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Anaesthesiology > Opiods > Flashcards

Opiods Flashcards

1
Q

What are opioids

A

These are narcotic analgesics

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2
Q

Where in the body are opioid receptors more concentrated?

A

Limbic system
Thalamus
Hypothalamus
Striatum
Reticular Activating System
Midbrain
Substantia Gelatinosa of spinal cord
Nerve plexus of intestines

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3
Q

What are the five species of opioid receptors?

A

Mu, Delta, Kappa, sigma, epsilon

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4
Q

What are the two general mechanisms of analgesic action

A

Supraspinal
Spinal

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5
Q

What are the sites of action of analgesics in the Supraspinal system

A

PeriAqueductal gray (found in the midbrain)

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6
Q

What are the sites of action of analgesics in the Spinal system

A

The site of action is receptors in the Substantia Gelatinosa region of the spinal cord (upper dorsal portion of spinal cord)

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7
Q

What are the general effects of morphine on the central nervous system?

A

Morphine has both depressive and stimulatory effects

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8
Q

What are the signs of depressive effects that morphine has on central nervous system?

A

Analgesia.
Sedation.
Mood changes.
Alveolar hypo ventilation

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9
Q

What are the stimulatory effects that morphine has on the central nervous system?

A

Pupillary constriction
Nausea and vomiting
Hyperactive spinal reflexes.
Convulsions

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10
Q

Why is morphine not a good anesthetic agent but a good analgesic?

A

This is because morphine and other. Agonist are selective analgesics because they can produce profile so with no effect on other sensory modalities i.e. unconsciousness.

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11
Q

True or false morphine is a complete anesthetic agent

A

False it is not a complete anesthetic agent. It has poor anesthetic properties.

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12
Q

How does morphine cause alveolar hypo ventilation?

A

This is a result of the direct action of morphine on respiratory centers in the brainstem.

The respiratory rate is diminished, and minute volume is reduced

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13
Q

When does the maximum respiratory effect of morphine occur with an IV dose versus an IM dose?

A

It occurs 5 to 10 minutes after an IV dose and between 30 and 60 minutes after an IM dose

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14
Q

True or false morphine is contraindicated in patients with respiratory insufficiency

A

True

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15
Q

In relation to the eyes, list one side effect of morphine

A

Pupillary constriction
Pinpoint pupils are the hallmark of an overdose of morphine

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16
Q

What causes miosis in morphine use?

A

Miosis is due to the stimulation of parasympathetic component of the third cranial nerve nucleus (Edinger- Westphal)

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17
Q

How does morphine cause, nausea and vomiting?

A

It directly stimulates the chemo receptor trigger zone at the Medulla

(Delayed SE, potentiated by ambulation)

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18
Q

What causes truncal rigidity with morphine administration?

A

Hyperactive spinal reflexes

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19
Q

Convulsions are usually a rare side effect of morphine when do they occur

A

With extremely high doses of morphine

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20
Q

What is the effect of morphine on the cardiovascular system?

A

It causes a dependent bradycardia by direct stimulation of the vagus nucleus however, it does not depress myocardial contractility

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21
Q

How can morphine cause orthostatic hypotension?

A

Morphine causes vasodilation of peripheral vessels, such as arteries and veins, and during the ambulatory patient orthostatic, hypertension can occur due to pooling of blood, in the more peripheral vessels from the vessels in the brain.

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22
Q

List two respiratory contraindications for morphine

A

Patients with asthma, or bronchitis, having an acute episode of bronchospasm

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23
Q

Why is morphine contraindicated in patients with asthma and bronchitis?

A

This is because morphine causes a histamine release which causes bronchoconstriction , and this can exacerbate bronchospasms experienced by patients with asthma and bronchitis

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24
Q

What is the effect of morphine on the physiology of the gastrointestinal tract?

A

Morphine stimulates, the smooth muscle of the G.I. tract but propulsive peristalsis is diminished and segmental tonic contraction is increased

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25
Q

What are the effects of morphine on the gastrointestinal tract?

A

Constipation.
Biliary colic in patients with gallbladder disease

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26
Q

How can morphine cause biliary colic in patients with gallbladder disease?

A

This is as a result of spasm of OD sphincter, and an increase in pressure in the biliary tree

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27
Q

How can you reverse the spasm of the gall bladder sphincter in patients with gall disease who are being treated with morphine?

A

This can be reserve first with administration of naloxone or nitroglycerin

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28
Q

Often times patients with gallbladder disease, who are being treated with morphine will get a sudden onset of pain, and that can be confused with acute myocardial ischemia which drug can relieve only morphine induced biliary colic, and which drug will relieve the pain of the morphine induced vary and the pain of myocardial ischemia

A

Naloxone will relieve morphine induced biliary colic
Nitroglycerin will relieve morphine induce, the biliary colic, and the pain of myocardial ischemia

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29
Q

What is the effect of morphine on the genito urinary tract?

A

It can cause spasm of the bladder, sphincter and lead to urinary retention

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30
Q

What is the effect of morphine on the intracranial pressure?

