Opiods/Analgesia Pharmcokinetic

Question 1

Fentanyl Onset/ Duration/0.5 Life/ContextSen/Potency/

Answer 1

Onset: 1 to 3 min Duration: 30 to 60 0.5 Life: 475 min ContextSen: 1-2 hr Potency: 100x

Question 2

Remifentanil Onset/ Duration/0.5 Life/Potency/ContextSen

Answer 2

Onset: 30 to 90 sec Duration: 30 to 60 min 0.5 Life: 3-10 min ContextSen: 3-6 min Potency: 80 to 100

Question 3

Sufentanil Onset/ Duration/0.5 Life/Potency/ContextSen

Answer 3

Onset: 1.5 to 3 min Duration: 20 min 0.5 Life: 2.5 -4.5 hr ContextSen: 17 min Potency: 500-4000x

Question 4

Alfentanil Onset/ Duration/0.5 Life/Potency/ContextSen

Answer 4

Onset: 1.5-2 min Duration: 20 min 0.5 Life: 1.5 - 2min ContextSen: 12-18 min Potency: 10-25x

Question 5

Morphine Dose/Onset/ Duration/0.5 Life/Potency/

Answer 5

Dose: 2 to 10 mg q 4 hr Onset: 20-30 min Duration: 2 to 3 hr 0.5 Life: 2-4 hr Potency: 1x

Question 6

Hydromorphone Dose/Onset/ Duration/0.5 Life/Potency/

Answer 6

Dose: 0.4 to 2mg iv Onset: 15 min Duration: 2 to 4 hour 0.5 Life: 2.64hr Potency: 5-7x

Question 7

Meperidine Dose/Onset/ Duration/0.5 Life/Potency

Answer 7

Dose: Sedation 50 to 150 mg IV/IM q3 to 4 Infusion 0.3 to 1m5 mg/kg/h postop shivering 12.5 to 25 mg Onset: 15 min Duration: 2 to 3 hour 0.5 Life: 3-5 hr Potency: 0.1x

Question 8

Fentanyl Partial Coefficient/ProteinBinding/Elimination/Clearance

Answer 8

Partial Co: 820 Diffuse to Fat, skeletal muscle quick onset, distribution to inactive sites Duration of Action inc with large and repeated doses Protein: 84% Elimin: Norfentynl (active up to 45 hr) then to inactive Clearance: Liver (CYP 450 3A4) 10 percent unchanged in urine intensitinal mucosa

Question 9

Remifentanil Partial Coefficient/ProteinBinding/Elimination/Clearance

Answer 9

Partial Co: 17.8 Protein: 80% Elimin: Unique and Rapid via Ester Linkage in by nonspeficic blood and tissue estates May diminish in effect if given in the same as transfusion.

Question 10

Sufentanil Partial Coefficient/ProteinBinding/Elimination/Clearance

Answer 10

Partial Co: 1750 Protein: 92% Elimin: Liver CYP3A4, renal billiary removal Clearance:

Question 11

Alfentanil Partial Coefficient/ProteinBinding/Elimination/Clearance

Answer 11

Partial Co: 130 Protein: 92% Elimin: Liver CYP3A4 Rapid peak effect useful for blunting response to single briefbstimukus Initial Dose should be on ideal body weight for obese pt.

Question 12

Morphine Partial Coefficient/ProteinBinding/Elimination/Clearance

Answer 12

Partial Co: 1.4 Protein: 26-36% Elimin: Mostly Renal (adjust dose in renal injuries) Metabolizes to morpgine 3 glucuronide (55 to 75 inactive) Cross blood brain slowly may delay 10 to 40 min

Question 13

Hydromorphone Partial Coefficient/ProteinBinding/Elimination/Clearance

Answer 13

Partial Co: 1.3 Protein: 8-19 % Elimin: Clearance: via liver and urine,bile excrete metabolites 3 glucurinide (major) and 6 hydroxy minor

Question 14

Meperidine Partial Coefficient/ProteinBinding/Elimination/Clearance

Answer 14

Partial Co: 21 Protein: 70% Elimin: Liver metabolism, Urine excretion, converts to normeperidine (causes sz esp in elderly, renal impairment, chronic dosing

