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Mar: prep for clinicals > Opioid Agonists/Antagonists, Multimodal > Flashcards

Opioid Agonists/Antagonists, Multimodal Flashcards

1
Q

Morphine:
Dose
Onset
Peak
Duration

A

Dose: 1-10 mg IV
Onset: 10 to 20 mins (IV and IM)
Peak: 45 to 90 mins IM; 15 to 30 mins IV
Duration: 4-5 hours

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2
Q

How is Morphine metabolized?

A

Glucorinic acid conjugation

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3
Q

What are the two metabolites of morphine? Which is active? Inactive?

A

Morphine-3-glucoronide (Inactive)
Morphine-6-glucoride (Active)

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4
Q

Which active metabolite of Morphine contributes to late respiratory depression?

A

Morphine-6-Glucoronide

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5
Q

Which receptors does Meperidine/Pethidine agonize?

A

Mu and Kappa

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6
Q

What are the four analogues of Meperidine?

A

Fentanyl
Sufentanil
Alfentanil
Remifentanil

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7
Q

Meperidine
Dose:
Duration:
E 1/2 Time:
Metabolism:

A

Dose: 12.5 mg (Post-op shivering)
Duration: 2-4 hours
E 1/2 Time: 3-5 hours (35 hours with renal failure)
Metabolism: 90% Hepatic (Normeperidine)

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8
Q

Fentanyl dose for…
Analgesia?
Induction?
Adjunct with inhaled anesthetics?

A

Analgesia - 1 to 2 mcg/kg IV
Induction - 1.5 to 3 mcg/kg IV
Adjunct with inhaled anesthetics - 2 to 20 mcg/kg IV

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9
Q

Fentanyl dose for…
Surgical Anesthesia (Solo)
Intrathecal
Transmucosal (Oral)
Transdermal

A

Surgical Anesthesia (Solo): 50-150 mcg/kg IV
Intrathecal - 25 mcg
Transmucosal (Oral) - 5 to 20 mcg/kg
Transdermal - 75 to 100 mcg (18 hours steady delivery)

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10
Q

Sufentanil doses

A

Analgesia - 0.1 to 0.4 mcg/kg IV
Induction - 18.9 mcg/kg IV

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11
Q

Alfentanil dose for…
Induction laryngoscopy
Induction alone
Maintenance

A

Induction laryngoscopy - 15 to 30 mcg/kg IV
Induction alone - 150 to 300 mcg/kg IV
Maintenance - 25 to 150 mcg/kg/hours IV

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12
Q

Remifentanil induction dose? Maintenance?

A

Induction - 0.5 to 1.0 µg/kg IV over 30-60 secs
Maintenance - 0.25 to 1 µg/kg IV or 0.005 to 2 µg/kg/min IV

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13
Q

Hydromorphone dose?

A

0.5 mg IV (1 to 4 mg)

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14
Q

Codeine
E 1/2 Time
Metabolism
Cough suppressant dose
Analgesia dose

A

E 1/2 Time - 3 to 3.5 hours
Metabolism - Liver
Cough suppressant dose - 15 mg
Analgesia dose - 60 mg

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15
Q

120 mg of Codeine is equal to…

A

10 mg of Morphine

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16
Q

Fentanyl is ____ - ____ times more potent than morphine?

A

75 to 125

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17
Q

Pentazocine elimination 1/2 time?

A

2-3 hours

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18
Q

Pentazocine moderate chronic pain dose? What dose can cause analgesia, sedation, and depression of ventilation?

A

Moderate Pain Dose - 10 to 30 mg IV or 50 mg PO (Equivalent to Codeine 60 mg)

20 to 30 mg IM can cause analgesia, sedation, and depression of ventilation (SImilar to 10 mg of Morphine)

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19
Q

Butorphanol dose? Half-time? Metabolism?

A

2 to 3 mg IM (Equal to 10 mg of Morphine)
2.5 to 3.5 hours
Hepatic

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20
Q

Which opioid agonist-antagonist is equally potent to Morphine?