A

Morphine can cause hypercapnia, which can increase cerebral blood flow and cause rise and intracranial pressure in patients with intracranial space occupying lesions

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31
Q

Define tolerance

A

Tolerance to a drug is characterized by the need for increasing doses, to obtain the same therapeutic effect after repeated exposure

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32
Q

Tolerance to morphine is reversible when does sensitivity to therapeutic dose return to normal for a person with increased tolerance?

A

Returns to normal after an abstinence of one to two weeks

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33
Q

What is addiction?

A

Addiction is a state of psychological and physical dependence that manifest itself in the withdrawal syndrome

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34
Q

When do the signs of withdrawal of an opioid appear in long-term addict?

A

8hrs after the last dose

Peaks is 48-72 hours

Runs a 5-10 day course

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35
Q

What are the signs and symptoms of opioid withdrawal syndrome?

A

Lacrimation, rhinorrhea, diaphoresis, vomiting and diarrhea, incessant, yawning, goosebumps, dilated pupils, hypertension, tachycardia, abdominal cramps, muscle aches

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36
Q

Which drug is known to counteract the emetic effects of morphine, but potentiates, its analgesic, sedative and respiratory depressant effects

A

Phenothiazines (chlorpromazine)

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37
Q

True or false allergic reactions to morphine are very common

A

False
Wheels and itch at the site of injection are local reactions to histamine release, and should not be considered sign of true allergy

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38
Q

What is the difference between nociceptive and neuropathic pain?

A

Nociceptive pain is the results of stimulation of nose, receptors by noxious stimuli, whilst neuropathic pain is the result of dysfunction of the nervous system

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39
Q

What are the two afferent nerve fibers that conduct pain stimuli?

A

Small myelinated- A delta fibers : sharp pain
and
Unmyelinated C Delta fibers : dull pain

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40
Q

What is the oral dose of morphine?

A

5 - 20 mg every 4 hrs

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41
Q

What is the intramuscular dose of morphine?

A

0.1-0.2 mg/kg every 4 hrs

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42
Q

True or false morphine is particularly effective for sharp, superficial pain less effective for visceral pain

A

False

Morphine is particularly effective for visual pain and less effective for sharp superficial pain

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43
Q

What drug can you administer to reverse meiosis seen as a side effect of morphine administration?

A

Meiosis occurs in morphine administration due to stimulation of the Edinger Westfall nucleus, and can be reversed by using atropine

44
Q

What could be the possible cause of morphine poor anesthetic effect?

A

Morphine is poorly, lipid soluble, and only a small fraction of a given dose, crosses the blood brain barrier to act as an opioid receptor

45
Q

What is the main pathway for elimination of morphine?

A

Conjugation in the liver with glucuronic acid
Excretion of water soluble, metabolites by the kidneys

90% excreted in urine
10% excreted in bile and appears as faeces

46
Q

How much more potent is diamorphine than morphine

A

Twice (x2)

47
Q

Dimorphine is commonly used to treat what kind of pain and in want dose?

A

Dyspnoea associated with pulmonary edema at 2.5 - 10 mg

48
Q

Which opioid produces the greatest degree of euphoria and subsequently, has become a drug of abuse?

A

Diamorphine

49
Q

How much less potent is codeine to morphine?

A

10x less

50
Q

What are the common uses of codeine?

A

Antitussive
Ant diarrhea
Hypnotic.
Anxiolytic

51
Q

What is the dose given for IV fentanyl

A

1.5 µg per kilogram

52
Q

What is the duration of analgesic action of fentanyl?

A

30mins

53
Q

What is the use of Alfentanil

A

It is given in incremental doses to supplement inhalational anesthesia, or in a continuous infusion together with an intravenous anesthetic in total intravenous anesthesia

54
Q

How much more potent is fentanyl than morphine and how much more potent is it than fentanyl?

A

Sufentanil is 100 times more potent than morphine and 10 times more potent than fentanyl 

55
Q

Which opioid is widely used as an oral analgesic

A

Codeine

56
Q

List 3 groups of analgesics

A

Acetominophen
NSAIDS
OPIOIDS

57
Q

What are the 3 steps to pain management

A

Step 1: non-opioid: acetaminophen or NSAIDS

Step2: weak opioid: Codeine, Tramadol

Step 3 : strong opioid: Morphine, Oxycodone, Fentanyl

58
Q

List two examples of Acetaminophen drugs

A

Tylenol
Panadol (paracetamol)

59
Q

What type of pain is acetaminophen used for

A

Acute Mild pain

60
Q

What is a side effect of acetaminophen

A

Liver toxicity in high doses

61
Q

List 4 NSAIDS

A

Aspirin
Diclofenac
Ibuprofen
Naproxen

62
Q

NSAIDS are used to manage what type of pain?

