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Anaesthesiology > OPIODS > Flashcards

OPIODS Flashcards

1
Q

What is hyperalgesia?

A

It is an increased sensitivity to pain

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2
Q

What is life threatening about opioids?

A

They can cause respiratory depression

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3
Q

What is acute pain?

A
  • Pain that is of recent onset and is less than 6 weeks.

- Usually resolves with healing

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4
Q

What is chronic pain?

A
  • Pain that is is present for more than 3 months

- outlasts the potential for healing

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5
Q

How does depolarisation happen in the dorsal horn of the spinal cord?

A

Th nerve free endings(nociceptors) being stimulated cause depolarisation and then an impulse is generated

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6
Q

What type of pain do delta fibres transmit?

A

-sharp, well-localised pain followed by a dull and persistent pain via the C-fibres

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7
Q

What inflammatory markers are released?

A
  • potassium
  • serotonin
  • hitamine
  • substance P
  • cytokines
  • prostaglandins
  • nitric oxide
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8
Q

What favourable effects of opioids do we want?

A
  • analgesia
  • euphoria, tranquility
  • synergism
  • cardiovascular effects
  • respiratory depression
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9
Q

What is the function of opiods on the vagal nuclei?

A

It causes decreased heart rate and vasodilation(eg. if the surgeon opens up the patient and starts messing in there, the patient won’t have tachycardia and increased heart rate

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10
Q

What can you do to reverse respiratory depression caused by opiods?

A
  • provide oxygen
  • mechanical ventilation
  • naloxone to reverse however very short acting(around 0 minutes)
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11
Q

What are the things we can do to prevent respiratory depression?

A
  1. Decrease the dose of analgesia
  2. monitor the patients closely
  3. provide mechanical ventilation
  4. provide multimodal analgesia
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12
Q

Which drugs are lipophillic and hydrophillic?

A
  1. morphine-hydrophilic

2. fentanyl-lipophilic

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13
Q

Why do we need to give an infusion after a bolus of fentanyl?

A

-fentanyl is short acting and so we need to infuse it over time to ensure the patient does not feel pain during

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14
Q

What is morphine terminated by?

A

elimination

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15
Q

What is fentanyl terminated by?

A

redistribution

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16
Q

What drugs are categorised as the first step/simple analgesics?

A
  1. paracetamol
  2. NSAIDS
  3. Codeine
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17
Q

What drugs are categorised as the second step/moderate analgesics?

A
  1. Tramadol

2. Higher dose of codeine

18
Q

What drugs are categorised as severe pain analgesics?

A
  1. morphine

2. fentanyl

19
Q

What are the most NB factors regarding paracetamol?

A
  • acts centrally and peripherally via the COX-3 enzyme
  • no anti-inflammatory effects
  • anti-pyretic
  • possible hepatic necrosis and failure(give N-acetylcysteine to protect from liver damage
20
Q

What is the onset of action and duration of action for paracetamol?

A
  1. onset: 30 minutes

2. duration: 2-5 hours

21
Q

What is perfalgan?

A

-It is a IV form of paracetamol that has an onset of duration of 5-10 minutes

22
Q

Where do NSAIDS work?

A
  1. COX-1 and COX-2
23
Q

What are the effects of NSAIDS on thromboxane production?

A

1.

24
Q

What are the effects of NSAIDS on thromboxane production?

A
  1. reduced platelet aggregation and risks of bleeding
25
Q

What are the side effects of NSAIDS?

A
  1. gastric irritation
  2. bronchospasm
  3. renal dysfunction
  4. platelet dysfunction
  5. hepatotoxicity
  6. myocardial dysfunction
26
Q

What is the dosage of Ibuprofen?

A

200-400 mg orally 8 hourly

27
Q

What is the dosage of codeine?

A

30-60 mg orally 4-6 hourly

-available as a syrup or tablet

28
Q

What is the additional mechanism of tramadol?

A

-it inhibits noradrenaline and serotonin(5-HT) at the presynaptic nerve endings

29
Q

What are the side effects of pethidine?

A
  • originally intended as an anti-cholinergic

- can produce dry mouth, tachycardia, convulsions, hyperpyrexia, coma,

30
Q

What is the dosage of morphine that adults and children can get IV and IM?

A
  1. 0,1-0,2 mg.kg 4-6 hourly

oral dose is double the parenteral

31
Q

How much do we titrate morphine intra-operatively?

A

1-5mg IV

32
Q

How much more is fentanyl more lipid soluble than morphine?

A

600 times

33
Q

What is the onset of action and duration of action of fentanyl?

A
  1. onset: 3-4 minutes

2. duration: 30-40 minutes

34
Q

How does fentanyl help with LMA/ETT insertion?

A

It relaxes the laryngeal reflexes

35
Q

What is the difference between fentanyl ,alfentanil and sufentanil?

A

sufentanil and alfentanil are short acting when given as boluses
-alfentanil is particularly good at inhibiting the effect of increased BP and HR

36
Q

Remifentanil?

A

-ultra-short acting opiate as a result of rapid metabolism by non specific plasma and tissue esterases

37
Q

What is naloxone?

A
  • acts on all the pain receptors

- can cause pulmonary oedema, arrythmias, hypertension

38
Q

What does NSAIDS work on?

A

Cox 2+3

39
Q

What does paracetamol work on?

A

COX 1+2

40
Q

What are the intra-op signs of pain?

A
  1. Hypertension because of sympathetic stimulation
  2. FRC decreases
  3. FEV1 decreases
  4. Hyperglycaemia

Anaesthesiology (25 decks)

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