Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesia Pharmacology > Exam 2 - Opioid agonists > Flashcards

Exam 2 - Opioid agonists Flashcards

1
Q

Opiates are derived from what plant?
What are were the first three opiates?

A

Papaver somniferum aka poppy juice
- Morphine
- Codeine
- Papverine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The word narcotic comes from the greek word ____ , which means ____

A

stupor
has the potential to produce a physical dependance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What 3 drugs are the phenanthrenes?

A
  • Morphine
  • Codeine
  • Thebaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What 2 opioids are benzylisoquinolines?

A
  • Papaverine
  • Noscapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the general MOA of opiates?

A
  • Act on pre and post synaptic opioid receptors in the CNS
  • Presynaptic inhibition of ACh, dopamine, norepinephrine, and substance P
    → Hyper polarization via ↑K+ conductance
    → Ca+ channel inactivation
  • Decreased neurotransmisson of pain modulators
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where are opioid receptors in the brain?

A

-Periaqueductal gray (PAG)
- locus ceruleus
- rostral ventral medulla (RVM)
-hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where are opioid receptors located in the spinal cord?

A
  • Interneurons
  • Primary afferent neurons in the substantia gelatinosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where are opioid receptors outside of the CNS?

A
  • Sensory neurons
  • Immune cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

These 2 opioid receptors effects include low abuse potential and miosis?

A

Mu1 and Kappa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

These 2 opioid receptors cause physical dependence and constipation?

A

Mu2 and Delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

This opioid receptor is the only receptor that does not produce supraspinal analgesia?

A

Mu2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

This opiod receptor causes bradycardia, hypothermia, and urinary retention?

A

Mu1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

This opioid receptor can cause dysphoria and diuresis?

A

Kappa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Endorphins, morphine, and synthetic opioids are agonists of these receptors?

A

Mu1 and Mu2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the agonist for kappa and delta receptors?

A

Kappa: Dynorphins
Delta: Enkephalins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

These opioid receptors cause depression of ventilation?

A

Mu2 and delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the CV side effects from opioids?

A
  • Histamine release causing decreased SNS tone in veins = ↓ venous return, CO, and BP
  • Bradycardia
  • Increased effects with benzos or nitrous
  • Cardioprotective from MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Opiods effect on responsiveness to CO2?
Leads to what?

A

Decreased
Increases resting PaCO2 (shifts curve right)
Depresses ventilation leading to hypoventilation or apnea if overdosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What drug can antagonize the ventilatory depression of opiods?
How?

A
  • Physostigmine
  • Increases CNS ACh levels - reducing ventilatory effects while maintaing analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

These opiods can cause cough suppression:

A
  • Codeine
  • Dextromethorphan

The other opioids can cause reflexive coughing pre-induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why should you caution opioids in patients with head injuries?

A
  • Can decrease CBF
  • Affects wakefulness
  • Causes miosis
  • Increased PaCO2 can increase ICP
  • Damage to the BBB can increase sensitivity to opioids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Can opioids cause myoclonus?

A

Yes, in large doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What severe side effect of opioids can be exacerbated by mechanical ventilation?
Treatment?

A
  • Thoracic and abominal muscle rigidity - can lead to difficulty with ventilation/oxygenation
  • Tx: muscle relaxant or naloxone

Primarily seen with fentanyl and its derivatives, especially sufentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which opioids cautioned during an ERCP?
Why?
How can this be treated?

