Opioid Drugs

Question 1

Fentanyl Dosing

Answer 1

Induction dose as adjunct: 1 – 3 mcg/kg

Infusion: 0.01 – 0.05 mcg/kg/min

Small dose boluses: 25 – 50 mcg

Question 2

Fentanyl IV Onset, Peak, and DOA

Answer 2

Onset: 2 min

Peak effect: 20 min

DOA: 30 min

Question 3

Fentanyl Redistribution

Answer 3

Extensive uptake in lungs and red blood cells

Question 4

Fentanyl Metabolism

Answer 4

Hepatic metabolism to inactive metabolite norfentanyl

Question 5

Fentanyl Excretion

Answer 5

Eliminated in feces and urine

Question 6

Fentanyl Respiratory Effects

Answer 6

Pulmonary first pass can cause coughing

Question 7

Fentanyl Transdermal Patch (2)

Answer 7

Once applied, it takes 11 hours for peak effect

Once removed, it takes 18 hours for plasma concentration to decrease by half

Question 8

Meperidine Dosing

Answer 8

Intravenous small dose boluses: 12.5 – 25 mg

Question 9

Meperidine Onset, Peak, DOA

Answer 9

Onset: 5 minutes
Peak effect: 30 minutes
DOA: 2 hours

Question 10

Meperidine Metabolism

Answer 10

Hepatic metabolism via CYP system to normeperidine

Question 11

Meperidine Active Metabolite Considerations (5)

Answer 11

Normeperidine

½ the analgesic & ½ life significantly longer than meperidine

Lowers seizure threshold, induces CNS excitability

Accumulation causes CNS excitation

Tremors, muscle twitches, seizures

Risk with renal failure, high dose chronic use

Question 12

Meperidine Excretion

Answer 12

Eliminated by the kidneys

Question 13

Meperidine Special Considerations (5)

Answer 13

Structurally like atropine and may cause tachycardia

Demonstrates similarities to local anesthetics when administered intrathecally

Significant drug interaction with MAO inhibitors

Effective in decrease postoperative shivering, because of meperidine’s effects at the Kappa receptor

Meperidine (and morphine) can cause histamine related bronchospasm

Question 14

Hydromorphone Dosing

Answer 14

Intravenous small dose boluses: 0.2 mg

Question 15

Hydromorphone Onset, Peak, DOA

Answer 15

Onset: 15 minutes
Peak effect: 30 minutes
DOA: 4 hours

Question 16

Hydromorphone Metabolism

Answer 16

Hepatic metabolism via CYP system to hydromorphine-3-glucuronide (inactive)

Question 17

Hydromorphone Excretion

Answer 17

Eliminated by the kidneys

Question 18

Remifentanil Induction and Infusion Dosing

Answer 18

Intravenous induction dose: 2 mcg/kg

Intravenous infusion: 0.05 mcg/kg/min

Question 19

Remifentanil Risk During Administration

Answer 19

R/f opioid induced muscle rigidity

Question 20

Remifentanil Onset, Peak, DOA

Answer 20

Onset: 1 minutes
Peak effect: 1 minute
DOA: 5 minutes

Question 21

Remifentanil Metabolism

Answer 21

Ester hydrolysis via blood and tissue esterases

Question 22

Remifentanil Excretion

Answer 22

Eliminated by the kidneys

Question 23

Remifentanil CV Effects

Answer 23

Induction doses of reminfentanil may cause profound bradycardia and are often administered with ephedrine

Question 24

Remifentanil Pain Implications

Answer 24

May contribute to post-operative hyperalgesia, therefor the CRNA should create a plan for postoperative analgesia

Question 25

Remifentanil Metabolism Considerations

Answer 25

Remifentanil’s metabolism by plasma esterases (not pseudocholinesterases) lend itself well to patients with renal and/or liver failure

Remifentanil’s rapid onset, short DOA and titratability lend itself well to an intraoperative infusion

Question 26

Naloxone Class

Answer 26

Class: nonselective opioid antagonist

Question 27

Naloxone Uses

Answer 27

Reverses opioid induced respiratory depression, analgesia, sedation, nausea, puritis and constipation

Question 28

Naloxone Dose

Answer 28

Dose: 40 mcg boluses (titrate slowly)

Question 29

Naloxone Onset and DOA

Answer 29

Onset: 1 minutes | DOA: 30 minutes (shorter than most opioids)

Rebound sedation

Question 30

Naloxone Side Effects

Answer 30

Side effects: pulmonary edema, tachycardia, hypertension