Meds that affect TRANSDUCTION Analgesics

steriods NSAIDs antihistamines LAs section 1 flashcard

Meds that affect MODULATION Analgesics

NMDA SNRIs SSRIs Neuraxial LAs section 1 flashcard

Meds that affect TRANSMISSION Analgesics

PNB LAs Opioids section 1 flashcard

Factors increased by opioids Analgesics

PaCO2 gastric empyting time tidal volume biliary pressure section 3 flashcard

Opioid & Non-Opioid Analgesics (5.4) Flashcards by Kelly K

Identify the process by with a nociceptor converts a chemical stimulus into an action potential.
a. transmission
b. transduction
c. perception
d. modulation

Analgesics

b. transduction

pre-lesson Q1

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Molecular mechanisms of opioid receptor stimulation include: (Select 2)
a. decreased cAMP production
b. increased calcium conductance
c. increased adenylate cyclase activity
d. increased potassium conductance

Analgesics

a. decreased cAMP production
d. increased potassium

conductance hyperpolarizes nerve

pre-lesson Q2

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Cardiovascular consequences of opioid administration in healthy patients include:
a. bradycardia
b. myocardial depression
c. hypotension
d. impaired baroreceptor reflex

Analgesics

a. bradycardia

mu receptor stimulation

pre-lesson Q3

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

Analgesics

a. morphine
d. meperidine

M3G, M6G, and normeperidine

pre-lesson Q4

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Match each drug to its potency relative to morphine.
1. remifentanil
2. meperidine
3. sufentanil
4. alfentanil
a. 10X
b. 1000X
c. 100X
d. 0.1X

Analgesics

1c (Remifentanil 100X)
2d (Meperidine 0.1X)
3b (Sufentanil 1000X)
4a (Alfentanil 10X)

pre-lesson Q5

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Which drug is associated with anticholinergic side effects?
a. meperidine
b. naloxone
c. methadone
d. remifentanil

Analgesics

a. meperidine

atropine-like ring, causes mydriasis & tachycardia

pre-lesson Q6

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Which pharmacological characteristic accounts for the rapid onset of action of alfentanil?
a. low protein binding
b. low degree of ionization
c. high potency
d. high lipid solubility

Analgesics

b. low degree of ionization

pre-lesson Q7

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Which agents can be used to attenuate opioid-induced hyperalgesia? (Select 2)
a. ketamine
b. clonidine
c. morphine
d. magnesium sulfate

Analgesics

a. ketamine
d. magnesium sulfate

NMDA receptor antagonism

pre-lesson Q8

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Methadone provides analgesia by all of the following ways except:
a. mu receptor antagonism
b. NMDA receptor antagonism
c. monoamine reuptake inhibition
d. cholinergic receptor antagonism

Analgesics

d. cholinergic receptor antagonism

pre-lesson Q9

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Which are expected to increase during an episode of opioid-induced muscle rigidity? (Select 3)
a. oxygen consumption
b. thoracic compliance
c. pulmonary vascular resistance
d. intracranial pressure
e. functional residual capacity
f. mixed venous oxygen saturation

Analgesics

a. oxygen consumption
c. pulmonary vascular resistance
d. intracranial pressure

pre-lesson Q10

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Which drugs are represented by a dose response curve just below a full agonist? (Select 2)
a. buprenorphine
b. naloxone
c. nalmefene
d. butorphanol

Analgesics

a. buprenorphine
d. butorphanol

partial agonists

pre-lesson Q11

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An opioid-dependent patient is scheduled for a cesarean section. Side effects of naloxone administration in this patient include all of the following except:
a. pulmonary edema
b. bradycardia
c. nausea
d. neonatal opioid withdrawal syndrome

Analgesics

b. bradycardia

activates SNS=tachycardia

pre-lesson Q12

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Match each term with its definition as it relates to intravenous patient-controlled analgesia.
1. lockout interval
2. basal infusion rate
3. demand dose
4. initial loading dose
a. first dose required to achieve a given plasma concentration
b. dose delivered when the patient pushes the PCA button
c. amount of time that must elapse between demand doses
d. continous rate of background infusion

Analgesics

1c
2d
3b
4a

pre-lesson Q13

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Intrathecal administration is a contraindication to which opioid?
a. hydromorphone
b. remifentanil
c. morphine
d. sufentanil

Analgesics

b. remifentanil

mixed with glycine, causes skeletal muscle weakness

post lesson quiz

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When used to reverse opioid overdose, what is the primary mechanism by which naloxone can cause pulmonary edema?
a. sympathetic stimulation
b. pulmonary vasoconstriction
c. acute respiratory distress syndrome
d. right heart failure

