Opiods Flashcards
Morphine what happens with a more alkanyzed blood ph?
i.e hyperventilation
blood becomes more non-ionized
crosses BB
Morphine is affected by what clearance?
renal clearance
- not affected by hepatic clearance
Meperidine
what type of metabolism?
extensive hepatic metabolism
What are the metabolites of Morphine?
which one is active?
Fentanyl half-time with age?
special population: elderly
- decrease CYP and decrease hepatic blood flow
- may prolong effects
- decrease albumin reduction
Alfentanil characteristics?
Meperedine has a similar structure with
Atropine
Opioids with histamine release
Morphine
Meperedine
Receptor that causes
Euphoria
Mu 1 [responds to endorphins]
- Euphoria
- Low Abuse
- Miosis
- Bradycardia
Opiod receptor that causes
constipation
Mu2
- Analgesia [spinal]
- Depression of Vent
- Physical Dependence
- Constipation
Opioid receptor that causes sedation
Kappa (respond to dynorphins)
- dysphoria
- Sedation
- Low abuse
- Miosis
Opiod receptor that respond to Enkaphalins
Delta receptor responds to Enkaphalins
Where are the opiod receptors located?
- Brain
- Spinal cord [doral horn, interneurons]
- Periphery [sensory neurons, immune cells]
opiod effects in CV
no direct myocardial depression
bradycardia
Ventilation Opiod effects
Co2 response curve shift to the right
CBF: opiods
increase in PCo2 = increase in CBF
Chest wall rigidity on opioids?
its actually from laryngeal musculature contraction treated with paralysis
Opiods causes spasm on?
Biliary tract –> sphincter of Oddi
Naloxone or Glucagon
Chatacteristics of Tolerance and Dependence
Overdose: Manifestation and Treatment
Equianalgesic Potency
Meperedine
Morphine
Alfentanyl
Fentanyl
Remifentanyl
Sefentanyl
Charateristics of Morphine
- histamine release from mast cells
- dilation of cutaneous blood vessels
- decrease CMRO2
Characteristics of Meperedine
CAUTION WITH
- direct effects in contraction in large doses
– should not be used with SSRI, MAO
– seronin syndrome
Caution with: TCA
potentiation of ventilatory depression
Characteristics of Fentanyl
Opioid used for transient acute pain
The most potent opioid in common clinical use
- may cause hemodynamic instability due to breaducardia
- large doses of [10-30 mcg/kg]
useful for treatment of moderate to severe pain
Hydromorphone
Useful for tx of chroninc opiod abise and withdrawal chronic pain syndrome and cancer pain
Methadone
Characteristics of partial opioid agonists
Opioid Antagonist Naloxone potent SE
SE: CV stimulation, tachycardia, HTN, dysrhythmmias, pulmonary edema, N/V
- slow titration every two mins to minimize SE
- CROSSES THE PLACENTA
Characteristics of Naltrexone
Equipotent with Naloxone?
- Quaternary ammonium opioid receptor antagonist
- used for constipation
