Narcotics - Remifentanil Flashcards
Sufentanil (1000x)>
Fentanyl=Remifentanil (100x)>
Alfentanil (20x)>
Dilaudid (5x)>
Morphine
What is the typical induction dose of Remifentanil?
A. 0.1-0.2 mcg/kg
B. 0.5-1 mcg/kg
C. 1-2 mcg/kg
D. 2-4 mcg/kg
B. 0.5-1 mcg/kg
TxWes
Induction
0.5 to 1 µg/kg IV over 30-60 seconds
Maintenance
0.25 to 1 µg/kg IV or 0.005 to 2 µg/kg/min IV
Tx Wes Reference
infusion 0.125 - 0.375 µ/kg/min
What is the range for the General Anesthesia (GA) infusion dose of Remifentanil?
A. 0.01-1 mcg/kg/min
B. 0.02-2 mcg/kg/min
C. 0.1-5 mcg/kg/min
D. 1-10 mcg/kg/min
B. 0.02-2 mcg/kg/min
(turn off 6 mins before breathing and give longer acting)
Castillo
Induction:
0.5 to 1 µg/kg IV over 30-60 seconds
Maintenance:
0.25 to 1 µg/kg IV or 0.005 to 2 µg/kg/min IV
TxWes
Load: 0.5 - 1 µ/kg over 1 min
Infusion: 0.125 - 0.375 µ/kg/min
onset: 30 - 60 sec
duration: 6 -8 min
Corn pharm 2 vid:
1mcg bolus can cause respiratory arrest for intubation
How should Remifentanil be administered in relation to the end of the surgical procedure?
A. Start the infusion at the end of the procedure.
B. Turn off the infusion 6 minutes before the end of the procedure and switch to a longer-acting anesthetic.
C. Continue the infusion until the end of the procedure.
D. Administer a bolus dose at the end of the procedure.
B. Turn off the infusion 6 minutes before the end of the procedure and switch to a longer-acting anesthetic.
What is the reconstitution concentration of Remifentanil when prepared as 2 mg in 40 mL?
A. 10 mcg/mL
B. 20 mcg/mL
C. 25 mcg/mL
D. 50 mcg/mL
D. 50 mcg/mL
What is the primary mechanism of action (MOA) of Remifentanil?
A. Inhibition of serotonin reuptake
B. Suppression of pain through primary action on mu1 receptors, then kappa and delta opioid receptors
C. Activation of NMDA receptors
D. Antagonism of GABA-A receptors
B. Suppression of pain through primary action on mu1 receptors, then kappa and delta opioid receptors
How quickly does Remifentanil typically reach its peak effect after administration?
A. 0.5 minutes
B. 1 minute
C. 1.1 minutes
D. 3 minutes
C. 1.1 minutes
What is the duration of action for Remifentanil?
A. 1-3 minutes
B. 3-5 minutes
C. 5-10 minutes
D. 10-20 minutes
C. 5-10 minutes
Tx Wes Reference:
6-8 min
What is the elimination half-life (½ life) of Remifentanil?
A. 2 minutes
B. 6 minutes
C. 15 minutes
D. 30 minutes
B. 6 minutes
Castillo:
Elimination half-time: 6.3 minutes (99.8%)
What percentage of Remifentanil undergoes first-pass uptake into the lungs for metabolism?
A. 25%
B. 50%
C. 75%
D. 90%
C. 75%
How is Remifentanil metabolized in the body?
A. By hepatic metabolism via CYP450 enzymes
B. By renal excretion
C. By hydrolysis via plasma and tissue esterases
D. By conjugation in the liver
C. By hydrolysis via plasma and tissue esterases
lack of accumulation
How is Remifentanil primarily eliminated from the body?
A. Hepatic metabolism
B. Renal excretion
C. Pulmonary metabolism
D. Gastrointestinal excretion
B. Renal excretion
(unchanged by renal/liver disease)
In what way is Remifentanil similar to fentanyl in terms of potency?
A. It has half the potency of fentanyl.
B. It has the same potency as fentanyl.
C. It is twice as potent as fentanyl.
D. It is ten times less potent than fentanyl.
B. Ester; It has the same potency as fentanyl.
What is a key reason Remifentanil is used in
Total Intravenous Anesthesia (TIVA) with propofol (no gas craniotomy)
Total Intravenous Anesthesia (TIVA) with propofol (no gas craniotomy)
doesn’t interfere with MEPs
For which type of procedure is Remifentanil particularly useful due to its properties?
A. Long-term sedation
B. Carotid endarterectomy
C. Chronic pain management
D. Postoperative analgesia
B. Carotid endarterectomy
Why is Remifentanil contraindicated for intrathecal administration?
A. It causes severe hypotension.
B. It forms glycine, which is toxic to nerves.
C. It leads to significant respiratory depression.
D. It causes excessive sedation.
B. It forms glycine, which is toxic to nerves.
How does Remifentanil affect MAC (Minimum Alveolar Concentration) of inhaled anesthetics?
A. It increases MAC by 90%.
B. It decreases MAC by 90%.
C. It has no effect on MAC.
D. It decreases MAC by 50%.
B. It decreases MAC by 90%.
What adjustment should be made for elderly patients or those with renal failure when administering Remifentanil?
A. Increase the dose to compensate for decreased metabolism.
B. Use the standard dose as renal function does not impact metabolism.
C. Decrease the dose due to potential prolonged effects.
D. Avoid using Remifentanil altogether.
C. Decrease the dose due to potential prolonged effects.
What is a key precaution to consider when using Remifentanil in combination with propofol?
A. It may increase MAC (Minimum Alveolar Concentration) by 90%.
B. It can cause synergistic respiratory depression with propofol.
C. It requires higher doses of propofol to achieve the desired effect.
D. It reduces the risk of hypotension when used with propofol.
B. It can cause synergistic respiratory depression with propofol.
Which of the following side effects is commonly associated with Remifentanil use?
A. Tachycardia
B. Hyperalgesia
C. Hypoglycemia
D. Increased gastrointestinal motility
B. Hyperalgesia
seen d/t tolerance and anion disequilibrium between microglia and neuron pathway
What is a common neurological side effect of Remifentanil that resembles seizure activity?
A. Nystagmus
B. Myoclonus
C. Tremors
D. Dysphasia
B. Myoclonus
Which of the following is a respiratory side effect of Remifentanil?
A. Increased ventilation
B. Hyperventilation
C. Depression of ventilation and laryngospasms
D. Bronchoconstriction
C. Depression of ventilation and laryngospasms
What is a notable cardiovascular side effect of Remifentanil related to baroreceptor function?
A. Increased baroreceptor reflex sensitivity
B. Depression of baroreceptor reflex and carotid sinus
C. Enhanced baroreceptor reflex
D. Normal baroreceptor function
B. Depression of baroreceptor reflex and carotid sinus
Bradycardia, hypotension
Which side effects are associated with Remifentanil? Select 2
A. Diarrhea
B. Constipation
C. Itching
D. Gastric bleeding
B. Constipation
C. Itching