Analgesics

a. sympathetic stimulation

post-lesson quiz

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A patient will experience pain the soonest after discontinuation of which opioid infusion?
a. sufentanil
b. alfentanil
c. remifentanil
d. fentanyl

Analgesics

c. remifentanil

post lesson quiz

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Methadone should be avoided in the patient with a history of:
a. type-1 sensitivity to fentanyl
b. myasthenia gravis
c. congenital long QT syndrome
d. phenelzine therapy

Analgesics

c. congenital long QT syndrome

can increase QT interval

post lesson quiz

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A patient receiving a fentanyl PCA appears sedated and is only arousable to tactile stimulation. Clinical findings in this patient most likely include: (Select 2.)
a. decreased blood pH
b. increased intracranial pressure
c. decreased tidal volume
d. increased A-a gradient

Analgesics

a. decreased blood pH
b. increased intracranial pressure

post lesson quiz

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What is the most important site of pain modulation?
a. dorsal horn of spinal cord
b. cerebral cortex
c. thalamus
d. nociceptors

Analgesics

a. dorsal horn of spinal cord

post lesson quiz

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A patient receiving a morphine PCA experiences significant respiratory depression. Which laboratory finding would have best predicted this outcome?
a. ALT 503 units/L
b. creatinine 4.3 mg/dL
c. albumin 2.1 g/dL
d. sodium 127 meq/L

Analgesics

b. creatinine 4.3 mg/dL

unable to excrete morphine metabolite M6G which is more potent and longe

post lesson quiz

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Mu receptor stimulation contributes to all of the following except:
a. miosis
b. increased biliary pressure
c. antishivering effect
d. bradycardia

Analgesics

c. antishivering effect

mediated by kappa stimulation

post-lesson quiz

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Match each opioid receptor with its primary agonist.
1. delta
2. kappa
3. mu
a. endorphins
b. enkaphalins
c. dynorphins

Analgesics

1b
2c
3a

post-lesson quiz

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Which drugs have the equianalgesic potency of 50 mcg of fentanyl IV? (Select 2)
a. sufentanil 10 mcg
b. morphine 10 mg
c. hydromorphone 0.7 mg
d. alfentanil 500 mcg

Analgesics

c. hydromorphone 0.7 mg
d. alfentanil 500 mcg

morphine 10 mg=fentanyl 100 mcg= hydromorphone 1.4 mg= Alfentanil 1 mg

post-lesson quiz

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Meds that affect PERCEPTION

Analgesics

General anesthesia
Alpha-2 agonist
Opioids

section 1 flashcard

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Meds that affect TRANSDUCTION ## Footnote Analgesics

steriods NSAIDs antihistamines LAs ## Footnote section 1 flashcard

Meds that affect MODULATION ## Footnote Analgesics

NMDA SNRIs SSRIs Neuraxial LAs ## Footnote section 1 flashcard

Meds that affect TRANSMISSION ## Footnote Analgesics

PNB LAs Opioids ## Footnote section 1 flashcard

Mu Receptor effects ## Footnote Analgesics

respiratory depression miosis increased biliary pressure urinary retention supraspinal analgesia spinal analgesia bradycardia pruritis ## Footnote section 2 flashcard

Factors increased by opioids ## Footnote Analgesics

PaCO2 gastric empyting time tidal volume biliary pressure ## Footnote section 3 flashcard

Factors decreased by opioids ## Footnote Analgesics

RR HR pupillary diameter peristalsis natural killer cell function immune function ## Footnote section 3 flashcard

What is the equianalgesic dose to morphine 10 mg IV? 1. fentanyl 2. hydromorphone 3. remifentanil 4. meperidine 5. sufentanil 6. alfentanil ## Footnote Analgesics

1. 100 mcg 2. 1.4 mg 3. 100 mcg 4. 100 mg 5. 10 mcg 6. 1 mg ## Footnote lesson 4 flashcard

Define dependence. ## Footnote Analgesics

Dependence occurs when a person taking a drug will go through withdrawal upon discontinuation of that drug. ## Footnote lesson 4 flashcard

Define tolerance. ## Footnote Analgesics

Tolerance occurs when a patient requires higher doses of a drug to achieve a given effect. ## Footnote lesson 4 flashcard

Define addiction. ## Footnote Analgesics

Addiction occurs when a person cannot stop using a drug despite negative consequences from using that drug (it's a disease). ## Footnote lesosn 4 flashcard

Which opioids produce an active metabolite? ## Footnote Analgesics

-meperidine -morphine ## Footnote lesson 4 flashcard

What 2 opioid receptors are stimulated by meperidine? ## Footnote Analgesics

1. Mu 2. Kappa ## Footnote lesson 5 flashcard

What is the active metabolite of meperidine? ## Footnote Analgesics

normeperidine | 1/2 the potency ## Footnote lesson 6 flashcard

What are 2 significant side effects of meperidine's active metabolite? ## Footnote Analgesics

1. Myoclonus 2. Seizures ## Footnote lesson 6 flashcard

What patient populations are at greatest risk for meperidine toxicity? ## Footnote Analgesics

1. Elderly 2. Renal failure patients ## Footnote lesson 6 flashcard

What is the risk of administering meperidine to a patient on isocarboxazid? ## Footnote Analgesics

serotonin syndrome ## Footnote lesson 6 flashcard

What are 4 signs and symptoms of serotonin syndrome? ## Footnote Analgesics

1. Hyperthermia 2. Mental status changes 3. Hyperreflexia 4. Seizures ## Footnote lesson 6 flashcard

How do alfentanil's pharmacokinetics differ from other opioids? ## Footnote Analgesics

-it has the lowest pKa = 6.5 -highest non-ionized fraction = 90% ## Footnote lesson 7 flashcard

Why does alfentanil have the fastest onset of all opioids? ## Footnote Analgesics

-more molecules are available to enter the brain because alfentanil is 90% non-ionized at physiologic pH -also has a low Vd ## Footnote lesson 7 flashcard

What opioid has the lowest non-ionized fraction at physiologic pH? ## Footnote Analgesic

meperidine (only 7%) ## Footnote lesson 7 flashcard

What opioid has the same potency as remifentanil? ## Footnote Analgesics

Fentanyl ## Footnote lesson 8 flashcard

How is remifentanil metabolized? ## Footnote Analgesics

Hydrolysis by erythrocyte and tissue esterases | not pseudocholinesterase ## Footnote lesson 8 flashcard

Which 2 drugs can reduce the incidence of opioid-induced hyperalgesia from remifentanil? ## Footnote Analgesics

1. Ketamine 2. Magnesium sulfate ## Footnote lesson 8 flashcard

List 3 patient populations that benefit from methadone therapy. ## Footnote Analgesics

1. chronic opioid abuse 2. chronic pain syndrome 3. cancer pain ## Footnote lesson 9 flashcard

What 3 ways does methadone decrease pain? ## Footnote Analgesics

1. Mu receptor agonist 2. NMDA receptor antagonist 3. Inhibits reuptake of monoamines in the synaptic cleft ## Footnote lesson 9 flashcard

How does methadone affect the EKG? ## Footnote Analgesics

QT prolongation | risk of Torsades de pointes ## Footnote lesson 9 flashcard

What 4 opioids are most likely to cause skeletal muscle rigidity? ## Footnote Analgesics

1. Sufentanil 2. Fentanyl 3. Remifentanil 4. Alfentanil ## Footnote lesson 10 flashcard

In the patient with skeletal muscle rigidity, where is the greatest resistance to ventilation? ## Footnote Analgesics

Larynx ## Footnote lesson 10 flashcard

What is the best treatment for skeletal muscle rigidity? ## Footnote Analgesics

paralysis and intubation ## Footnote lesson 10 flashcard

What are 4 disadvantages of using partial agonist opioids? ## Footnote Analgesics

1. Reduces the efficacy of previously administered opioids 2. Can cause acute opioid withdrawal in the opioid-dependent patient 3. Can cause dysphoric reactions 4. Has a ceiling effect beyond which additional analgesia is not possible ## Footnote lesson 11 flashcard

Name 1 partial opioid agonist that can be administered via the intranasal route. ## Footnote Analgesics

Butorphanol ## Footnote lesson 11 flashcard

Name 1 partial opioid agonist that can be administered via the transdermal route. ## Footnote Analgesics

Buprenorphine ## Footnote lesson 11 flashcard

Name 2 partial opioid agonists that provide better analgesia than morphine. ## Footnote Analgesics

1. Buprenorphine 2. Butorphanol ## Footnote lesson 11 flashcard

What is the dose of naloxone? ## Footnote Analgesics

1-4 mcg/kg ## Footnote lesson 12 flashcard

What is the duration of naloxone? ## Footnote Analgesics

30-45 minutes ## Footnote lesson 12 flashcard

How is naloxone metabolized? ## Footnote Analgesics

liver ## Footnote lesson 12 flashcard

List 4 side effects that can occur when naloxone is given to a patient with pain? ## Footnote Analgesics

1. Neurogenic pulmonary edema 2. Cardiac dysrhythmias 3. Tachycardia 4. Sudden death ## Footnote lesson 12 flashcard

Which opioid antagonist does not reverse opioid-induced respiratory depression? ## Footnote Analgesics

Methylnaltrexone ## Footnote lesson 12 flashcard

Which opioid antagonist is best for opioid-induced bowel dysfunction? ## Footnote Analgesics

