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Pharmacology II > Opioid Agonist (Exam 2) *Quick Review* > Flashcards

Opioid Agonist (Exam 2) *Quick Review* Flashcards

1
Q

Hydromorphone: Potency

A

5x more potent than morphine

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2
Q

Alfentanil: Potency

A

1/5th potency of fentanyl

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3
Q

Fentanyl: Potency

A

75 to 125 x more potent than morphine

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4
Q

Remifentanil: Potency

A

15-20 x as potent as alfentanil
..Not sure about Fentanyl?..

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5
Q

Sufentanil: Potency

A

5-12 x more potent than Fentanyl

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6
Q

Meperidine: Potency

A

1/10th potency of morphine

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7
Q

Meperidine: Clinical Uses

A

-Post op shivering because of K and a2 receptors

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8
Q

Meperidine: Dose

A

post op shivering 12.5 mg IV

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9
Q

Meperidine: Onset

A

5-15 mins

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10
Q

Meperidine: Duration

A

2-4 hours

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11
Q

Meperidine: Metabolism

A

-90% in Liver

-Metabolite: Normeperidine

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12
Q

Meperidine: E 1/2 Time

A

3-5 hrs
35 hrs with Renal failure

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13
Q

Meperidine: Clearance

A

1.02 L/min

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14
Q

Meperidine: CNS

A

-Sedation,

-Euphoria

-SEROTONIN SYNDROME – careful with TCA’s and MAOI’s

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15
Q

Meperidine: Other Side Effects

A

-TOXICITY: Delirium (confusion and hallucinations, myoclonus and seizures)

-CROSSES PLACENTAL BARRIER!

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16
Q

Morphine:Clinical uses

A
  • Relieves visceral, skeletal muscles, joints
  • Integumental dull > sharp (better for post op c-fiber pain)
  • Intermittent pain
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17
Q

Morphine: Dose (induction)

A

Intra Op: 1-10 mg IV

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18
Q

Morphine: Onset

A

10 - 20 mins

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19
Q

Morphine: Peak (IM & IV)

A

IM: 45-90
IV: 15-30 minutes

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20
Q

Morphine: Duration

A

4-5 hours

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21
Q

Morphine: Metabolism

A
  • Glucoronic acid conjugation
    -Morphine -3 glucorinide (75-95%) INACTIVE

-Morphine -6-glucoride: ACTIVE

-Causes the late ventilatory depression

22
Q

Morphine: E 1/2 Time

A

1.5-3.5 hrs

23
Q

Morphine: Clinical Consideration

A
  • Caution with use in renal and elderly patients.

-Metabolites stick around longer in renal patients

  • Serum plasma concentrations increase with age.

-Women > men: analgesic potency and slower speed of offset

24
Q

Hydromorphone: Dose (induction)

A

Intra Op: 1-4 mg
**Give 0.5 mg intermittently!
HAVE TO REDOSE Q 4 HOURS

25
Q

Hydromorphone: Onset

A

5 - 15 mins.

26
Q

Hydromorphone: Duration

A

2 - 4 hours

27
Q

Hydromorphone: Metabolism

A

Has active metabolites!

28
Q

Hydromorphone: Special consideration (Hint: gives it an edge on morphine)

A

No histamine release

Remember this is an issue with Morphine that we dont like

29
Q

Alfentanil: Induction dose

A

-Induction Laryngoscopy: 15-30 µg/kg IV
**give 90 sec prior

-Induction alone: 150-300 µg/kg IV

30
Q

Alfentanil: Maintenance Dose

A

25-150 µg/kg/hour w/ inhaled gas

31
Q

Alfentanil : Onset

A

1.4 mins

32
Q

Alfentanil: protein binding

A

92 % Binds to α1- acid glycoprotein

33
Q

Alfentanil: Metabolism

A

-CYP 3A4

-Noralfentanil

34
Q

Alfentanil: Special Considerations

A

USE IN PARKINSON’S = ACUTE DYSTONIA

35
Q

Fentanyl: Dose (Induction)

A

1.5 - 3 𝝻g/ kg IV
**give 5 mins prior

36
Q

Fentanyl: Other doses

A

-Analgesia: 1-2 𝝻g/kg IV

-Adjunct with inhaled gases: 2-20 µg/kg IV

-Surgical Anesthesia:(solo): 50-150 µg/kg

-Transdermal: 75-100 µg (18 hr steady state delivery

-Transmucosal (oral): 5-20 µg/kg

-Peds 2-8 yo: 15-20 µg/kg PO 45 min prior

***1 mg PO Fentanyl=5 mg PO morphine

37
Q

Fentanyl: Onset

A

30 - 60 seconds

38
Q

Fentanyl: Duration

A

1 - 1.5 hours

39
Q

Fentanyl: Metabolism

A

-CYP3A

-Metabolite: Norfentanyl

40
Q

Fentanyl: CNS

A

‣**Seizure like activity **on SSEP and EEG with **doses > 30 µg/kg IV **

‣ ↑ ICP (6-9 mmHg)

41
Q

Remifentanil: Structure

A

Ester structure

42
Q

Remifentanil: Doses (Induction)

A

0.5 - 1 µg/kg over 1 min
DOSE IN IBW

43
Q

Remifentanil: Other Doses

A

Maitenance:
- 0.25-1 µg/kg n IV
OR
- 0.125-0.375 µg/kg/min IV

* before stopping give longer acting opioid*

44
Q

Remifentanil: Onset

A

30 - 60 secs.

45
Q

Remifentanil: Metabolism

A

Hydrolysis by plasma and tissue esterases allows for:
- Brief action,
- Rapid onset and offset,
-Lack of accumulation
-Rapid recovery when discontinued.

SIMILAR TO PROPOFOL AND KETAMINE

46
Q

Remifentanil: Clearance

A

-Kidneys (unaffected by renal or liver dx)

-3L/min

8x faster than alfentanil

47
Q

Sufentanil: Dose (Induction)

A

18.9 µg/kg IV

48
Q

Sufentanil: Other doses

A

Analgesia: 0.1-0.4 µg/kg IV

49
Q

Sufentanil: Onset

A

30 - 60 secs.

50
Q

Sufentanil: Clearance

A

-Renal and fecal

-Caution with chronic renal failure

51
Q

Sufentanil: Other Side Effects

A

CHEST WALL AND ABDOMINAL MUSCLE REIGIDITY.

Pharmacology II (8 decks)

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