Opioid & non-opioid analgesics 2

Question 1

How do opioids affect RR and tidal volume?

Answer 1

decrease RR, increased tidal volume

Question 2

With opioids, we may see an increase in __________ if ventilation is not maintained

Answer 2

PaCO2

Question 3

What effects do opioids have on SSEPs?

Answer 3

minimal effects

Question 4

What is the reason behind miosis with opioids?

Answer 4

Edinger Westphal nucleus stimulation–> increased PNS stimulation of ciliary ganglion and oculomotor nerve CN3

Question 5

With morphine and meperidine, we may see a decrease in __________

Answer 5

BP as a result of histamine

Question 6

Is the baroreceptor reflex affected with opioids?

Answer 6

no

Question 7

Is myocardial contractility affected with opioids?

Answer 7

no; myocardial depression can occur if combined with N2O

Question 8

What causes the lowest increase in biliary pressure and contraction of sphincter of Oddi?

Answer 8

meperidine

Question 9

What are the effects that opioid has on gastric emptying and peristalsis?

Answer 9

prolonged
slows peristalsis–> constipation

Question 10

How do opioids affect thermoregulation?

Answer 10

resets hypothalamic temperature set point–> reduced core body temperature

Question 11

What are the classifications of opioids?

Answer 11

naturally occurring
semisynthetic
synthetic

Question 12

____________ is the standard by which all other opioids are compared

Answer 12

Morphine

Question 13

Opioids ordered from most to least potent are

Answer 13

Sufentanil> fentanyl=remifentanil>alfentanil>hydromorphone>morphine>meperidine

Question 14

____________ occurs when a person taking a drug will go through withdrawal upon discontinuation of that drug

Answer 14

Dependence

Question 15

_____________ occurs when a patient requires higher doses of a drug to achieve a given effect

Answer 15

Tolerance

Question 16

____________ is a disease; If a person cannot stop using a drug despite negative consequences from using that drug.

Answer 16

Addiction

Question 17

Tolerance develops to nearly all the side effects associated with opioids with the exception of

Answer 17

miosis and constipation

Question 18

Patients who are physically dependent on opioid agonists will experience

Answer 18

s/sx of withdrawal upon discontinuation of these drugs

Question 19

What are early s/sx of withdrawal?

Answer 19

diaphoresis
insomnia
restlessness

Question 20

What are later s/sx of withdrawal?

Answer 20

abdominal cramping
N/V

Question 21

What are the naturally occurring opioids?

Answer 21

phenanthrene derivatives= morphine, codeine

Question 22

What are the semisynthetic opioids?

Answer 22

morphine derivatives= hydromorphone, naloxone, naltrexone, heroin
thebane derivatives= oxycodone

Question 23

What are the synthetic opioids?

Answer 23

piperidines= meperidine
phenylpiperidines= fentanyl, sufentanil, remifentanil, alfentanil
diphenylpropylamines= methadone

Question 24

A dose of fentanyl that is equal to 10 mg of morphine is

Answer 24

100 mcg

Question 25

A dose of sufentanil that is equal to 10 mg of morphine is

Answer 25

10 mcg

Question 26

A dose of remifentanil that is equal to 10 mg of morphine is

Answer 26

100 mcg

Question 27

A dose of alfentanil that is equal to 10 mg of morphine is

Answer 27

1000 mcg

Question 28

A dose of hydromorphone that is equal to 10 mg of morphine is

Answer 28

1.4 mg

Question 29

A dose of meperidine that is equal to 10 mg of morphine is

Answer 29

100 mg

Question 30

__________ occurs when tolerance to one drug produces tolerance to another drug that has similar functions or effects.

Answer 30

Cross-tolerance

Question 31

The time course of opioid withdrawal is a function of

Answer 31

the drug's half-life

Question 32

Which opioids produce an active metabolite? (select 2) a. morphine b. remifentanil c. alfentanil d. meperidine

Answer 32

a. morphine d. meperidine

Question 33

Except for ___________, all the opioids undergo __________________

Answer 33

remifentanil; hepatic biotransformation

Question 34

What opioids produce active metabolites?

Answer 34

morphine meperidine hydromorphone- it depends on what you read

Question 35

What is the active metabolite of meperidine?

Answer 35

normeperidine (increases CNS irritability)

Question 36

What is the active metabolite of morphine?

Answer 36

morphine-3-glucuronide (hyperalgesia, agitation) and morphine-6-glucuronide (respiratory depression, drowsiness)

Question 37

An opioid that produces an active metabolite may require a dose adjustment in a patient with

Answer 37

an impaired clearance mechanism (kidney or liver failure)

Question 38

Remifentanil is hydrolyzed in

Answer 38

the plasma by erythrocyte and tissue esterases

Question 39

Remifentanil is dosed at

Answer 39

lean body weight

Question 40

Normeperidine is ___________ as potent as its parent compound

Answer 40

one half

Question 41

Normeperidine (CNS effects)

Answer 41

reduces the seizure threshold and increases CNS excitability

Question 42

Signs and symptoms of CNS excitability include

Answer 42

muscle twitches, tremors, and seizures

Question 43

Meperidine should be avoided in

Answer 43

patients on dialysis and the elderly

Question 44

M3G causes

Answer 44

hyperalgesia, agitation, myoclonus, and delirium

Question 45

M6G causes

Answer 45

respiratory depression drowsiness N/V coma

Question 46

______________ patients are more likely to experience respiratory depression and toxicity after morphine

Answer 46

Renal failure patients

Question 47

______________________ to patients with normal renal function can also cause M6G accumulation and toxicity

Answer 47

Chronic morphine administration