Med Review Precedex, Opioids

Question 1

What is the MOA of precedex?

Answer 1

⍺₂ receptor agonist which causes pre-synaptic inhibition (turns down the SNS)

Question 2

What effects can be observed from ⍺₂A receptor agonism?

Answer 2

• sedation
• hypnosis
• sympatholysis

Question 3

What effects can be observed from ⍺₂B receptor agonism?

Answer 3

• vasoconstriction
• anti-shivering
• analgesia

Question 4

What effects can be observed from ⍺₂C receptor agonism?

Answer 4

• Learning
• startle response

Question 5

Precedex administered too quickly can cause what?

Answer 5

Hypertension initially (transient)

Question 6

What are the respiratory effects of precedex?

Answer 6

• minimal respiratory depression (sleep-like depression)
• anti-sialogogue (dries secretions)

Question 7

Intrathecal morphine can cause potential for delayed respiratory depression up to ___?

Answer 7

Intrathecal morphine can cause potential for delayed respiratory depression up to 24 hours

Question 8

Which opioid has a high incidence of significant histamine release?

Answer 8

Morphine

Question 9

Which opioid has a prolonged half-life in elderly, liver failure, and renal failure patients?

Answer 9

Morphine

Question 10

Dilaudid is how much stronger than morphine?

Answer 10

Dilaudid is 7 times more potent than morphine

Question 11

What is the typical infusion dose for fentanyl?

Answer 11

3 - 6 mcg/kg/hr

Question 12

Which weight measurement should fentanyl be dosed based off of?

Answer 12

IBW
M: (Ht cm - 100) = kg
F: (Ht cm - 105) = kg

Question 13

What receptors are affected by meperidine?

Answer 13

mu
kappa
delta

Question 14

Meperidine’s active metabolite can lead to what?

Answer 14

can lead to CNS stimulation (seizures)

Question 15

A major drug interaction contraindication with demerol is what?

Answer 15

Contraindicated with MAOI’s

Question 16

Sufentanil is highly selective for which receptor?

Answer 16

Highly selective mu opioid receptor agonist

Question 17

Is sufentanil generally CV stable or instable?

Answer 17

CV stable

Question 18

Which opioid is targetted by remifentanil?

Answer 18

mu opioid receptor agonist

Question 19

How is remifentanil metabolized?

Answer 19

by plasma esterases (independent of organ function)

Question 20

Use of a remifentanil drip can reduce MAC by how much?

Answer 20

up to 70% reduction of MAC

Question 21

Due to its short duration, what considerations should be made with use of remifentanil?

Answer 21

Must cover for postop pain with another drug

Question 22

Naloxone (narcan) provides opioid receptor antagonism to which opioid receptors?

Answer 22

mu
kappa
delta

Question 23

Abrupt reversal of analgesia can lead to what?

Answer 23

cardiac stimulation