Methylnaltrexone ## Footnote lesson 12 flashcard

List 5 factors that increase the risk of respiratory depression with IV PCA. ## Footnote Analgesics

1. Basal infusion rate (background infusion) 2. Administration of other sedative medications 3. Old age 4. Pulmonary disease 5. Obstructive sleep apnea ## Footnote lesson 13 flashcard

How do you determine the lockout interval for IV PCA? ## Footnote Analgesics

the lockout interval is based on the time it takes for the demand dose to reach an effective plasma concentration ## Footnote lesson 13 flashcard

Does a basal infusion rate improve the quality of sleep? ## Footnote Analgesics

No but it does increase the risk of respiratory depression ## Footnote lesson 13 flashcard

Match each opioid agonist with its respective drug class. 1. Fentanyl 2. Methadone 3. Morphine a. phenylpiperidine b. phenanthrene c. diphenylpropylamine ## Footnote Analgesics

1a 2c 3b ## Footnote review exam

Identify the physiologic effects commonly associated with mu receptor stimulation. (Select 3) a. bradycardia b. dysphoria c. antishivering effect d. pruritus e. respiratory depression f. diuresis ## Footnote Analgesics

a. bradycardia d. pruritus e. respiratory depression ## Footnote review exam

Which opioid side effects are most resistant to tolerance? (Select 2) a. miosis b. respiratory depression c. constipation d. emetic effects ## Footnote Analgesics

a. miosis c. constipation ## Footnote review exam

A patient becomes hypotensive after 10 mg of IV morphine. What is the least likely explanation for this finding? a. myocardial depression b. histamine release c. decreased preload d. decreased sympathetic tone ## Footnote Analgesics

a. myocardial depression ## Footnote review exam

In women, morphine is associated with a: a. greater analgesic potency b. faster onset of action c. higher post-operative opioid consumption d. shorter duration of action ## Footnote Analgesics

a. greater analgesic potency ## Footnote review exam

Anesthesia is induced in a healthy 35 year-old male with propofol 160 mg, sufentanil 150 mcg, and succinylcholine 120 mg. After 1 minute he becomes impossible to ventilate. What is the most likely explanation for this situation? a. malignant hyperthermia b. pulmonary embolism c. bronchospasm d. skeletal muscle rigidity ## Footnote Analgesics

c. bronchospasm | succ=histamine release=bronchospasm; succ treat skeletal muscle rigid ## Footnote review exam

Match each opioid agonist to its unique characteristic. 1. Methadone 2. Sufentanil 3. Alfentanil 4. Codeine a. Metabolized to morphine b. pKa is less than physiologic pH c. most potent opioid agonist d. QT interval prolongation ## Footnote Analgesics

1d 2c 3b 4a ## Footnote review exam

Which drugs are most effective at reducing opioid-induced hyperalgesia after the administration of remifentanil? (Select 2) a. magnesium b. ketamine c. ketorolac d. dexmedetomidine ## Footnote Analgesics

a. magnesium b. ketamine | NMDA receptor antagonists ## Footnote review exam

An opioid dependent patient is experiencing intense signs of withdrawal 8 hours after his last dose. Which of the following drugs is the patient most likely abusing? ## Footnote Analgesics

Fentanyl | peak 6-12 hours Morphine: 36-72 hours Methadone: 3-21 days ## Footnote review exam

Which opioid inhibits nerve conduction? a. hydromorphone b. morphine c. sufentanil d. meperidine ## Footnote Analgesics

d. meperidine ## Footnote review exam

The endogenous pain modulation pathway terminates in the: a. rostroventral medulla b. substantia gelatinosa c. periaqueductal grey d. ventral root ganglion ## Footnote Analgesics

b. substantia gelatinosa ## Footnote review exam

Which agent is associated with the greatest amount of rostral spread when injected into the intrathecal space? a. hydromorphone b. morphine c. meperidine d. fentanyl ## Footnote Analgesics

b. morphine | least lipophilic; can cause early and late phase resp. depression ## Footnote review exam

Which route of morphine administration is associated with reactivation of herpes simplex labialis virus? a. oral b. intravenous c. intramuscular d. epidural ## Footnote Analgesics

d. epidural ## Footnote review exam

Butorphanol reduces post-operative shivering by: a. kappa receptor agonism b. alpha-1 receptor antagonism c. acetylcholine receptor antagonism d. mu receptor agonism ## Footnote Analgesics

a. kappa receptor agonism ## Footnote review exam

Cardiovascular side effects of naloxone include all of the following except: a. hypertension b. cardiac dysrhythmias c. myocardial ischemia d. bradycardia ## Footnote Analgesics

d. bradycardia ## Footnote review exam