu 1, mu 2 and delta

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66
Q

what receptors cause constipation and physical dependence (2)

A

mu 2 (constipation is worse), delta

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67
Q

what receptor can reverse mu 2 resp depression

A

kappa

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68
Q

what receptor is used in L&D often

A

kappa

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69
Q

what receptor can cause sedation

A

kappa

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70
Q

what receptors can cause miosis (3)

A

mu 1, mu 2, kappa

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71
Q

Exogenous opioids act on the brain circuits by stimulating the release of ___________ opioid peptides.

A

exogenous opioids (drugs) stimulate endogenous ligands (endorphins, enkaphalins, dynorphins)

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72
Q

what happens with patients with:
debilitated
or
increased sympathetic tone (increased HR, increased SVR) due to trauma, hypovolemic) when given opioids

A

This leads to exaggerated MAJOR decrease in BP

due to ATTENuation of compensation

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73
Q

______________ responsiveness to PaCO2, the CO2 response curve shifts to the ______

A

Decreased responsiveness to PaCO2, the CO2 response curve shifts to the right

Takes a higher PaCO2 to make the patient want to breathe!

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74
Q

opioids cause:
___________ respiratory rate, compensation occurs in the body with ___________tidal volumes

A

decreased respiratory rate,
compensation occurs with increased tidal volumes

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75
Q

If patient is manual ventilated (so hypercarbia is avoided):
opioids are cerebral vaso___________

A

vasoconstrictors, decreased ICP

normal situations!
manual ventilation!

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76
Q

if patient is spontaneously breathing and is hypoventilating:
opioids are cerebral vaso___________

A

vasodilators, increased ICP

increased PaCO2 results in cerebral vasodilation

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77
Q

consciousness, amnesia,
and response to stimulation

low doses =

A

Mild sedation, NO amnesia, YES response to stimulation

consciousness, amnesia,
and response to stimulation

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78
Q

consciousness, amnesia,
and response to stimulation

moderate doses =

A

Moderate sedation, NO amnesia, some response to stimulation

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79
Q

consciousness, amnesia,
and response to stimulation

massive doses =

A

unconciousness, NO amnesia, some response to stimulation

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80
Q

true or false
pupillary changes are NOT effective during general anesthesia as a tool to assess opioid effects

A

true
do not use it!

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81
Q

how do opioids work at the biliary

A

narrows the sphincter of Oddi; causes increasing intrabiliary pressure and epigastric distress

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82
Q

opioids work by _________ stimulation of _______________ trigger zone in floor of the _________ ventricle

opioids act like partial __________ at __________ receptors!

A

direct stimulation of chemoreceptor trigger zone in floor of the fourth ventricle

Opioids act like partial agonists at dopamine receptors!

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83
Q

what is the treatment for biliary spasm

A

glucagon, then narcan

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84
Q

avoid what 4 things to help reduce N/V for patients getting opioids

A

Ambulation
Extreme pain
PCA pumps
Epidurals

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85
Q

Stiff Chest Syndrome/Trunchal Rigidity
cause:

A

LARGE, RAPID doses of highly lipid-soluble opioids (fentanyl, sufentanil, alfentanil)

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86
Q

Stiff Chest Syndrome/Trunchal Rigidity:
__________ of GABA; ___________ in dopamine

A

Inhibition of GABA; increase in dopamine

Intensification of tone of large muscles of the thorax and abdomen

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87
Q

Stiff Chest Syndrome/Trunchal Rigidity
treatment

A

NMBs

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88
Q

If patient is asleep, what might indicate biliary spasm at the sphincter for a cholangiogram

A

the surgeon cannot get the dye to make it in because it is spasming

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89
Q

true or false
opioids CAN pass the placental barrier

A

true

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90
Q

are opioids teratogenic

A

no, opioids CAN be used for non-deliveries

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91
Q

True or false
you give opioids once the cord is clamped in a c-section

A

true

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92
Q

termination of effect
small/single dose of opioid

A

redistribution

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93
Q

termination of effect
large/repeated doses of opioids

A

metabolism

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94
Q

which drug and its metabolite is eliminated solely through the kidneys

A

Meperidine/Demerol
Normeperidine

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95
Q

which drugs are eliminated through the kidneys and bile

A

Morphine, Fentanyl, Sufentanil, Remifentanil, Alfentanil

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96
Q

what opioid is metabolized by plasma esterases

A

remifentanil (very short half time)

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97
Q

what benzodiazepine is metabolized by tissue esterases

A

byfavo (ultra short acting)

98
Q

opioid induced hyperalgesia:

Potent pain relief during case, then once they don’t have that, they are ______ sensitive to their pain

more likely to occur with ________ doses

Possibly due to alteration in _______ receptor

A

Potent pain relief during case, then once they don’t have that, they are MUCH MORE sensitive to their pain

more likely to occur with LARGE doses

Possibly due to alteration in NMDA receptor

99
Q

what is treatment for opioid induced hyperalgesia

A

Ketamine and magnesium (NMDA blockers)

100
Q

what is the most potent opioid, can cause stiff chest syndrome, glottic obstruction (laryngospasm), and weak alpha blockade of aorta

A

sufentanil

apnea upon induction! make sure you are giving slow and splitting it up! sit there!