A
  • Fentanyl, morphine, and meperidine
  • Causes sphincter of Oddi spasms (3 % incidence)
  • Tx: Glucagon 2 mg IV, reverses spasm but not analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How can you determine is someone is having biliary pain from opioids or angina?
Give naloxone - biliary pain will improve but angina will not
26
How do opioids cause N/V?
Directly stimulates the chemotherapy trigger zone Increases GI secretions and delays emptying
27
What are all of the drug treatment options for Sphintcter of Oddi spasms?
28
Opioid effecs on GU, skin, and placenta?
GU: urinary urgency Skin: histamine release causes flushing Placenta: neonatal depression and chronic dependence
29
What is tolerance and when does it occur? How does tolerance happen physiologically?
The development of the requirement for increased drug dosages Usually after 2-3 weeks Opioid receptors become downregulated
30
What are the initial symptoms of opioid withdrawl? At 72 hours?
Initial: Yawning, diaphoresis, lacrimation, or coryza. Insomnia and restlessness. 72 hrs: Abdominal cramps, N/V, and diarrhea.
31
What is the time course of opioid withdrawl for meperidine, fentanyl, morphine, heroin, and methadone?
32
High doses of intra-op opiods can cause ____ post op pain?
Greater Due to hyperalgesia - low dose intraop is preferred
33
The gold standard opiod is ? How was it named?
Morphine Named after the greek god of dream morpheus
34
Is morphine better for dull or sharp pain? What fibers does this probably work on then?
* Dull * C fibers
35
Morphine: IV: Onset: IV peak: IM peak: Duration:
IV: 1-10 mg Onset: 10-20 mins IV peak: 15-30 mins IM peak: 45-90 mins Duration: 4-5 hours
36
Morphine is metabolized via ____ Its metabolites are ____ and ____ Prolonged ____ with renal failure
Glucoronic acid conjugation Morphine-3-glucuronide (inactive) and Morphine-6-glucuronide (active - same ventilatory effects as morphine) ventilatory depression
37
What effects of morphine are greater in women than men?
Analgesic potency and slower offset speed
38
Morphine comes in 10 mgs/mL, how much dilutent will you add to obtain a concentration of 1 mg/mL?
9 mL
39
The other name for meperidine is?
Pethidine
40
The uses for meperidine are?
Intrathecal, IM for analgesia, IV for post op shivering
41
Meperidine works on ____ and ____ opioid receptors Its analogues are?
μ and kappa Fentanyl, sufentanil, alfentanil, and remifentanil
42
Meperidine is structurally similar to ____ and ____? How does the structure relate to side effects?
lidocaine and atropine S/E include tachycardia, myadraisis, dry mouth (all symptoms of atropine also)
43
**Meperidine** Dose: Duration: Effects: Metabolism: Elimination: Toxicity:
Dose: 12.5 mg (post op shivering) Duration: 2-4 hours Effects: sedation, euphoria, N/V, depressed ventilation Metabolism: Hepatic → normeperidine Elimination: Renal, 3-5 hours Toxicity: delerium, myoclonus, seizures
44
Shivering can cause in increase of ____ % in O2 consumption which can cause ____ and ____
500% MI or CVA
45
Lung first pass effect of fentanyl? What does this mean?
* 75% * The lungs act as reservoirs and remove compounds from the pulmonary arterial blood, reducing the concentration of the active drug available to reach its site of action
46
**Fentanyl** Metabolite: Excretion: Vd:
Metabolite: Norfentanyl Excretion: Kidneys Vd: Large - in less than 5 mins 80% is gone into vascular tissues
47
Why is fentanyl's context sensitive half life so high?
Fentanyl saturates inactive tissues - when the infusion is stopped there is a large amount of drug that returns to the plasma
48
**Fentanyl Dosing** Analgesia: Induction: Adjucted with inhaled anesthetics: Solo anesthetic: Intrathecal: Transmucosal: Transdermal:
Analgesia: 1-2 mcg/kg IV Induction: 1.5-3 mcg/kg IV Adjucted with inhaled anesthetics: 2-20 mcg/kg Solo anesthetic: 50-150 mcg/kg Intrathecal: 25 mcg Transmucosal: 5-20 mcg/kg Transdermal: 75-100 mcg (18 hours steady state)
49
1 mg of PO fentanyl = ____ mg of IV morphine
50
50
Why does fentanyl decrease BP and cardiac output?
Depresses the carotid baroreceptor reflex
51
CNS side effects with fentanyl?
- Seizure like activity - Modest increase in ICP (6-9 mmHg)
51
Synergysim considerations for fentanyl?
- Potentiates benzos - Dosage decrease required when given with propofol
52
Sufentanil binds to what plasma protein?
⍺1 acid glycoprotein
53
**Sufentanil Dosing** Analgesia: Induction: Intraop: Infusion:
Analgesia: 0.1 - 0.4 mcg/kg Induction: 18.9 mcg/kg Intraop: 0.3 - 1 mcg/kg Infusion: 0.5 - 1 mcg/kg/hour
54
Side effects of sufentanil include:
Bradycardia causing decreased CO Chest/abdominal wall rigidity
55
You have 250mcg/5 mL vial of sufentanil. How many mcg in 1 mL? mcg in 2 mL? If you dilute 2 mL in a 20 mL syringe, what is the concentration?
- 50 mcg - 100 mcg - 5 mcg/mL
56
**Alfentanil dosing** Laryngoscopy: Induction: Maintenance:
Laryngoscopy: 15-30 mcg/kg (90 seconds prior) Induction: 150-300 mcg/kg Maintenance: 25-150 mcg/kg/hour
57
Why is alfentanil contraindicated in parkinson's?
Acute dystonia
58
Remifentanil is a selective ____ agonist It has a ____ structure Metabolized via ____ by ____ Offset occurs in ____ mins
mu opioid Ester hydrolysis; plasma and tissue esterases 15
59
**Remifentanil Dosing** Induction: Maintenance:
Induction: 0.5-1 mcg/kg Maintenance: 0.25-1 mcg/kg or .05-2 mcg/kg/min
60
Give ____ before stopping remifentanil drip Not recommended for ____ use
longer acting opioid spinal or epidural
61
Hydromorphone is ____ more potent than morphine Dose? Redose time?
5x 0.5 mg IV (1-4 mgs total) Every 4 hours
62
Why cant codeine be given IV?
Histamine induced hypotension
63
**Codeine Dosing** Cough supressant: Analgesia:
Cough supressant: 15 mg Analgesia: 60 mg | 120 mg = 10 mg morphine
64
Tramadol PO dosing?
3 mg/kg
65
Rank the opioids in lecture from most potent to least potent?
sufentanil > fentanyl = remifentanil > alfentanil > hydromorphone > morphine > meperidine > codeine
66
Effect site equilibration best represents what?
Onset of action

Anesthesia Pharmacology (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions