Opioid & non-opioid analgesics 2 Flashcards
How do opioids affect RR and tidal volume?
decrease RR, increased tidal volume
With opioids, we may see an increase in __________ if ventilation is not maintained
PaCO2
What effects do opioids have on SSEPs?
minimal effects
What is the reason behind miosis with opioids?
Edinger Westphal nucleus stimulation–> increased PNS stimulation of ciliary ganglion and oculomotor nerve CN3
With morphine and meperidine, we may see a decrease in __________
BP as a result of histamine
Is the baroreceptor reflex affected with opioids?
no
Is myocardial contractility affected with opioids?
no; myocardial depression can occur if combined with N2O
What causes the lowest increase in biliary pressure and contraction of sphincter of Oddi?
meperidine
What are the effects that opioid has on gastric emptying and peristalsis?
prolonged
slows peristalsis–> constipation
How do opioids affect thermoregulation?
resets hypothalamic temperature set point–> reduced core body temperature
What are the classifications of opioids?
naturally occurring
semisynthetic
synthetic
____________ is the standard by which all other opioids are compared
Morphine
Opioids ordered from most to least potent are
Sufentanil> fentanyl=remifentanil>alfentanil>hydromorphone>morphine>meperidine
____________ occurs when a person taking a drug will go through withdrawal upon discontinuation of that drug
Dependence
_____________ occurs when a patient requires higher doses of a drug to achieve a given effect
Tolerance
____________ is a disease; If a person cannot stop using a drug despite negative consequences from using that drug.
Addiction
Tolerance develops to nearly all the side effects associated with opioids with the exception of
miosis and constipation
Patients who are physically dependent on opioid agonists will experience
s/sx of withdrawal upon discontinuation of these drugs
What are early s/sx of withdrawal?
diaphoresis
insomnia
restlessness
What are later s/sx of withdrawal?
abdominal cramping
N/V
What are the naturally occurring opioids?
phenanthrene derivatives= morphine, codeine
What are the semisynthetic opioids?
morphine derivatives= hydromorphone, naloxone, naltrexone, heroin
thebane derivatives= oxycodone
What are the synthetic opioids?
piperidines= meperidine
phenylpiperidines= fentanyl, sufentanil, remifentanil, alfentanil
diphenylpropylamines= methadone
A dose of fentanyl that is equal to 10 mg of morphine is
100 mcg
A dose of sufentanil that is equal to 10 mg of morphine is
10 mcg
A dose of remifentanil that is equal to 10 mg of morphine is
100 mcg
A dose of alfentanil that is equal to 10 mg of morphine is
1000 mcg
A dose of hydromorphone that is equal to 10 mg of morphine is
1.4 mg
A dose of meperidine that is equal to 10 mg of morphine is
100 mg
__________ occurs when tolerance to one drug produces tolerance to another drug that has similar functions or effects.
Cross-tolerance
The time course of opioid withdrawal is a function of
the drug’s half-life
Which opioids produce an active metabolite? (select 2)
a. morphine
b. remifentanil
c. alfentanil
d. meperidine
a. morphine
d. meperidine
Except for ___________, all the opioids undergo __________________
remifentanil; hepatic biotransformation
What opioids produce active metabolites?
morphine
meperidine
hydromorphone- it depends on what you read
What is the active metabolite of meperidine?
normeperidine (increases CNS irritability)
What is the active metabolite of morphine?
morphine-3-glucuronide (hyperalgesia, agitation) and morphine-6-glucuronide (respiratory depression, drowsiness)
An opioid that produces an active metabolite may require a dose adjustment in a patient with
an impaired clearance mechanism (kidney or liver failure)
Remifentanil is hydrolyzed in
the plasma by erythrocyte and tissue esterases
Remifentanil is dosed at
lean body weight
Normeperidine is ___________ as potent as its parent compound
one half
Normeperidine (CNS effects)
reduces the seizure threshold and increases CNS excitability
Signs and symptoms of CNS excitability include
muscle twitches, tremors, and seizures
Meperidine should be avoided in
patients on dialysis and the elderly
M3G causes
hyperalgesia, agitation, myoclonus, and delirium
M6G causes
respiratory depression
drowsiness
N/V
coma
______________ patients are more likely to experience respiratory depression and toxicity after morphine
Renal failure patients
______________________ to patients with normal renal function can also cause M6G accumulation and toxicity
Chronic morphine administration
