Opioid Agonists/Antagonists, Multimodal Flashcards
Morphine:
Dose
Onset
Peak
Duration
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
How is Morphine metabolized?
Glucorinic acid conjugation
What are the two metabolites of morphine? Which is active? Inactive?
Morphine-3-glucoronide (Inactive)
Morphine-6-glucoride (Active)
Which active metabolite of Morphine contributes to late respiratory depression?
Morphine-6-Glucoronide
Which receptors does Meperidine/Pethidine agonize?
Mu and Kappa
What are the four analogues of Meperidine?
Fentanyl
Sufentanil
Alfentanil
Remifentanil
Meperidine
Dose:
Duration:
E 1/2 Time:
Metabolism:
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)
Fentanyl dose for…
Analgesia?
Induction?
Adjunct with inhaled anesthetics?
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
Fentanyl dose for…
Surgical Anesthesia (Solo)
Intrathecal
Transmucosal (Oral)
Transdermal
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)
Sufentanil doses
Analgesia - 0.1 to 0.4 mcg/kg IV
Induction - 18.9 mcg/kg IV
Alfentanil dose for…
Induction laryngoscopy
Induction alone
Maintenance
Induction laryngoscopy - 15 to 30 mcg/kg IV
Induction alone - 150 to 300 mcg/kg IV
Maintenance - 25 to 150 mcg/kg/hours IV
Remifentanil induction dose? Maintenance?
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
Hydromorphone dose?
0.5 mg IV (1 to 4 mg)
Codeine
E 1/2 Time
Metabolism
Cough suppressant dose
Analgesia dose
E 1/2 Time - 3 to 3.5 hours
Metabolism - Liver
Cough suppressant dose - 15 mg
Analgesia dose - 60 mg
120 mg of Codeine is equal to…
10 mg of Morphine
Fentanyl is ____ - ____ times more potent than morphine?
75 to 125
Pentazocine elimination 1/2 time?
2-3 hours
Pentazocine moderate chronic pain dose? What dose can cause analgesia, sedation, and depression of ventilation?
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)
Butorphanol dose? Half-time? Metabolism?
2 to 3 mg IM or 0.5-2mg IV (Equal to 10 mg of Morphine)
2.5 to 3.5 hours
Hepatic
Which opioid agonist-antagonist is equally potent to Morphine?
Nalbuphine (10 mg = 10 mg)
Which dose of Buprenorphine is equal to 10 mg of Morphine?
0.3 mg IM/IV
Buprenorphine dose? Onset? Duration?
0.3 mg IM/IV
Onset - 30 mins
Duration - 8 hours
Dezocine dose?
0.15 mg/kg IM
100 mg of what drug is equal to 8 mg of Morphine?
Meptazinol (Duration < 2 hrs)
Naloxone dose? Continuous infusion? Shock? Epidural?
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
Naloxone duration? Metabolism? E 1/2 time?
30 to 45 mins
Liver (Glucoronic Acid)
60-90 min half-time
Naltrexone duration? Use?
24 hours
Alcoholism
Nalmefene dose? E 1/2 time?
15 to 25 mcg IV q 2 to 5 mins
10.8 hours
Which drugs are given pre-op and post-op?
Acetaminophen
Gabapentin
Gabapentin dose for preemptive analgesia?
300 to 1200 mg PO 1-2 hours before OR
Celebrex dose? Peak?
200-400 mg PO QD
3 hours
Ofirmev Dose? Peak? Duration?
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
Ketorolac dose? Max dose?
15-30 mg IM q6H
Max 60-120 mg QD
Ibuprofen dose? Peak?
200 to 800 IV over 30 mins q6 hours (3200 mg/day max)
Peak - 1 to 2 hours
Lidocaine initial bolus dose? Continuous drip?
Initial = 1 to 2 mg/kg IV
Drip = 1 to 2 mg/kg/hour (Terminated in 12 to 72 hours)
Magnesium dose?
50 mg/kg IV preop
8 mg/kg/hr intraoperatively
Zofran dose?
4 mg IV (Up to 8)
0.1 mg/kg IV (Pediatric)
Dexamethasone (Decadron) dose?
8 to 10 mg
What two meds should you give before administering Ketamine?
Glycopyrrolate (Antisialagogue)
Versed (To prevent emergence delirium)
What is the active metabolite of Ketamine?
Norketamine
Which opioid agonist has the largest Vd?
Fentanyl
What is Fentanyl’s E 1/2 time? Why is that significant?
3.1-6.6 hrs
It’s the longest among the opioid agonists.
Which opioid agonist has the lowest lipid solubility and the lowest clearance (300 mL/min)?
Alfentanil
Alvimopan is metabolized in the…
Gut flora - prevents/treats illeus
Which opioid receptor has the following effects?
-Analgesia (Supraspinal, spinal)
-Euphoria
-Low abuse potential
-Miosis
-Bradycardia
-Hypothermia
-Urinary retention
Mu-1
Which opioid receptor has the following effects?
-Analgesia (Spinal)
-Depression of ventilation
-Physical Dependence
-Constipation (marked)
Mu-2
Which opioid receptor has the following effects?
-Analgesia (Supraspinal, spinal)
-Dysphoria, sedation
- Low abuse potential
-Miosis
-Diuresis
Kappa
Agonist - Dynorphins
Which opioid receptor has the following effects?
-Analgesia (Supraspinal, spinal)
-Depression of ventilation
-Physical Dependence
-Constipation (minimal)
-Urinary Retention
Delta (Agonist - Enkephalins)