A

Mild- Moderate

63
Q

What is the moa of NSAIDs

A

Cox 1 & Cox 2 inhibitor
Reducing pro inflammatory and prostaglandin synthesis

64
Q

List 5 complications or side effects of NSAIDs

A

Gastric Ulcer
Decreased Renal Perfusion
Photosensitivity
Premature closure of ductus arteriosus in pregnancy
CI in dengue due to reduced platelet count

65
Q

List 3 examples of oral opioids

A

Codeine
Oxycodone
Morphine

66
Q

List 3 examples of parentéral opioids

A

Morphine
Hydromorphone
Fentanyl

67
Q

Opioids are used in the management of what type of pain?

A

Moderate acute pain (oral)
Moderate- severe acute pain (parenteral)

68
Q

What is the moa of opioids

A

Dampens nociceptive transmission between 1st and 2nd order neurons in the dorsal horn

69
Q

List 8 SEs of opioids

A

(HECK OF A DREAM)
H- histamine release
E- emesis
C- CVS (hypotension)

D- depression of cough reflex, decreased GI motility, depression of CNS = analgesia
R- respiratory depression
E- euphoria
A- analgesia
M- miosis

70
Q

List 7 Opioid Agonists

A

Codeine
Morphine
Oxycodone
Fentanyl
Remifentanil
Methadone
Pethidine

71
Q

What is the dose given for Codeine

A

15-30mg PO

72
Q

What is the dose given for Meperidine for postoperative shivering

A

20-25mg

73
Q

Which drug is commonly used to treat post operative shivering

A

meperidine 20-25mg

74
Q

What is the dose given for Morphine IM and IV

A

IM- 0.1-0.2mg/kg q4hr
IV- 0.2-0.3 mg/kg

75
Q

What is the dose given for Fentanyl

A

2-3 micrograms/kg IV

76
Q

What is the dose given for Pethidine

A

0.5-1mg/kg

77
Q

List 3 opioids with a rapid onset of action

A

Fentanyl (<5mins)
Remifentanil (1-3mins)
Pethidine (<5mins)

78
Q

What is the onset of action of Morphine?

A

5-10mins

79
Q

What is the onset of action of Codeine?

A

30-60mins

80
Q

What is the duration of action of Codeine?

A

4-6hrs

81
Q

What is the duration of action of Morphine?

A

2-4hrs

82
Q

What is the duration of action of Oxycodone (controlled release)?

A

8-12 hrs

83
Q

What is the duration of action of Fentanyl?

A

0.5-1hr

84
Q

What is the duration of action of Remifentanil

A

<10mins

85
Q

What is the duration of action of Pethidine?

A

2-3hrs

86
Q

What is the effect of codéine on BP

A

Significant decrease in BP

87
Q

Why isn’t Meperidine commonly used for pain management?

A

Due to potential toxicity compared with other opioids

88
Q

Contraindications for Meperidine

A

MAOI (antidepressant) use

89
Q

What is the effect of Morphine on the CVS

A

Decreased BP

90
Q

What are the main uses for Codeine

A

Post operative pain
Antitussive
Anti diarrheal
Anxiolytic

91
Q

Morphine is mainly used to manage what type of pain?

A

Visceral Pain
(Less effective for sharp superficial pain)

92
Q

What is the main side effect seen in Fentanyl with high doses?

A

Transient muscle rigidity

93
Q

What is the effect of fentanyl on BP

A

No significant effect

94
Q

What type of pain is Fentanyl used to manage?

A

Pain associated with minor surgery

95
Q

High doses of what opioid is used to obtund the CVS effects of Laryngoscopy

A

Fentanyl

96
Q

When is Remifentanil used ?

A

During induction and maintenance of anaesthesia

97
Q

What is the effect of Remifentanil on BP

A

Reduces BP

98
Q

What is the most common use for Meperidine?

A

Slow weaning programmed for Opioid Addicts

99
Q

Pethidine is commonly used in the management of what pain?

A

Pain during labour

100
Q

What is the effect of Pethidine on CVS

A

Inc. BP
Inc. HR initially
Followed by a fall after 10-15 mins

101
Q

What are some contraindications for Pethidine use?

A

Use with MAOI (antidepressants) leading to coma , convulsions, hyperpyrexia

102
Q

What is patient controlled analgesia?

A

This involves the use of computerized pumps that can deliver a constant infusion and bolus breakthrough doses of parentally administered opioid analgesics under the patient’s control

103
Q

What are the most common drugs used in PCA - patient controlled analgesia

A

Morphine
Hydromorphone

104
Q

List 4 advantages of PCA

A
  • improved patient satisfaction
  • fewer side effects
  • accommodates patient variability
  • accommodates changes in opioid requirements
105
Q

List 2 opioid antagonists

A

Nalaxone
Naltrexone

106
Q

Between nalaxone and naltrexone (opioid antagonists) which is long acting and which is short acting?

A

Nalaxone is short acting (repeated doses may have to be given since the half life is shorter than the half life or morphine- so when Nalaxone wears off the effects of the opioid may return is a second dose is not administered)

Naltrexone is long acting

Anaesthesiology (10 decks)

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