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Pharm 2 (3rd Quarter) > Opiates > Flashcards

Opiates Flashcards

1
Q

Fentanyl analgesic dose

As adjuvant to inhaled anesthesia

A

1-2mcg/kg analgesia

2-20 mcg/kg w/ inhaled anesthesia

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2
Q

Fentanyl dose as primary anesthetic

A

50-150 mcg/kg

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3
Q

Are opiods reliable as a sole anesthetic

Why?

A

No

Unreliable anmesia
No muscle relaxation
Post-op ventilatory depression 
Sympathetic breakthrough possible
Absorbed by CBP circuits
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4
Q

Fentanyl analgesic effects go hand in hand with

A

Ventilatory depressant effects

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5
Q

Causes lead chest

A

Too rapid and too large fentanyl dose

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6
Q

Transdermal fentanyl delivers

A

75-100mcg/hg

Peaks 18 hours

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7
Q

Fentanyl lollipops deliver _____

Risk of

A

5-20 mcg/kg

Risk of PONV and hypoxemia

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8
Q

Sufentanil dose

A

0.2-0.6 mcg/kg w/ inhalation anesthesia

8-30 mcg/kg for cardiac

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9
Q

Remifentanil dose

A

Up to 1 mcg/kg bolus

0.5-2 mcg/kg/min infusions

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10
Q

Morphine dose

A

2-15 mg adult

0.1 mg/kg peds

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11
Q

Meperidine dose

A

0.5-1.5 mg/kg.

Shivering

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12
Q

Hydromorphone dose

A
  1. 25-2 mg adult

0. 01-0.04 mg/kg peds

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13
Q

Meperidine principle metabolite

Elimination 1/2 life of metabolite

A

Normeperidine

15 hours

Greater effect in elderly, malnourished, liver failure

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14
Q

Fentanyl has much greater volume of distribution than morphine due to

A

Greater lipid solubility

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15
Q

Unlike morphine Sufentanil has rapid penetration of

A

BBB

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16
Q

Enhanced neonate effect to Sufentanil due to

A

Lower plasma protein levels so less binding sites

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17
Q

Termination effect of Sufentanil due to

A

Redistribution to inactive tissues and metabolism

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18
Q

Remifentanil metabolism

Provides for

A

Hydrolysis at ester linkage

Short action
Precise titration
No cumulative effect
Rapid recovery

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19
Q

Recovery from Remifentanil infusion

A

5-10 minutes regardless of duration of infusion

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20
Q

Neuroaxial opiods (fentanyl/Sufentanil) work in part via

A

Systemic absorption

Absorbed into epidural fat and epidural space venous plexus
and CSF

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21
Q

Cephalad movement of opiods

A

Greater with less lipid soluble (morphine)

Follows CSF currents to brain

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22
Q

Opiods work by imitating

A

Endogenous opioids

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23
Q

Only what 2 types of opiods bind to receptors

A

Non-ionized

Levorotary

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24
Q

Opioid receptor activation decreases NTS transmission via

A

presynaptic NTS inhibition

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25
Q

Mos important opioid receptor in anesthesia

A

Mu

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26
Q

CNS sites of opioid analgesia
- ascending pain sensory pathways

-descending pain modulation pathway

A
  • ascending
    Nociceptive nerve endings
    Spinal cord
    Thalamus
  • descending
    Mid brain
    Medulla
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27
Q

First drug shown to bind to mu receptors

A

Morphine

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28
Q

First drug to attatch to kappa receptors

A

Ketocyclazocine

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29
Q

Mu receptor agonist given to

A

Decrease perception of pain

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30
Q

Ventilatory depression with mu receptor agonist occurs where

A

Nucleus of slitract, nucleus ambiguous, parabrachial nucleus

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31
Q

Kappa receptors are a mixed agonist/antagonist site causing

A

Some analgesia, less than mu

Dysphroia, sedation

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32
Q

Facilitate mu activities

A

Delta receptors

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33
Q

Develops tolerance to mu agonists

A

Nociceptin receptors

34
Q

Opioid actions
(+)

(-)

A 
(+)
Analgesia
Euphoria
Sedation
Decreased concentration
(-)
Nausea
Warmth
Dry mouth
Pruitis
35
Q

For visceral and skeletal muscle pain analgesia is best

A

When given before pain

36
Q

Opioids with greater efficacy have what effect on MAC

A

Lower more than those with less efficacy

37
Q

Primary metabolite of meperidine is ____

Causes

A

Normeperidine

CNS stimulation
Myoclonus
Seizures

Confusion and hallucinations

38
Q

Narrowest therapeutic index of any opiod

A

Meperidine

39
Q

Single dose of ____ produces greater analgesia and ventilatory depression than fentanyl

