Opioid Agonist (Exam 2) *Quick Review*

Question 1

Hydromorphone: Potency

Answer 1

5x more potent than morphine

Question 2

Alfentanil: Potency

Answer 2

1/5th potency of fentanyl

Question 3

Fentanyl: Potency

Answer 3

75 to 125 x more potent than morphine

Question 4

Remifentanil: Potency

Answer 4

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

Question 5

Sufentanil: Potency

Answer 5

5-12 x more potent than Fentanyl

Question 6

Meperidine: Potency

Answer 6

1/10th potency of morphine

Question 7

Meperidine: Clinical Uses

Answer 7

-Post op shivering because of K and a2 receptors

Question 8

Meperidine: Dose

Answer 8

post op shivering 12.5 mg IV

Question 9

Meperidine: Onset

Answer 9

5-15 mins

Question 10

Meperidine: Duration

Answer 10

2-4 hours

Question 11

Meperidine: Metabolism

Answer 11

-90% in Liver

-Metabolite: Normeperidine

Question 12

Meperidine: E 1/2 Time

Answer 12

3-5 hrs
35 hrs with Renal failure

Question 13

Meperidine: Clearance

Answer 13

1.02 L/min

Question 14

Meperidine: CNS

Answer 14

-Sedation,

-Euphoria

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

Question 15

Meperidine: Other Side Effects

Answer 15

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

-CROSSES PLACENTAL BARRIER!

Question 16

Morphine:Clinical uses

Answer 16

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

Question 17

Morphine: Dose (induction)

Answer 17

Intra Op: 1-10 mg IV

Question 18

Morphine: Onset

Answer 18

10 - 20 mins

Question 19

Morphine: Peak (IM & IV)

Answer 19

IM: 45-90
IV: 15-30 minutes

Question 20

Morphine: Duration

Answer 20

4-5 hours

Question 21

Morphine: Metabolism

Answer 21

• Glucoronic acid conjugation

  -Morphine -3 glucorinide (75-95%) INACTIVE
  
  -Morphine -6-glucoride: ACTIVE 

-Causes the late ventilatory depression

Question 22

Morphine: E 1/2 Time

Answer 22

1.5-3.5 hrs

Question 23

Morphine: Clinical Consideration

Answer 23

• 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

Question 24

Hydromorphone: Dose (induction)

Answer 24

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

Question 25

Hydromorphone: Onset

Answer 25

5 - 15 mins.

Question 26

Hydromorphone: Duration

Answer 26

2 - 4 hours

Question 27

Hydromorphone: Metabolism

Answer 27

Has active metabolites!

Question 28

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

Answer 28

No histamine release **Remember this is an issue with Morphine that we dont like**

Question 29

Alfentanil: Induction dose

Answer 29

-Induction Laryngoscopy: 15-30 µg/kg IV **give 90 sec prior -Induction alone: 150-300 µg/kg IV

Question 30

Alfentanil: Maintenance Dose

Answer 30

25-150 µg/kg/hour w/ inhaled gas

Question 31

Alfentanil : Onset

Answer 31

1.4 mins

Question 32

Alfentanil: protein binding

Answer 32

92 % Binds to α1- acid glycoprotein

Question 33

Alfentanil: Metabolism

Answer 33

-CYP 3A4 -Noralfentanil

Question 34

Alfentanil: Special Considerations

Answer 34

USE IN PARKINSON'S = ACUTE DYSTONIA

Question 35

Fentanyl: Dose (Induction)

Answer 35

1.5 - 3 𝝻g/ kg IV **give 5 mins prior

Question 36

Fentanyl: Other doses

Answer 36

-**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

Question 37

Fentanyl: Onset

Answer 37

30 - 60 seconds

Question 38

Fentanyl: Duration

Answer 38

1 - 1.5 hours

Question 39

Fentanyl: Metabolism

Answer 39

-CYP3A -Metabolite: Norfentanyl

Question 40

Fentanyl: CNS

Answer 40

‣**Seizure like activity **on SSEP and EEG with **doses > 30 µg/kg IV ** ‣ **↑ ICP (6-9 mmHg)**

Question 41

Remifentanil: Structure

Answer 41

Ester structure

Question 42

Remifentanil: Doses (Induction)

Answer 42

0.5 - 1 µg/kg over 1 min **DOSE IN IBW**

Question 43

Remifentanil: Other Doses

Answer 43

Maitenance: - 0.25-1 µg/kg n IV OR - 0.125-0.375 µg/kg/min IV *** before stopping give longer acting opioid***

Question 44

Remifentanil: Onset

Answer 44

30 - 60 secs.

Question 45

Remifentanil: Metabolism

Answer 45

**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**

Question 46

Remifentanil: Clearance

Answer 46

-Kidneys **(unaffected by renal or liver dx)** -3L/min **8x faster than alfentanil**

Question 47

Sufentanil: Dose (Induction)

Answer 47

18.9 µg/kg IV

Question 48

Sufentanil: Other doses

Answer 48

Analgesia: 0.1-0.4 µg/kg IV

Question 49

Sufentanil: Onset

Answer 49

30 - 60 secs.

Question 50

Sufentanil: Clearance

Answer 50

-Renal and fecal -***Caution with chronic renal failure***

Question 51

Sufentanil: Other Side Effects

Answer 51

CHEST WALL AND ABDOMINAL MUSCLE REIGIDITY.