Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Fentanyl dose as primary anesthetic

A

50-150 mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fentanyl analgesic effects go hand in hand with

A

Ventilatory depressant effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes lead chest

A

Too rapid and too large fentanyl dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Transdermal fentanyl delivers

A

75-100mcg/hg

Peaks 18 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Fentanyl lollipops deliver _____

Risk of

A

5-20 mcg/kg

Risk of PONV and hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sufentanil dose

A

0.2-0.6 mcg/kg w/ inhalation anesthesia

8-30 mcg/kg for cardiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Remifentanil dose

A

Up to 1 mcg/kg bolus

0.5-2 mcg/kg/min infusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Morphine dose

A

2-15 mg adult

0.1 mg/kg peds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Meperidine dose

A

0.5-1.5 mg/kg.

Shivering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hydromorphone dose

A
  1. 25-2 mg adult

0. 01-0.04 mg/kg peds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Meperidine principle metabolite

Elimination 1/2 life of metabolite

A

Normeperidine

15 hours

Greater effect in elderly, malnourished, liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fentanyl has much greater volume of distribution than morphine due to

A

Greater lipid solubility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Unlike morphine Sufentanil has rapid penetration of

A

BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Enhanced neonate effect to Sufentanil due to

A

Lower plasma protein levels so less binding sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Termination effect of Sufentanil due to

A

Redistribution to inactive tissues and metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Remifentanil metabolism

Provides for

A

Hydrolysis at ester linkage

Short action
Precise titration
No cumulative effect
Rapid recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Recovery from Remifentanil infusion

A

5-10 minutes regardless of duration of infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Neuroaxial opiods (fentanyl/Sufentanil) work in part via

A

Systemic absorption

Absorbed into epidural fat and epidural space venous plexus
and CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cephalad movement of opiods

A

Greater with less lipid soluble (morphine)

Follows CSF currents to brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Opiods work by imitating

A

Endogenous opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Only what 2 types of opiods bind to receptors

A

Non-ionized

Levorotary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Opioid receptor activation decreases NTS transmission via

A

presynaptic NTS inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Mos important opioid receptor in anesthesia
Mu
26
CNS sites of opioid analgesia - ascending pain sensory pathways -descending pain modulation pathway
- ascending Nociceptive nerve endings Spinal cord Thalamus - descending Mid brain Medulla
27
First drug shown to bind to mu receptors
Morphine
28
First drug to attatch to kappa receptors
Ketocyclazocine
29
Mu receptor agonist given to
Decrease perception of pain
30
Ventilatory depression with mu receptor agonist occurs where
Nucleus of slitract, nucleus ambiguous, parabrachial nucleus
31
Kappa receptors are a mixed agonist/antagonist site causing
Some analgesia, less than mu Dysphroia, sedation
32
Facilitate mu activities
Delta receptors
33
Develops tolerance to mu agonists
Nociceptin receptors
34
Opioid actions (+) (-)
``` (+) Analgesia Euphoria Sedation Decreased concentration ``` ``` (-) Nausea Warmth Dry mouth Pruitis ```
35
For visceral and skeletal muscle pain analgesia is best
When given before pain
36
Opioids with greater efficacy have what effect on MAC
Lower more than those with less efficacy
37
Primary metabolite of meperidine is ____ Causes
Normeperidine CNS stimulation Myoclonus Seizures Confusion and hallucinations
38
Narrowest therapeutic index of any opiod
Meperidine
39
Single dose of ____ produces greater analgesia and ventilatory depression than fentanyl
Sufentanil
40
Large doses of Sufentanil (10-30 mcg/kg) effect on hemodynamics
Minimal hemodynamic changes
41
________ and ______ attenuate bradycardia effects of Remifentanil
Glyco and atropine
42
Pharmacodynamic effects of remi increase in patients with
Increasing age
43
Neuroaxial opiods epidural placement works via
Mu spinal cord receptors Systemic action
44
Effect of neuraxial opiods occurs in
Substantia gelatinosa of spinal cord
45
Adverse effects of neuroaxial opioids with
CSF concentration greater Greater systemic concentrations
46
Opioid miosis due to
Excitation of Edinger-Westphal nucleus of the occulomotor nerve
47
Neuroaxial opiods spinal cord damage if
Opiods with preservatives used | Ex. Sodium benzoate
48
Sedation accompanies
Ventilatory depression
49
Sedation most common with
Sufentanil
50
Meperidine decreases post op shivering by
Kappa agonist induced change in shivering threshold
51
__________ causes mydriasis not miosis bc structurally similar to atropine
Meperidine
52
_____________ many cause increase ICP with maintaining baseline ETCO2 Counteract by
Fentanyl family Hyperventilating down to ETCO2 30
53
Use opiods in _______ cautiously
Neuro patients
54
Decreased venous return with opioids is r/t
Decreased SNS tone to capacitance vessels
55
Bradycardia with opiods die to
Greater vagal activity from stimulation of vagal nuclei in medulla
56
Histamine release with opioid causes Minimize by
Lower BP Slow administration, supine position, IVF
57
Morphine with nitrous
Depresses myocardium
58
Meperidine CV effects
Negative inotrope Tachycardia Hypotension
59
Fentanyl and Sufentanil CV effects
No histamine release so less hypotension Bradycardia more prominent bc baroreceptors reflex depressed
60
Bradycardia is more of problem with neonates bc
stroke volume is fixed so if HR goes down, cardiac output goes down
61
Systemic opiods most serious adverse effect
Ventilatory depression
62
Neuroaxial opioid ventilatory depression within _________ due to ______. After _____ due to ______ Occurs most with
Within 2 hours due to systemic absorption 2 hours due to cephalad migration or opioid in CSF or interaction with ventral medulla Morphine
63
____________ decreases sensitivity of ventilatory center to CO2
Morphine
64
__________ depresses airway ciliary activity
Morphine
65
All opioid agonist effect on sensitive of ventilatory centers to CO2
Decreases sensitivity
66
A powerful antitussive
Morphine
67
Fentanyl adverse effects
- persistent/recurrent ventilatory depression - second plasma peak conc occurs when stored fentanyl released from gastric fluid and lung washout re-enters systemic circulation
68
Most effective counter action to ventilatory depression of opioids
Pain
69
GI effects of all opioids
Constipation Delayed gastric emptying NV (stimulate CTZ)
70
Causes spasm of biliary smooth muscle Relieved by Can lead to
Morphine Narcan, glucagon Pancreatitis
71
Better for biliary duct pain/spasm
Meperidine
72
GU effects of opioids
Greater uretal tone and peristalsis Urinary urgency (difficulty urinating)
73
Fentanyl and Sufentanil endocrine effects
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
Thoracic and abdominal rigidity (lead chest) can occur with__________ by___________
Rapid administration of opioids due to actions on dopaminergic and GABA neurons
75
Treat lead chest with
Succ or non-depolarizer
76
Neuroaxial opioids main side effects Are dependent on_________ Due to_______ Treat with_______
Pruitis (esp face, neck, upper thorax) Urinary retention Ventilatory depression Sedation Dose dependent Not histamine but cephalad migration to trigeminal nucleus Naloxone, antihistamines
77
Most common neuroaxial opioid side effect
Pruitis (especially where blush- face, neck, upper thorax)
78
Urinary retention with opioids most common in
Young males
79
Neuroaxial opioids can cause _________ 2-5 days post administration
Reactivation of herpes
80
__________ contraindicated in patients receive in MAOIs w/i 14 days
Meperidine

Pharm 2 (3rd Quarter) (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions