meds; opioids Flashcards by Mary Munoz

Morphine intraop dose

1-10 mg

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Mu 1 receptor effects

analgesia
euphoria
no dependence
hypothermia
bradycardia
miosis
urinary retention

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Morphine Postop dose

5-20 mg

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Mu2 receptor effects

analgesia
physical dependence
constipation
depression of ventilation

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Onset for morphine

10-20 min

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Kappa receptor effect

anaglesia
dysphoria/sedation
no dependence
miosis
diuresis
antishivering

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duration of morphine

4-5 hr

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Delta receptor effect

anaglesia
depression of ventilation
physical dependence
constipation
urinary retention
pruritis

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Morphine MOA

receptors; Mu1 and Mu 2

dull> sharp pain

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General opioid side effects

chest wall and abd rigidity
cardiac protective
sphincter of opioid spasm (fent>morphine> meperidine)
x placenta

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Morphine side effects

hydrophilic = slow cephalad spread w/ blocks

MU 1 and 2 effects

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Morphine metabolism

glucuronic acid conjugation -> active metabolites (morphine - 6)

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Fentanyl intraop dose

1-3 mcg/ kg

IBW

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onset of fent

30-60 seconds

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duration of fent

1-1.5 hr

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Fent potency

75-125 x more pot than morphine

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Side Effects of fent

increase ICP
depression of carotid sinus baro r
potentiates benzos

(lipophilic)

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Fent metabolism

lung first pass effect; 75%

cyp3A -> norfentanyl

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Fent MOA

Mu 1 and 2 > kappa and delta

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Sufent intraop dose

0.3-1mcg/kg

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Sufent MOA

› Highly selective mu opioid receptor agonist

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sufent onset

30-60 seconds

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Sufent concentration

50mcg/ml

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Sufent duration

1-1.5 hr

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sufent gtt dose

0.5-1 mcg/kg/ hr

Sufent potency

Fent < sufent 1000 x more potent than morphine

sufent side effect

bradycardia (lipophilic)

sufent metabolism

alpha 1 acid glycoprotein binding (92.3%) 60% lung first pass hepatic metabolism

remifent intraop dose

load; 0.5-1 mcg/kg over 1 min **IBW

Remifent trade name

Ultiva

remifent onset

30-60 sec

remifent duration

6-8 min

remifent gtt dose

0.125-0.375 mcg/kg/min IBW**

Remifent moa

selective mu

remifent side effects

hyperalgesia/tolerance bradycardia

Remifent metabolism

tissue esterase metabolism

Remifent is used for what cases?

neuro, carotid endarterectomy, eye blocks, TIVA

What should be given prior to stopping remifent gtt?

a longer acting analgesic

remifent potency

fent < remi 100-300 x more potent than morphine

Meperidine postop dose and whats it given for?

12.5 mg given for shivering

Meperidine onset

5-15 min

meperidine duration

2-4 hr

Meperidine potency

1/10th as potent as morphine

meperidine MOA

mu, Kappa and alpha 2 agonist structurally similar to atropine and LA

Meperidine side effects

tachycardia, mydriasis, dry mouth serotonin syndrome negative inotrope x placenta w/d symptoms faster than morphine decrease sz threshold -> sz/ myoclonus (active metabolite causes)

Brand name for meperidine

pethidine/ demerol

Hydromorphone intraop dose

1-4 mg

hydromorphone postop dose

1.5-4 mg

hydromorphone onset

5-15 min

hydromorphone duration

2-4 hr

hydromorphone potency

7x more pot than morphine

hydromorphone metabolism

CYP3A4; active metabolite hydromorphone- 3 glucuronide (neurotoxic, sz, allodynia, myoclonus)

Naloxone intraop dose

40-80 mcg

Naloxone post op dose

40-80 mcg

Naloxone onset

1-5 min

Naloxone duration

30 min

Naloxone moa

competitive antagonist for Mu, kappa, and delta opioid Rectors Reduces/reverses mu related SE’s: pruritis, urinary retention, muscle rigidity, biliary spasm

Naloxone side effects

N/V, - analgesia, increased SNS flash pulmonary edema

Naloxone concentration

400mcg/ml (must dilute)

Opioids are usually weak acids or bases?

Bases

Tramadol dose PO

3 mg/kg PO 50-100 mg

Tramadol MOA

mu, weak kappa and delta

Tramadol potency

5-10x less potent than morphine

Tramadol SE

Interactions with coumadin

Codeine dose PO

15-60 mg

Hydrocodone dosage PO

5-7.5mg

Oxycodone PO dose

5mg

Methadone PO dose

2.5-10 mg NMDA antagonist

Hydrocodone trade name

vicadin

Methadone potency

4x more pot than morphine

What is Percocet

oxycodone + acetaminophen

Methadone IV dose

0.2-0.3mg/kg

What is percodone

Oxycodone + aspirin

Methadone uses

opioid w/drawal and chronic pain T1/2 = 1-2 days inc QTC NMDA antag

Fentanyl trade name

Sublimaze

fentanyl gtt dose

3-6mcg/kg/hour (off 60 minutes before breathing)

fentanyl concentration

50 mcg/ml

Meperidine contraidicated

with MAOI's