Narcotics - Dilaudid/Hydromorphone Flashcards
Sufentanil (1000x)>
Fentanyl=Remifentanil (100x)>
Alfentanil (20x)>
Dilaudid (5x)>
Morphine
Cornelius:
› 7x more potent than morphine
› Less histamine release
› IV relief peaks at 5-20 minutes
› Duration 2-4 hours
› Favored by many anesthesia providers towards to end of surgery, carryover into PACU
› Very potent, lower doses needed, be cautious about delayed response. Dose slow and low.
What is the concentration of Dilaudid?
2mg in 10mL syringe
for 0.2 mg/mL
A patient weighing 70 kg is scheduled for surgery and will receive Dilaudid. The dosing protocol is 0.02 mg/kg, with half given up front after induction if tolerated, followed by 0.2 mg each hour except the last hour, with a maximum of 2 mg during the case. What is the correct initial dose?
A) 0.14 mg
B) 0.7 mg
C) 1.4 mg
D) 2 mg
E) 0.02 mg
C) 2 mL
D) 1 mL
A) 0.14 mg
Calculate 0.02 mg/kg and give half up front after induction if patient can tolerate, then 0.2 every preceding hour besides the last hour. Usually no more than 2 mg during case. Also titrate to RR 12-20.
Given the concentration of 2 mg in a 10 mL syringe (0.2 mg/mL), how many mL of the solution are needed to administer a dose of 0.6 mg?
A) 1.5 mL
B) 2.0 mL
C) 3.0 mL
D) 4.0 mL
Answer: C) 3.0 mL
C) 3.0 mL
Concentration: 2mg in 10mL syringe for 0.2 mg/mL
Which opioid receptors are primarily targeted by Dilaudid to suppress pain, according to the MOA described?
A) Delta and kappa opioid receptors
B) Mu1 opioid receptors
C) Mu1, kappa, and delta opioid receptors
D) Mu2 and kappa opioid receptors
B) Mu1 opioid receptors
Suppress pain through primary action on mu1-R, then kappa and delta opioid-Rs. Directly inhibit ascending nociceptive presynaptic transmission of excitatory NTs, and activation of descending inhibitory pain pathway
What is onset and the time to peak effect of the medication? Select 2
A) 3 minutes
B) 10 minutes
C) 15 minutes
D) 2 hours
A) 3 minutes
C) 15 minutes
onset 3 minutes with peak at 15 min
After administering Dilaudid intravenously, what is the expected time for its onset of action?
A) 1 minute
B) 3 minutes
C) 5 minutes
D) 10 minutes
E) 15 minutes
B) 3 minutes
What is the half-life of Dilaudid?
A) 1 hour
B) 2 hours
C) 4 hours
D) 6 hours
B) 2 hours
How is Dilaudid primarily metabolized in the body?
A) Through oxidative metabolism in the liver
B) Via glucuronidation in the liver
C) By hydrolysis in the kidneys
D) Through phase I metabolism in the intestines
B) Via glucuronidation in the liver
Metabolism: Glucuronidation in liver to produce hydromorphone-3-glucuronide (active)
What is Dilaudid used for and why?
Action:
A) pain control for longer cases over 2 hours;
B) used for orthopedic cases;
C) more sedation and less euphoria;
D) will not accumulate with renal failure (safer than morphine here)
F) All of the above
F) All of the above
What is the primary route of elimination for Dilaudid?
A) Sweat and saliva
B) Feces and breath
C) Urine and bile
D) Exhalation and perspiration
C) Urine and bile
Elimination: Excreted in urine/bile unchanged
How does the potency of the medication compare to morphine?
A) It is 2x more potent than morphine
B) It is equally potent as morphine
C) It is 5x more potent than morphine
D) It is less potent than morphine
C) It is 5x more potent than morphine
In which of the following conditions is Dilaudid contraindicated?
A) Postoperative pain management
B) Gastrointestinal obstruction or ileus
C) Chronic pain conditions
D) Minor surgical procedures
B) Gastrointestinal obstruction or ileus
Why should care be taken to avoid overshooting the dose of Dilaudid?
A) It may cause excessive sedation
B) It can lead to prolonged duration of action
C) It may necessitate the administration of Narcan at the end of the procedure
D) It may cause severe hypertension
C) It may necessitate the administration of Narcan at the end of the procedure
Precautions: Active metabolite; Don’t overshoot with this med or you’ll be pushing Narcan at end.
Which of the following is a common side effect of Dilaudid? Select 2
A) Diarrhea
B) Hyperactivity
C) Nausea and vomiting
D) Itching
C) Nausea and vomiting
D) Itching