101
Q

The development of increased dose needed to achieve the same analgesia as previously with a smaller dose

A

tolerance

Usually requires 2-3 weeks to develop with morphine, but can develop more quickly with highly potent opioids

102
Q

which drug is more potent than fentanyl, and patients can still be extubated sooner

A

sufentanil

103
Q

context sensitive half time (shortest to longest)

A

Remifentanil > sufentanil > alfentanil > Fentanyl

104
Q

what 2 drugs have a high synergistic effect

A

fentanyl and versed

(respiratory depression, sedation, hemodynamic changes)

105
Q

true or false
You can give normeperidine to a patient with a seizure disorder

A

true
UNLESS you are giving repeated doses or the patient has renal failure

106
Q

what is the most potent amnesia benzo

A

lorazepam

107
Q

what is the most hemodynamically stable benzo

A

diazepam

108
Q

what benzo has the fastest clearance rate

A

versed

109
Q

what metabolite (elimination half life) is 48-96 hours and is only slightly less potent than its parent drug

A

dezmethyldiazepam
(elderly are sensitive)

110
Q

what is termination of action for benzodiazepines

A

redistribution

111
Q

MOA:
Moderate affinity for mu receptors; weak activators of kappa and delta
This creates less respiratory depression
Inhibits reuptake of norepi and serotonin
Inhibits release of presynaptic release of serotonin

A

tramadol

112
Q

MOA:
Competes with benzos and displaces them for the benzodiazepine receptor site on the GABA receptor
Reverses respiratory depressant effect

A

flumazenil

113
Q

MOA:
Displaces the opioid from the receptor, binds to receptor, inactivates it

A

Narcan

114
Q

MOA:
Stimulates hypoxic drive via activation of ______________________ in the __________
1 mg/kg = PaO2 of 38 mmHg (tricks the body into thinking this, does NOT change it)

A

Doxapram

Stimulates hypoxic drive via activation of chemoreceptors in the carotid

115
Q

MOA:
Diffuse across the dura to affect ____ receptors on the spinal cord AND are absorbed to produce the effects like IV opioids

A

neuraxial opioids
mu receptors

116
Q

MOA:
Bind to ____________ receptors (part of the GABA receptor), which enhance the affinity of binding of GABA to its receptor, opening of chloride channel, hyperpolarization of the neuron, and inhibition of the neuron to excitation

A

benzodiazepines

117
Q

do H1 and H2 blockers alter the RELEASE of histamine

A

no
they just block the receptors so they cannot attach

118
Q

Opioids cause bradycardia by:
___ node ___________, ________ conduction through ___ node

A

SA node depression, slowed conduction through AV node

119
Q

agonists and antagonists:
cause antagonistic effect of what 2 receptors (helpful for pain management)

A

mu and kappa

120
Q

true or false
agonists and antagonists limit toxicity of drug (ceiling effect, so the patient cannot overdose on it)

A

TRUE

121
Q

true or false
agonists and antagonists cause no significant increase in interbiliary pressure

A

TRUE

122
Q

agonists and antagonists
Maintain an analgesic effect () while simultaneously reversing respiratory depression () of opioid overuse

A

Maintain an analgesic effect (к) while simultaneously reversing respiratory depression (µ) of opioid overuse

123
Q

reversibly binds receptor at SAME site as agonist but does NOT activate receptor

A

competitive antagonist

124
Q

IRreversibly binds receptor at SEPERATE site from agonists (disables receptor)

A

non-competitive antagonist

125
Q

true or false
Subsequent doses of agonist after opioid agonists and antagonists may NOT provide adequate analgesia

A

true

efficacy is reduced

126
Q

what receptor causes withdrawal with agonists antagonists

A

µ receptor antagonist

127
Q

which 2 agonists antagonists cause CV effects

A

Talwin
Stadol

128
Q

which agonist antagonist is best for chronic pain and moderate pain

A

Talwin

129
Q

which agonist antagonist is best for migraine headaches, post op pain, and shivering

