Opioids Flashcards
Dilaudid is a ___ opioid agonist.
mu
Morphine onset:
1 min
What is the most rapidly acting opioid currently available?
Remifentanil
Some opioids have a low volume of distribution due to high clearance (fentanyl/remifentanil) and/or high protein binding.
remifentanil
Dilaudid duration:
2-3 hrs
Hydromorphone (___)
(Dilaudid)
Remifentanil is ___ times more potent than ___.
100-200; morphine
Fentanyl dose (conc.):
2-20 mcg/kg (20 mcg/kg for CARDIAC ONLY)
(50 mcg/cc)
typically given in doses of either 25, 50, 100 mcg
Narcan MOA:
displaces opioids from mu receptors
Remifentanil dose (conc.):
0.5-1 mcg/kg/min
(1-2 mg –>reconstitute)
Common side effects of opioids:
(Relaxation/Contraction) of the sphincter of Oddi
contraction; increases biliary pressure and can be reversed with naloxone or glucagon
Narcan duration:
15-45 mins –> requires it to be redosed or administered as a continuous infusion when antagonism is required for long-acting opioids
Fentanyl is (able/not able) to cross the blood brain barrier.
able –> due to high lipophilicity
Sufentanil is an opioid with (medium/strong) potency.
strong
Remifentanil metabolism:
contains a methyl ester side chain that is metabolized by blood and tissue nonspecific esterases.
Allows for rapid clearance of drug and consistently short context-sensitive half time.
Dilaudid onset:
10-15 mins
Fentanyl is a (natural/semisynthetic/synthetic) opioid.
synthetic
Remifentanil (_______)
___ (Ultiva)
Adverse effects associated with the reversal of opioids using Narcan (6):
- sudden pain
- pulmonary edema
- cardiac arrhythmias
- HTN
- seizures
- cardiac arrest
Remifentanil duration:
3-6 mins
Where is Dilaudid most often used perioperatively?
Intraop and in PACU
Fentanyl (_______)
___ (Sublimaze)
The requirements for inhalational anesthetics and propofol are reduced by about __% when administering ___ IV fentanyl.
50%
1.5-3 mcg/kg IV fentanyl
Morphine excretion:
kidneys (careful in renal compromised patients, b/c it can accumulate)
Remifentanil is an opioid classified as having (medium/strong) potency.
strong
Common side effects of opioids:
Pregnancy (___)
placental transfer –> due to lipophilicity
Dilaudid is a (natural/semisynthetic/synthetic) opioid.
semisynthetic
What are our six primary uses for opioids?
Preoperative medication
Monitored Care Anesthesia
Induction
Intraoperative pain control
Adjunct to anesthesia
Postoperative pain control
Some opioids have a high volume of distribution due to high lipophilicity and low protein-binding affinity, such as (fentanyl/remifentanil)
Fentanyl
Common side effects of opioids:
(bradycardia/tachycardia)
bradycardia
Morphine is a ___ agonist.
mu1, mu2, and kappa
The plasma level of remifentanil decreases by __% in as little as __ seconds.
50%;
40 seconds
Fentanyl metabolism:
liver –> CYP450 enzymes
Fentanyl is about __ times more potent than ___.
100; morphine
The clearance of remifentanil is ___ L/min.
What does this information tell us?
3-5 L/min;
this exceeds liver blood flow and affirms its extrahepatic clearance.
Morphine duration:
2-7 hrs
Remifentanil context sensitive half-time duration:
2-3 minutes
Remifentanil is a (natural/semisynthetic/synthetic) opioid.
synthetic
Sufentanil is a ___ derivative of fentanyl and about __ times more potent.
It is __ times more liphophilic than fentanyl.
thienyl
10;
2
Narcan dose (conc.):
40 mcg at a time, every 1-2 mins until good respirations/ventilation
0.4 mg per vial –> dilute 1 vial (0.4 mg) in 9 cc NS = (40 mcg/cc)
Hydromorphone (Dilaudid) is an opioid classified as having (medium/strong) potency.
medium
Fentanyl has a much (shorter/longer) context sensitive half-life than Remifentanil.
longer; remifentanil is fastest due to metabolism via tissue nonspecific esterase hydrolysis.
Sufentanil is a (natural/semisynthetic/synthetic) opioid.
synthetic
Fentanyl acts at the __ opioid receptor, causing the following symptoms:
kappa
spinal analgesia, respiratory depression, sedation, miosis
MAC is (decreased/increased) with a concurrent remifentanil infusion.
decreased
Common side effects of opioids:
___ –> due to histamine release (especially by ___ and ___)
allergies; morphine, meperidine
Sufentanil onset:
1-3 mins
Common side effects of opioids:
respiratory (depression/stimulation)
depression
Common side effects of opioids:<br></br>______ –> caused by stimulation of the chemoreceptor zone in the medulla and possibly the vestibular apparatus.
nausea and vomiting
Remifentanil onset:
1 min`
Fentanyl is an opioid classified as having (medium/strong) potency.
strong
Fentanyl onset:
30 seconds
Sufentanil is (able/not able) to cross the BBB.
able to cross due to high lipophilicity of piperidines
Dilaudid dose (conc.):
0.01-0.04 mg/kg
(2mg/cc)
Sufentanil metabolism:
liver
CYP450 enzyme system
What are our five opioids classified as piperidines?
Meperidine
Fentanyl
Sufentanil
Alfentanil
Remifentanil
Common side effects of opioids:
Opioid ___
dependence
Morphine metabolism:
liver
Sufentanil dose (conc.):
0.6-4 mcg/kg
(50 mcg/cc)
Fentanyl is used during anesthesia to decrease ______ from ______.
cardiovascular responses to noxious stimulation from laryngoscopy, intubation, skin incision, and surgical stress
Sufentanil duration:
20-45 mins
Morphine is an opioid classified as having (medium/strong) potency.
medium
Sufentanil (_______)
___ (Sufenta)
Naloxone (_________)
___ (Narcan)
Morphine dose (conc.):
0.1 mg/kg
(10 mg/cc)
Fentanyl duration:
10-20 mins (dose-dependent)
Fentanyl duration of action:
10-20 mins, dose-dependent
Sufentanil (___)
(Sufenta)
Morphine is (able/not able) to cross the blood brain barrier.
able, but has low lipophilicity so it crosses BBB slowly
When is morphine most commonly given perioperatively?
Given in PACU rather than intraop
Morphine is a (natural/semisynthetic/synthetic) opioid.
natural (can also be called an opiate)