Question 15

Fentanyl Dose: Intubate; Intrathecal; epidural PCA, Infusion, Loca Anesth, Post op,sedation

Answer 15

Intubate: 1.5-3 mcg/kg (100-200 mcg) Intrathecal: 25 mcg Epidural PCA: 10-30 mcg q10 min; Epidural Infusion 5-10 mcg/ml Post op 0.5-1.5 kg (35-105 mcg) Sedation: 0.5 mcg/kg Load with 0.01 to 0.04 mcg/kg/min PCA 10 mcg/ 8 to 10 min/ 6 demands plus basal/ 10 to 30 mcg per hr peds pca 0.25 to 0.5 mcg per kg / 10 min / 3 mcg per kg per hr / 0.15 to 0.5 mcg/kg/hr

Question 16

Remifentanil Dose: Induction; GA adjunct, Sedation

Answer 16

Induction: 1mcg/kg over 30 to 60 sec GA Adjunct: 1mcg/kg bolus with 0.5 to 1 mcg/kg Maintence 0.05 to 2 mcg/kg/min Sedation: 0.5 to 1 mcg/kg bolus x 60 seconds 0.025 to 0m2 mcg/kg/min maintain

Question 17

Morphine Dose: Sedation, Analgesia, Intrathecal, Epidural; Infusion, PCA

Answer 17

Sedation: 2 to 10 mg iv Analgesia: 2 to 20 mg iv, Im, sc for meds Intrathecal: 0.1 to 0.5 mg Epidural: 2 to 6 mg q8 to qd bolus. 0.08 to 0 16 mg/h for infusuin max 10mg/24hr peds 0.03 to 0.05 mg/kg max at 0.1 mg/kg or 5mg/24hr PCA: 1/8 to 10min/ 6x/ 0.5 to 1 mg per h Kid PCA 10 to 20 mcg per kg / 10 min /6x/ 5 to 20 mcg p kg p hr

Question 18

Hydromorphone Dose: Analgesia, PCA

Answer 18

Analgesia 0.4 to 2mg PCA: 0.2 /8 to 10 min / 6 demands plus basal/ 0.1 to 0.2 mg per hr peds PCA 2 to 4 mcg/kg/ 8 to 15 min / 20 mcg/mg each hr / 1 to 5 mcg/kg/hr

Question 19

Meperidine Dosing: Sedation, Epidural, Postop Shivering

Answer 19

Sedation/analgesic :50 to 150 mg Ivm q3,4 Infusion 0.3 to 1.5 mg/kg/hr Postop Shivering 12.5 to 25 mg iv

Question 20

Dolophine, Methadone Indication Dosing, Clearance, MOA AE

Answer 20

Indication chronic pain, withdrawl Dosing: 2.5 to 10 mg po ie 2.5 to 5 mg if tid/bid po to IV, x2 Clearance:Hepatic, Renal (use only 1/2 in renal jmpairment) MOA: Opioid Partial Agonist AE resp depression that ladr linger than analgesia Variable 1/2 life 12 to 100 hr Less dose conversion when initially given Prolongs QT (higher chance in high doses)

Question 21

Sufentanil Dose: GA (minor, Mod, Major), Sedation, Epidural

Answer 21

GA Minor: 1 to 2 mcg/kg load theb 10 to 50 mcg prn GA moderate: 2 to 8 mcg/mg with 10 to 50 mcg pen or infusion of 0.3 to 1.5 mxg/kg/hr GA Major: 8 to 30 mcg/kg, then 10 to 50 mcg prn or 0.5 to 2.5 mxg/kg/hr Sedation:0.1 to 0.5 mcg/kg infusion should be 0.2 to 0.5 mcg/kg/h Epidural: 10 to 15 mcg/10ml of 0.125 percent bupivicaine

Question 22

Tramadol Dose, Clearance, MOA

Answer 22

Dose: 25 to max 400 mg/qd or 300 mg/d if age>75 Clearance: Hepatic Met + Renal Excret MOA: Opiate agonist, spinal inhibition to pain similar to TCA via SNRI

Question 23

Sufentanil Onset/ Duration/0.5 Life/

Answer 23

Onset: 1.5-3 min Duration 20 min