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Top Drawer Medications > Opioids > Flashcards

Opioids Flashcards

1
Q

Dilaudid is a ___ opioid agonist.

A

mu

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2
Q

Morphine onset:

A

1 min

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3
Q

What is the most rapidly acting opioid currently available?

A

Remifentanil

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4
Q

Some opioids have a low volume of distribution due to high clearance (fentanyl/remifentanil) and/or high protein binding.

A

remifentanil

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5
Q

Dilaudid duration:

A

2-3 hrs

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6
Q

Hydromorphone (___)

A

(Dilaudid)

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7
Q

Remifentanil is ___ times more potent than ___.

A

100-200; morphine

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8
Q

Fentanyl dose (conc.):

A

2-20 mcg/kg (20 mcg/kg for CARDIAC ONLY)

(50 mcg/cc)
typically given in doses of either 25, 50, 100 mcg

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9
Q

Narcan MOA:

A

displaces opioids from mu receptors

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10
Q

Remifentanil dose (conc.):

A

0.5-1 mcg/kg/min
(1-2 mg –>reconstitute)

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11
Q

Common side effects of opioids:

(Relaxation/Contraction) of the sphincter of Oddi

A

contraction; increases biliary pressure and can be reversed with naloxone or glucagon

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12
Q

Narcan duration:

A

15-45 mins –> requires it to be redosed or administered as a continuous infusion when antagonism is required for long-acting opioids

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13
Q

Fentanyl is (able/not able) to cross the blood brain barrier.

A

able –> due to high lipophilicity

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14
Q

Sufentanil is an opioid with (medium/strong) potency.

A

strong

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15
Q

Remifentanil metabolism:

A

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.

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16
Q

Dilaudid onset:

A

10-15 mins

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17
Q

Fentanyl is a (natural/semisynthetic/synthetic) opioid.

A

synthetic

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18
Q

Remifentanil (_______)

A

___ (Ultiva)

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19
Q

Adverse effects associated with the reversal of opioids using Narcan (6):

A
  1. sudden pain
  2. pulmonary edema
  3. cardiac arrhythmias
  4. HTN
  5. seizures
  6. cardiac arrest
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20
Q

Remifentanil duration:

A

3-6 mins

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21
Q

Where is Dilaudid most often used perioperatively?

A

Intraop and in PACU

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22
Q

Fentanyl (_______)

A

___ (Sublimaze)

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23
Q

The requirements for inhalational anesthetics and propofol are reduced by about __% when administering ___ IV fentanyl.

A

50%
1.5-3 mcg/kg IV fentanyl

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24
Q

Morphine excretion:

A

kidneys (careful in renal compromised patients, b/c it can accumulate)

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25
Q

Remifentanil is an opioid classified as having (medium/strong) potency.

A

strong

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26
Q

Common side effects of opioids:
Pregnancy (___)

A

placental transfer –> due to lipophilicity

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27
Q

Dilaudid is a (natural/semisynthetic/synthetic) opioid.

A

semisynthetic

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28
Q

What are our six primary uses for opioids?

A

Preoperative medication
Monitored Care Anesthesia
Induction
Intraoperative pain control
Adjunct to anesthesia
Postoperative pain control

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29
Q

Some opioids have a high volume of distribution due to high lipophilicity and low protein-binding affinity, such as (fentanyl/remifentanil)

A

Fentanyl

30
Q

Common side effects of opioids:
(bradycardia/tachycardia)

A

bradycardia

31
Q

Morphine is a ___ agonist.

A

mu1, mu2, and kappa

32
Q

The plasma level of remifentanil decreases by __% in as little as __ seconds.

A

50%;
40 seconds

33
Q

Fentanyl metabolism:

A

liver –> CYP450 enzymes

34
Q

Fentanyl is about __ times more potent than ___.

A

100; morphine

35
Q

The clearance of remifentanil is ___ L/min.
What does this information tell us?

A

3-5 L/min;
this exceeds liver blood flow and affirms its extrahepatic clearance.

36
Q

Morphine duration:

A

2-7 hrs

37
Q

Remifentanil context sensitive half-time duration:

A

2-3 minutes

38
Q

Remifentanil is a (natural/semisynthetic/synthetic) opioid.

A

synthetic

39
Q

Sufentanil is a ___ derivative of fentanyl and about __ times more potent.
It is __ times more liphophilic than fentanyl.

A

thienyl
10;
2

40
Q

Narcan dose (conc.):

A

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)

41
Q

Hydromorphone (Dilaudid) is an opioid classified as having (medium/strong) potency.

A

medium

42
Q

Fentanyl has a much (shorter/longer) context sensitive half-life than Remifentanil.

A

longer; remifentanil is fastest due to metabolism via tissue nonspecific esterase hydrolysis.

43
Q

Sufentanil is a (natural/semisynthetic/synthetic) opioid.

A

synthetic

44
Q

Fentanyl acts at the __ opioid receptor, causing the following symptoms:

A

kappa

spinal analgesia, respiratory depression, sedation, miosis

45
Q

MAC is (decreased/increased) with a concurrent remifentanil infusion.

A

decreased

46
Q

Common side effects of opioids:
___ –> due to histamine release (especially by ___ and ___)

A

allergies; morphine, meperidine

47
Q

Sufentanil onset:

A

1-3 mins

48
Q

Common side effects of opioids:
respiratory (depression/stimulation)

A

depression

49
Q

Common side effects of opioids:<br></br>______ –> caused by stimulation of the chemoreceptor zone in the medulla and possibly the vestibular apparatus.

A

nausea and vomiting

50
Q

Remifentanil onset:

A

1 min`

51
Q

Fentanyl is an opioid classified as having (medium/strong) potency.

A

strong

52
Q

Fentanyl onset:

A

30 seconds

53
Q

Sufentanil is (able/not able) to cross the BBB.

A

able to cross due to high lipophilicity of piperidines

54
Q

Dilaudid dose (conc.):

A

0.01-0.04 mg/kg
(2mg/cc)

55
Q

Sufentanil metabolism:

A

liver
CYP450 enzyme system

56
Q

What are our five opioids classified as piperidines?

A

Meperidine
Fentanyl
Sufentanil
Alfentanil
Remifentanil

57
Q

Common side effects of opioids:
Opioid ___

A

dependence

58
Q

Morphine metabolism:

A

liver

59
Q

Sufentanil dose (conc.):

A

0.6-4 mcg/kg
(50 mcg/cc)

60
Q

Fentanyl is used during anesthesia to decrease ______ from ______.

A

cardiovascular responses to noxious stimulation from laryngoscopy, intubation, skin incision, and surgical stress

61
Q

Sufentanil duration:

A

20-45 mins

62
Q

Morphine is an opioid classified as having (medium/strong) potency.

A

medium

63
Q

Sufentanil (_______)

A

___ (Sufenta)

64
Q

Naloxone (_________)

A

___ (Narcan)

65
Q

Morphine dose (conc.):

A

0.1 mg/kg
(10 mg/cc)

66
Q

Fentanyl duration:

A

10-20 mins (dose-dependent)

67
Q

Fentanyl duration of action:

A

10-20 mins, dose-dependent

68
Q

Sufentanil (___)

A

(Sufenta)

69
Q

Morphine is (able/not able) to cross the blood brain barrier.

A

able, but has low lipophilicity so it crosses BBB slowly

70
Q

When is morphine most commonly given perioperatively?

A

Given in PACU rather than intraop

71
Q

Morphine is a (natural/semisynthetic/synthetic) opioid.

A

natural (can also be called an opiate)

Top Drawer Medications (13 decks)

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