A

Sufentanil

40
Q

Large doses of Sufentanil (10-30 mcg/kg) effect on hemodynamics

A

Minimal hemodynamic changes

41
Q

________ and ______ attenuate bradycardia effects of Remifentanil

A

Glyco and atropine

42
Q

Pharmacodynamic effects of remi increase in patients with

A

Increasing age

43
Q

Neuroaxial opiods epidural placement works via

A

Mu spinal cord receptors

Systemic action

44
Q

Effect of neuraxial opiods occurs in

A

Substantia gelatinosa of spinal cord

45
Q

Adverse effects of neuroaxial opioids with

A

CSF concentration greater

Greater systemic concentrations

46
Q

Opioid miosis due to

A

Excitation of Edinger-Westphal nucleus of the occulomotor nerve

47
Q

Neuroaxial opiods spinal cord damage if

A

Opiods with preservatives used

Ex. Sodium benzoate

48
Q

Sedation accompanies

A

Ventilatory depression

49
Q

Sedation most common with

A

Sufentanil

50
Q

Meperidine decreases post op shivering by

A

Kappa agonist induced change in shivering threshold

51
Q

__________ causes mydriasis not miosis bc structurally similar to atropine

A

Meperidine

52
Q

_____________ many cause increase ICP with maintaining baseline ETCO2

Counteract by

A

Fentanyl family

Hyperventilating down to ETCO2 30

53
Q

Use opiods in _______ cautiously

A

Neuro patients

54
Q

Decreased venous return with opioids is r/t

A

Decreased SNS tone to capacitance vessels

55
Q

Bradycardia with opiods die to

A

Greater vagal activity from stimulation of vagal nuclei in medulla

56
Q

Histamine release with opioid causes

Minimize by

A

Lower BP

Slow administration, supine position, IVF

57
Q

Morphine with nitrous

A

Depresses myocardium

58
Q

Meperidine CV effects

A

Negative inotrope
Tachycardia
Hypotension

59
Q

Fentanyl and Sufentanil CV effects

A

No histamine release so less hypotension

Bradycardia more prominent bc baroreceptors reflex depressed

60
Q

Bradycardia is more of problem with neonates bc

A

stroke volume is fixed so if HR goes down, cardiac output goes down

61
Q

Systemic opiods most serious adverse effect

A

Ventilatory depression

62
Q

Neuroaxial opioid ventilatory depression within _________ due to ______.

After _____ due to ______

Occurs most with

A

Within 2 hours due to systemic absorption

2 hours due to cephalad migration or opioid in CSF or interaction with ventral medulla

Morphine

63
Q

____________ decreases sensitivity of ventilatory center to CO2

A

Morphine

64
Q

__________ depresses airway ciliary activity

A

Morphine

65
Q

All opioid agonist effect on sensitive of ventilatory centers to CO2

A

Decreases sensitivity

66
Q

A powerful antitussive

A

Morphine

67
Q

Fentanyl adverse effects

A
  • persistent/recurrent ventilatory depression
  • second plasma peak conc occurs when stored fentanyl released from gastric fluid and lung washout re-enters systemic circulation
68
Q

Most effective counter action to ventilatory depression of opioids

A

Pain

69
Q

GI effects of all opioids

A

Constipation
Delayed gastric emptying
NV (stimulate CTZ)

70
Q

Causes spasm of biliary smooth muscle

Relieved by

Can lead to

A

Morphine

Narcan, glucagon

Pancreatitis

71
Q

Better for biliary duct pain/spasm

A

Meperidine

72
Q

GU effects of opioids

A

Greater uretal tone and peristalsis

Urinary urgency (difficulty urinating)

73
Q

Fentanyl and Sufentanil endocrine effects

A

Suppression of stress response

Lower body temp- inhibition of shivering

Water retention (rt vaso release)

Poikothermia (inability to maintain temp- will equilibrate with environment)

74
Q

Thoracic and abdominal rigidity (lead chest) can occur with__________ by___________

A

Rapid administration of opioids due to actions on dopaminergic and GABA neurons

75
Q

Treat lead chest with

A

Succ or non-depolarizer

76
Q

Neuroaxial opioids main side effects

Are dependent on_________

Due to_______

Treat with_______

A

Pruitis (esp face, neck, upper thorax)
Urinary retention
Ventilatory depression
Sedation

Dose dependent

Not histamine but cephalad migration to trigeminal nucleus

Naloxone, antihistamines

77
Q

Most common neuroaxial opioid side effect

A

Pruitis (especially where blush- face, neck, upper thorax)

78
Q

Urinary retention with opioids most common in

A

Young males

79
Q

Neuroaxial opioids can cause _________ 2-5 days post administration

A

Reactivation of herpes

80
Q

__________ contraindicated in patients receive in MAOIs w/i 14 days

A

Meperidine

Pharm 2 (3rd Quarter) (6 decks)

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