A

Nalbuphine (10 mg = 10 mg)

21
Q

Which dose of Buprenorphine is equal to 10 mg of Morphine?

A

0.3 mg IM

22
Q

Buprenorphine dose? Onset? Duration?

A

0.3 mg IM
Onset - 30 mins
Duration - 8 hours

23
Q

Dezocine dose?

A

0.15 mg/kg IM

24
Q

100 mg of what drug is equal to 8 mg of Morphine?

A

Meptazinol (Duration < 2 hrs)

25
Q

Naloxone dose? Continuous infusion? Shock? Epidural?

A

1 to 4 µg/kg IV (or 40-80mcg)
Continuous - 5 µg/kg IV
Shock - > 1 mg/kg IV
Epidural - 0.25 µg/kg/hour IV

26
Q

Naloxone duration? Metabolism? E 1/2 time?

A

30 to 45 mins
Liver (Glucoronic Acid)
60-90 min half-time

27
Q

Naltrexone duration? Use?

A

24 hours
Alcoholism

28
Q

Nalmefene dose? E 1/2 time?

A

15 to 25 mcg IV q 2 to 5 mins
10.8 hours

29
Q

Which drugs are given pre-op and post-op?

A

Acetaminophen
Gabapentin

30
Q

Gabapentin dose for preemptive analgesia?

A

300 to 1200 mg PO 1-2 hours before OR

31
Q

Celebrex dose? Peak?

A

200-400 mg PO QD
3 hours

32
Q

Ofirmev Dose? Peak? Duration?

A

Dose: 1000 mg IV q4-6H (Max 3000-4000 mg QD)
Peak: PO (1-3 hours), IV (30 mins to 1 hour)
Duration: 6-8 hours

33
Q

Ketorolac dose? Max dose?

A

15-30 mg IM q6H
Max 60-120 mg QD

34
Q

Ibuprofen dose? Peak?

A

200 to 800 IV over 30 mins q6 hours (3200 mg/day max)
Peak - 1 to 2 hours

35
Q

Lidocaine initial bolus dose? Continuous drip?

A

Initial = 1 to 2 mg/kg IV
Drip = 1 to 2 mg/kg/hour (Terminated in 12 to 72 hours)

36
Q

Magnesium dose?

A

50 mg/kg IV preop
8 mg/kg/hr intraoperatively

37
Q

Zofran dose?

A

4 mg IV (Up to 8)
0.1 mg/kg IV (Pediatric)

38
Q

Dexamethasone (Decadron) dose?

A

8 to 10 mg

39
Q

What two meds should you give before administering Ketamine?

A

Glycopyrrolate (Antisialagogue)
Versed (To prevent emergence delirium)

40
Q

What is the active metabolite of Ketamine?

A

Norketamine

41
Q

Which opioid agonist has the largest Vd?

A

Fentanyl

42
Q

What is Fentanyl’s E 1/2 time? Why is that significant?

A

3.1-6.6 hrs
It’s the longest among the opioid agonists.

43
Q

Which opioid agonist has the lowest lipid solubility and the lowest clearance (300 mL/min)?

A

Alfentanil

44
Q

Alvimopan is metabolized in the…

A

Gut flora - prevents/treats illeus

45
Q

Which opioid receptor has the following effects?
-Analgesia (Supraspinal, spinal)
-Euphoria
-Low abuse potential
-Miosis
-Bradycardia
-Hypothermia
-Urinary retention

A

Mu-1

46
Q

Which opioid receptor has the following effects?
-Analgesia (Spinal)
-Depression of ventilation
-Physical Dependence
-Constipation (marked)

A

Mu-2

47
Q

Which opioid receptor has the following effects?
-Analgesia (Supraspinal, spinal)
-Dysphoria, sedation
- Low abuse potential
-Miosis
-Diuresis

A

Kappa
Agonist - Dynorphins

48
Q

Which opioid receptor has the following effects?
-Analgesia (Supraspinal, spinal)
-Depression of ventilation
-Physical Dependence
-Constipation (minimal)
-Urinary Retention

A

Delta (Agonist - Enkephalins)

Mar: prep for clinicals (15 decks)

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