Narcotics - Fentanyl Flashcards
Sufentanil (1000x)>
Fentanyl=Remifentanil (100x)>
Alfentanil (20x)>
Dilaudid (5x)>
Morphine
What is the typical dose range of Fentanyl for analgesia or sympathetic block during induction in adults?
A. 0.5-1 mcg/kg IV
B. 1-2 mcg/kg IV
C. 2-3 mcg/kg IV
D. 3-4 mcg/kg IV
B. 1-2 mcg/kg IV
TxWes
Cardiopulmonary Bypass?
Analgesia: 1 to 2 µg/kg IV
Induction: 1.5 to 3 µg/kg IV 5 mins prior
Adjunct with inhaled anesthetics:
2 to 20 µg/kg IV
Direct laryngoscopy during intubation
Sudden changes in surgical stimulation level
Tx Wes Reference:
1.5-3 mcg/kg
When using Fentanyl as an adjunct with inhaled anesthetics, what is the recommended dose range?
A. 5-10 mcg
B. 12.5-50 mcg
C. 50-75 mcg
D. 75-100 mcg
B. 12.5-50 mcg
(used during DL and sudden changes in sx stimulation level)
TxWes
Cardiopulmonary Bypass?
Analgesia: 1 to 2 µg/kg IV
Induction: 1.5 to 3 µg/kg IV 5 mins prior
Adjunct with inhaled anesthetics:
2 to 20 µg/kg IV
Direct laryngoscopy during intubation
Sudden changes in surgical stimulation level
What is the concentration of Fentanyl typically available in vials for intravenous administration?
A. 10 mcg/mL
B. 25 mcg/mL
C. 50 mcg/mL
D. 100 mcg/mL
C. 50 mcg/mL
What is the primary receptor through which Fentanyl exerts its analgesic effects?
A. Alpha-1 adrenergic receptor
B. Mu-1 opioid receptor
C. Beta-2 adrenergic receptor
D. NMDA receptor
B. Mu-1 opioid receptor
then kappa and delta opioid-Rs.
In addition to the mu-1 opioid receptor, which other opioid receptors does Fentanyl interact with?
A. Alpha-1 and beta-2 adrenergic receptors
B. Kappa and delta opioid receptors
C. NMDA and GABA receptors
D. Serotonin and dopamine receptors
Answer: B. Kappa and delta opioid receptors
Fentanyl’s mechanism of action involves the activation of which type of pain pathway?
A. Ascending excitatory pain pathway
B. Descending inhibitory pain pathway
C. Peripheral nociceptive pain pathway
D. Central sensory processing pathway
B. Descending inhibitory pain pathway
What is the typical onset time for Fentanyl when administered intravenously?
A. 30 seconds
B. 1-3 minutes
C. 5 minutes
D. 10 minutes
B. 1-3 minutes
high lipid soluble (potent);
Tx Wes Reference:
30-60 sec
To achieve peak effect during rapid sequence induction (RSI) with Fentanyl, how many minutes before induction should it be administered?
A. Immediately before induction
B. 1 minute before induction
C. 3 minutes before induction
D. 5 minutes before induction
C. 3 minutes before induction
What is the typical duration of action for Fentanyl?
A. 10-20 minutes
B. 20-30 minutes
C. 30-60 minutes
D. 60-90 minutes
C. 30-60 minutes
Tx Wes Reference:
1-1.5 hr
What is the elimination half-life (1/2) of Fentanyl?
A. 1-2 hours
B. 2-4 hours
C. 3-6 hours
D. 6-8 hours
C. 3-6 hours
What is the context-sensitive half-life of Fentanyl, which reflects its clearance after prolonged infusions?
A. 60 minutes
B. 120 minutes
C. 180 minutes
D. 260 minutes
D. 260 minutes
Which statement is true regarding the effects of continuous intravenous administration of Fentanyl?
A. Continuous IV administration of Fentanyl decreases its effects over time.
B. Continuous IV administration of Fentanyl yields greater effects as the duration of infusion increases.
C. Continuous IV administration of Fentanyl has no effect on its overall efficacy.
D. Continuous IV administration of Fentanyl leads to a plateau in effects regardless of duration.
B. Continuous IV administration of Fentanyl yields greater effects as the duration of infusion increases.
Among Fentanyl, Alfentanil, Sufentanil, and Remifentanil, which opioid has the highest context-sensitive half-life (CSHL)?
A. Alfentanil
B. Fentanyl
C. Sufentanil
D. Remifentanil
B. Fentanyl
Which opioid has the lowest context-sensitive half-life among the following?
A. Fentanyl
B. Alfentanil
C. Sufentanil
D. Remifentanil
D. Remifentanil
What percentage of the initial dose of Fentanyl undergoes first-pass pulmonary uptake?
A. 25%
B. 50%
C. 75%
D. 90%
C. 75%
Which of the following describes the primary metabolic pathway of Fentanyl?
A. Hydrolysis to an active metabolite
B. N-demethylation to norfentanyl
C. Glucuronidation to morphine
D. Oxidation to a major active metabolite
B. N-demethylation to norfentanyl (inactive)
Which enzyme system is primarily involved in the metabolism of Fentanyl?
A. CYP2D6
B. CYP2C19
C. CYP3A
D. CYP1A2
Answer:
C. CYP3A
substrate for CYP3A
Plasma concentration doesn’t decrease rapidly→ prolonged analgesia + depressed ventilation
The primary enzyme that metabolizes fentanyl is cytochrome P450 3A (CYP3A), which is found in the liver and intestinal mucosa. CYP3A is responsible for metabolizing about half of all pharmaceuticals in humans.
What is the primary route of elimination for Fentanyl?
A. Biliary excretion
B. Exhalation through the lungs
C. Excretion via kidneys
D. Metabolism through liver
C. Excretion via kidneys
What effect does the significant first-pass pulmonary uptake have on Fentanyl’s plasma concentration and overall effect?
A. Rapid decrease in plasma concentration and short duration of action
B. Minimal impact on plasma concentration with prolonged analgesia
C. Immediate increase in plasma concentration and short-term effects
D. Rapid increase in plasma concentration and prolonged effects
B. Minimal impact on plasma concentration with prolonged analgesia
Fentanyl is a member of which class of synthetic opioids?
A. Phenylheptamine-derivative
B. Phenylpiperidine-derivative
C. Benzylisoquinoline-derivative
D. Dipeptide-derivative
B. Phenylpiperidine-derivative
How does Fentanyl’s potency compare to morphine?
A. 10 times more potent
B. 50 times more potent
C. 100 times more potent
D. 200 times more potent
C. 100 times more potent
What contributes to the prolonged analgesia and potential for depressed ventilation seen with Fentanyl administration?
A. Rapid metabolism and excretion
B. First-pass pulmonary uptake and slow plasma concentration decrease
C. High hepatic clearance rate
D. Immediate and complete renal excretion
B. First-pass pulmonary uptake and slow plasma concentration decrease
What effect does Fentanyl have when used in combination with benzodiazepines?
A. Decreased risk of respiratory depression
B. Potentiation of benzodiazepines, leading to increased risk of apnea
C. Reduced analgesic effects of both drugs
D. Increased metabolism of both drugs
B. Potentiation of benzodiazepines, leading to increased risk of apnea
How should the dose of Propofol be adjusted when Fentanyl is administered?
A. Increase the dose of Propofol
B. No adjustment is needed
C. Decrease the dose of Propofol
D. Administer Propofol at a different time
C. Decrease the dose of Propofol
What is a potential side effect of Fentanyl that involves the chest wall?
A. Hypotension
B. Chest wall rigidity
C. Increased respiratory rate
D. Decreased heart rate
B. Chest wall rigidity
What impact does Fentanyl have on intracranial pressure (ICP)?
A. Decreases ICP by 6-9 mmHg
B. Increases ICP by 6-9 mmHg
C. No effect on ICP
D. Increases ICP by 10-15 mmHg
B. Increases ICP by 6-9 mmHg
How should the dose of Fentanyl be adjusted in elderly patients?
A. Increase the dose due to decreased metabolism
B. Use the normal dose
C. Decrease the dose due to reduced hepatic function and lower albumin levels
D. Avoid using Fentanyl in elderly patients
C. Decrease the dose due to reduced hepatic function and lower albumin levels
How does liver cirrhosis affect the dosing of Fentanyl?
A. Requires a reduced dose due to decreased CYP production
B. Requires a normal dose due to unchanged CYP production
C. Requires a significant dose increase
D. No effect on dosing
B. Requires a normal dose due to unchanged CYP production
What is the effect of Fentanyl on Minimum Alveolar Concentration (MAC) of inhaled anesthetics?
A. No effect on MAC
B. Increases MAC by up to 70%
C. Decreases MAC by up to 70%
D. Increases MAC by up to 30%
C. Decreases MAC by up to 70%
Which of the following is a common respiratory side effect of Fentanyl?
A. Hyperventilation
B. Depression of ventilation and laryngospasms
C. Increased tidal volume
D. Enhanced airway reflexes
B. Depression of ventilation and laryngospasms
How does Fentanyl affect the baroreceptor reflex and carotid sinus reflex?
A. Enhances baroreceptor reflex activity
B. Has no effect on baroreceptor reflex or carotid sinus reflex
C. Depresses baroreceptor reflex and carotid sinus reflex
D. Stimulates baroreceptor reflex but depresses carotid sinus reflex
C. Depresses baroreceptor reflex and carotid sinus reflex
What cardiovascular effects can be expected with Fentanyl administration?
A. Tachycardia and hypertension
B. Bradycardia and hypotension
C. Normal heart rate and blood pressure
D. Increased blood pressure with decreased heart rate
B. Bradycardia and hypotension
Which of the following gastrointestinal effects is associated with Fentanyl use?
A. Diarrhea
B. Nausea and vomiting
C. Increased gastrointestinal motility
D. Enhanced appetite
B. Nausea and vomiting
What is a common dermatological side effect of Fentanyl?
A. Rash and urticaria
B. Itching
C. Dry skin
D. Erythema
B. Itching
How does Fentanyl affect bowel movements?
A. Increases bowel movements
B. Causes constipation,
Sphincter of Oddi spasm
C. Has no effect on bowel movements
D. Results in diarrhea
Answer: B. Causes constipation, including
Sphincter of Oddi spasms
Which of the following is a neuromuscular side effect of Fentanyl?
A. Myoclonus
B. Increased muscle strength
C. Reduced muscle tone
D. Muscle spasms
A. Myoclonus
TxWes Castillo
Cardiopulmonary Bypass? Not used, attaches to circuit
Analgesia: 1 to 2 µg/kg IV
Induction: 1.5 to 3 µg/kg IV 5 mins prior
Adjunct w/ inhaled anesthetics: 2 to 20 µg/kg IV
Direct laryngoscopy during intubation
Sudden changes in surgical stimulation level
Surgical Anesthesia (solo): 50 to 150 µg/kg IV
Intrathecal: 25 µg
Transmucosal (Oral): 5 to 20 µg/kg
Rapid dissolving film or lozenge: Pediatrics
2 to 8 yo: 15 to 20 µg/kg PO 45 minutes prior
1 mg of PO Fentanyl = 5 mgs of IV Morphine
Transdermal: 75 to 100 µg (18 hours steady delivery)
