Hydromorphone - IV

Question 1

What is the brand/trade name for hydromorphone?

Answer 1

• Dilaudid

“iM AllERgIc tO aLL oF ThEm eXCEpt tHe ONe thAT STarTs WiTH ‘D’”

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

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Question 2

What is the pharmacologic category/class of hydromorphone?

Answer 2

• Opioid Analgesic — Semisynthetic
• Morphine derivative

Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 4. Classification, Relative Potency & Opioid Abuse

Nagelhout (7th ed.), pp. 139 - Box 11.1, 147

Question 3

What is the mechanism of action of hydromorphone?

Answer 3

Opioid rececptor agonism, especially mu and kappa

• Presynaptic: decreases cAMP-dependent influx of calcium ions → inhibition of neurotransmitter release
• Post synaptic: increased outward K⁺ conductance → hyperpolarization of nerve cell

resultant increase in pain threshold, altered pain perception, and inhibition ascending pain pathways

_{Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 2. Opioid Receptors
Nagelhout (7th ed.), pp. 141 - Fig. 11.2, 142, 147, 1295-1296
Stoelting’s Pharmacology (5th ed.), pp. 218-219}

Question 4

What is the typical dose range of hydromorphone for analgesia in adults?

Emphasis because ranges may vary depending on patient

Answer 4

• 0.4-2 mg IV q 2-4 hrs PRN

_{Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
UpToDate - Hydromorphone: Drug Information}

Question 5

What is the onset of action for hydromorphone?

Answer 5

• 2-5 minutes, with maximal effects in ~15 minutes

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

UpToDate - Hydromorphone: Drug Information

Question 6

What is the duration of action for hydromorphone?

Answer 6

• 4-6 hrs

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Nagelhout (7th ed.), p. 1299

Question 7

What organ(s) are responsible for hydromorphone’s clearance (metabolism/elimination)?

Answer 7

• Metabolism: Liver
• Elimination: Kidneys

Half-life: ~2-4 hours

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

UpToDate - Hydromorphone: Drug Information

Question 8

Cardiovascular effects of hydromorphone include:

Answer 8

• Bradycardia
• Minimal effect on blood pressure in healthy patients
  _{less histamine than morphine - not significant}

Note that these are similar to those of other opioids

Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3

Nagelhout (7th ed.), pp. 147

Stoelting’s Pharmacology (5th ed.), p. 240

Question 9

What are the respiratory effects of hydromorphone?

Answer 9

• Dose dependent depression of ventilation — RR affected before Vt
  _{(shifting of the CO2 response curve)}
• Inhibits hypoxic ventilatory drive
• Apnea at large doses

Note that these are similar to those of other opioids

Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3

Nagelhout (7th ed.), p. 142

Stoelting’s Pharmacology (5th ed.), p. 222

Question 10

What are the effects of hydromorphone on the CNS?

Answer 10

• Sedation
  _{somewhat more when compared to morphine}
• Miosis/pinpoint pupils
• Mild hypothermia
  _{resets hypothalamic temperature setpoint}
• N/V
  _{Partial dopamine agonists at CTZ}

Note that these are similar to those of other opioids

Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3

Nagelhout (7th ed.), p. 142

Stoelting’s Pharmacology (5th ed.), p. 222

Question 11

What are the GI/GU effects of hydromorphone?

Answer 11

• Slowed peristalsis → CONSTIPATION
• N/V
• Contraction of sphincter of Oddi → biliary colic
  _{evidence is kind meh on this}
• Delayed gastric emptying
• Urinary retention (IDGAF)
  _{detrusor relaxation, urinary sphincter constriction}

Note that these are similar to those of other opioids

Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3

Nagelhout (7th ed.), pp. 143-144

Stoelting’s Pharmacology (5th ed.), pp. 223-224

Question 12

The experience of pain can be divided into four steps: transduction, transmission, modulation, and perception. Which of these does hydromorphone have an effect on?

Answer 12

Along with other opioids, hydromorphone effects

• transduction
  _{peripheral nerves}
• modulation
  _{spinal cord}
• perception
  _{brain/brainstem}

Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 1 & 2

Question 13

As an analgesic, hydromorphone is __________ times more potent than morphine

Answer 13

• ~7

This number varies slightly between texts

Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 4. Classification, Relative Potency & Opioid Abuse

Question 14

True or false:

While hydromorphone is a morphine derivative, it does not have active metabolites and is appropriate to use in patients with renal failure

Answer 14

• True

Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 5. Metabolism

Nagelhout (7th ed.), pp. 147, 1299

Question 15

What is the typical concentration (mg/mL) of hydromorphone vials?

Answer 15

• 1 mg/mL or 2 mg/mL

Often comes in 0.5-1 mL vials

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