A

Stadol

130
Q

↑Cardiac Output and cardiac workload
↑SBP and pulmonary artery pressure

Caution when using on patients with CHF or MI

A

Talwin and Stadol

131
Q

why is suboxone effective in regards to chronic pain patient who is opioid dependent

A

suboxone may reverse opioid-induced hyperalgesia (like ketamine and magnesium)

132
Q

Neural plasticity occurs

Pain spreads beyond the site of injury

Pain is exaggerated and prolonged in response to noxious stimuli

A

hyperalgesia

133
Q

what are the 5 effects of benzos

A
  • Sedation
  • Antegrade amnesia***
  • Anxiolysis
  • Anticonvulsant actions (good for seizures)
  • Skeletal muscle relaxation

(barbiturates also bind to GABA, so they will have a synergistic effect!)

134
Q

versed has a ___________ ring which makes it water soluble in pH of < 3.5

A

imadazole

135
Q

which benzo has a cardioprotective effect

A

versed

136
Q

versed: reduction of seizure activity:

alpha activity (resting) ___________
beta activity (attentiveness) ____________

A

alpha activity (resting) decreased
beta activity (attentiveness) increased

137
Q

what is a drawback of using diazepam

A

dezmethyldiazepam (48-96 hours elimination half life) causes prolonged effects

138
Q

which benzo has the slowest onset

A

lorazepam

139
Q

negative side effects of narcan (6)

A

pulm edema
N/V
sympathetic stimulation (tachy, vfib ventricular irritability, HTN)
neonatal (withdrawal)
precipitation of abstinence syndrome

140
Q

which drug do you use first: flumazenil or narcan

A

flumazenil (less side effects!)

141
Q

which drug increases Vt (and a little RR) resulting in increased minute ventilation

A

Doxapram

142
Q

where does NEGATIVE expectancy of analgesia occur

A

hippocampus

143
Q

where does POSITIVE expectancy of analgesia occur

A

endogenous ligands

144
Q

what receptor causes diaresis

A

kappa

145
Q

works DIRECTLY on myocardium (protective)

A

kappa and delta

146
Q

works PROXIMAL/noncardiac on myocardium (protective)

A

mu 1 and mu 2

147
Q

what are the 3 supraspinal descending pathways for modulation
Rostral __________ ___________
Locus ___________
Midbrain _______________ ______ area

A

Rostral ventral medulla
Locus caeruleus
Midbrain periaqueductal gray area

148
Q

as a result of the HPA axis, ______________ plasma cortisol levels occurs with _________ opioids

A

as a result of the HPA axis, decreased plasma cortisol levels occurs with chronic opioids

149
Q

what is the overdose triad

A

miosis
hypoventilation
coma

150
Q

which opioid should be used for ERAS protocol

A

fentanyl

151
Q

which 2 drugs have first pass in the lungs

A

fentanyl and sufentanil

152
Q

An active morphine metabolite that is toxic for renal failure patients, leads to prolonged duration

A

Morphine 6 Glucuronide

153
Q

GABA is what 2 things

A

Anticonvulsant
Sedation

154
Q

Glycine is what 2 things

A

muscle relaxant
anxiolytic

155
Q

glycine
muscle relaxant:

A

spinal cord

156
Q

glycine
anxiolytic:

A

brainstem

157
Q

GABA
anticonvulsant:

A

brain motor circuits

158
Q

GABA
sedation:

A

cortex

159
Q

good drug for respiratory depression reversal

A

physostigmine
increases Ach available, does not displace the opioid off the receptor

160
Q

high doses of opioids cause: apnea __________ loss of consciousness

A

high doses of opioids cause: apnea without loss of consciousness

161
Q

what 2 side effects never develop tolerance

A

miosis
constipation

162
Q

EPIDURAL:
_______________ added for ____________ absorption

A

SLOWER absorption: epinephrine added

163
Q

SPINAL:
_______________ added to morphine for _____________ analgesia

A

epinephrine added to morphine for ENHANCED analgesia:

164
Q

which side effect is not dose dependent for neuraxial opioids

A

urinary retention

165
Q

MOA: interacting with opioid receptors in the trigeminal nucleus to cause:

A

pruritus

treatment: narcan or gabapentin

166
Q

neuraxial decreased risk of vent depression

A

OB patients

167
Q

neuraxial
MOA: cephalad migration and interaction with non-opioid receptors in the brainstem or basal ganglia; blocking the inhibitory neurotransmitters: glycine and GABA

A

CNS excitation

168
Q

which drug can cause Serotonin syndrome

HTN, tachycardia, diaphoresis, hyperthermia, hyperreflexia, confusion, agitation, coma, seizures, coagulopathy, metabolic acidosis

A

demerol

169
Q

which drug is used for
Suppression of postoperative shivering
Pediatrics (tonsillectomy)

A

demerol

170
Q

fentanyl
_______________ stress response (when given WITH inhalation agent)

A

Suppresses stress response (when given WITH inhalation agent)

171
Q

fentanyl
______________ stimulation (when given WITHOUT inhalation agent)

A

Sympathetic stimulation (when given WITHOUT inhalation agent)

172
Q

More intense analgesia, LESS respiratory depression, extubated sooner

A

sufentanil

173
Q

o Moderate pain
o Chronic pain
o Increased risk of physical dependence
agonist antagonist

A

talwin

174
Q

agonist antagonist
o Migraines
o Post-op shivering and pain

A

stadol

175
Q

agonist antagonist
Analgesia more potent than morphine!

A

stadol

176
Q

o Good for CV patients!
o Relieves pruritis for OB patients
o “Lingering fentanyl induced respiratory depressant effects”
agonist antagonist

A

nubain

177
Q

“Lingering fentanyl induced respiratory depressant effects”
Cancer pain
Opioid dependence
narcan does NOT work

A

buprenex

178
Q

o “Lingering fentanyl induced respiratory depressant effects”
o Cancer pain
o Opioid dependence
agonist antagonist

A

buprenex

179
Q

Buprenorphine + Narcan (___:____ratio)

A

4:1 suboxone

180
Q

agonist antagonist for opioid induced hyperalgesia

A

suboxone

181
Q

benzo
indications include long cases, CV cases, cases where patient will be intubated post op

A

ativan

182
Q

benzo
indications include endoscopy, bronchoscopy, organ failure (due to tissue esterases)

A

byfavo

183
Q

4 Beneficial Properties of Opioids

A
  • Analgesia
  • Preservation of blood flow autoregulation (CNS, heart, kidneys)
  • Minimal cardiac depression with maintenance of hemodynamics
  • Blunting of autonomic responses to sympathetic stimulation
184
Q

which 2 drugs have cardiac protective effect

A

Morphine and remifentanil

185
Q

4 mild withdrawal symptoms

A

o Yawning
o Diaphoresis
o Lacrimation
o Coryza: severe nasal congestion

186
Q

which opioid is likely to cause respiratory depression (especially opioid naïve patients)

A

dilaudid

187
Q

o Great for patients with renal failure
o Terminally ill patients

A

dilaudid

188
Q

o Interacts with Zofran and Coumadin
o Seizures
o N/V

A

tramadol

189
Q

Potency (most potent > least potent)

A

Sufentanil > Fentanyl > Alfentanil > Morphine > Tramadol > Demerol

190
Q

Produces more euphoria
Interindividual variability related to P-450 CYP3A

A

alfentanil

191
Q

which agonist antagonist is resistant to narcan

A

buprenex

192
Q

Opioid Agonist: binds to opioid receptors at ______ the ____synaptic and ___synaptic sites in the CNS and peripheral sites (primary __fferent neurons)***

A

Opioid Agonist: binds to opioid receptors at both the PREsynaptic and POSTsynaptic sites in the CNS and peripheral sites (primary AFferent neurons)

193
Q

Opioids act like the endogenous peptides/ligands that normally activate these receptors***

A

enkaphalins
endorphins
dynorphins

194
Q

The principal effect of opioids binding to specific G protein-coupled receptors is a ___________ in neurotransmission***

A

DECREASE in neurotransmission

195
Q

KNOW THIS
activation of opioid receptor causes
___________ of voltage-gated Ca2+ channels on PREsynaptic nerve terminals to cause a _______________ of the release of neurotransmitters (glutamate, acetylcholine, dopamine, norepinephrine, serotonin, and substance P)

____________ of K+ channels to hyperpolarize the cell (conductance), thus causing ______________ of the POSTsynaptic neurons***

A

CLOSURE of calcium channels= REDUCTION in neurotransmitters

OPENING of potassium channels= inhibition of POST

196
Q

G protein coupled receptor:
_____________ adenylate cyclase
this results in ____________ in intracellular cAMP

A

INHIBITION of adenylate cyclase
results in DECREASE in cAMP

197
Q

little opioid CV response occurs (safe to use) for these (3) occasions***

A

healthy
supine
normovolemic

198
Q

with opioids, there is a ___________ responsiveness to PaCO2, so CO2 response curve shifts to the _________ and __________***

A

DECREASED responsiveness to PaCO2
shift to the RIGHT and FLATTENS

199
Q

primary RESPIRATORY response of opioids***

A

decreased respiratory rate

to compensate, increased Vt occurs

200
Q

Factors that accentuate ventilatory depression (6)***

A

Occurrence of natural sleep/sleep disorders
Older age >60 years
Male
Opioid naivety
Chronic heart failure
Intra-articular morphine

201
Q

opioids cause _____________ ciliary activity***

A

decreased
makes it harder to clear the airways

202
Q

true or false
opioids are NOT anesthetic***

A

TRUE
cannot be the only agent used!

203
Q

opioids for normal PaCO2 cause cerebal vaso_____________***

A

vasoconstriction, leading to decreased ICP
(they are brain-protectant)

204
Q

stiff chest syndrome is relieved by***

A

NMBs

205
Q

treatment for biliary spasm***

A

glucogan (causes relaxation of smooth muscle)

206
Q

what causes morphine’s slow onset and prolonged duration***

A

low lipid solubility

207
Q

which 2 drugs have first pass in the lungs***

A

Fentanyl and sufentanil

208
Q

what causes termination of action for small/single dose of opioids***

A

redistribution

209
Q

When used with propofol for TIVA, propofol inhibits degradation of alfentanil and sufentanil by ____-____%***

A

50-60%

210
Q

morphine has increased movement ___________ for neuraxial***

A

cephalad

211
Q

what is the only side effect that is NOT dose-dependent for neuraxials***
(NOT related to dose size)

A

urinary retention

212
Q

pruritius
MOA: interacting with OPIOID receptors in the _________ nucleus***

A

trigeminal

213
Q

what is the treatment for pruritus***

A

gabapentin

214
Q

how does hypothermia occur with opioids***

A

inhibition of shivering

215
Q

what opioid causes tachycardia (the only one!)
how does the tachycardia occur***

A

demerol
Similar in chemical structure to atropine

216
Q

which drug can cause myocardial depression***

A

demerol

217
Q

which drug is an anticholinergic***

A

demerol

218
Q

which drug can cause seizures (CNS stimulant) delirium, hallucinations***

A

normeperidine

219
Q

this drug causes MORE intense analgesia and LESS respiratory depression***

A

sufentanil

220
Q

drug for neuro assessments***

A

remifentanil

221
Q

drug that is great for patients with renal failure
and
has a similar metabolism to morphine***

A

diluadid

222
Q

agonist antagonist that causes
dissociation (kappa)***

A

talwin

223
Q

agonist antagonist
drug that RARELY causes dysphoria***

A

stadol

224
Q

agonist antagonist
subsequent morphine doses are less effective
and
good for CV patients***

A

nubain

225
Q

agonist antagonist
narcan does NOT work on this drug***

A

buprenex

226
Q

agonist antagonist that is used for hyperalgesia*

A

suboxone

227
Q

glycine
anxiolytic***

A

brainstem

228
Q

benzodiazepines
GABA receptor
If the receptor is “acted on” at more than one site, the inhibition of the CNS to excitation is _____________***

A

synergistic

229
Q

Water soluble
imidazole ring
pH of < 3.5 (becomes lipid-soluble in the body)***

A

versed

230
Q

versed:
Hypovolemic patients (trauma, extreme dehydration): exaggerated ________ decrease in SVR and BP***

A

major decrease

231
Q

diazepam causes this resp effect***

A

decrease in Vt

232
Q

dezmethydiazepam causes drowsiness to return within ___ hours***

A

6 hours

233
Q

always give flumazenil __________ narcan***

A

before

234
Q

flumazenil only has 1 side affect***

A

withdrawal seizures for patients on seizure meds
(NO other side effects (because it is a weak agonist)

235
Q

which drug can cause:
Acute pulmonary edema (increased pressure, permeability)
Sympathetic stimulation due to rapid return of pain (Tachycardia, V fib, HTN)
N/V***

A

narcan

push slow!

236
Q

drug that increases minute volume (by increasing Vt mostly and some RR)***

A

doxapram

237
Q

avoid doxapram for these patients (6)***

A

o Cerebrovascular disease
o Asthma (reactive airways)
o CAD, HTN

o Acute head injury
o Seizures
o Halothane (catecholamines)

238
Q

Things used to prevent histamine release BP drop with morphine***

A

H1 and H2 blockers
fluid
keep supine

239
Q

what 2 systems are preserved with opioids***

A

brain
heart

240
Q

how does bradycardia with opioids occur***

A

vagal stimulation in the medulla

241
Q

what is the greatest factor for duration and onset with opioids***

A

lipid solubility

Pharm 1 (9 decks)

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