Opioids Flashcards
Fentanyl: Class
Opioid agonist
Fentanyl: Use
Reduce pain
Postoperative analgesia
Decrease Somatic and Autonomic response
Fentanyl: Mechanism of Action
Binds to Mu1, Mu2, Kappa and delta receptors
Fentanyl: Dose
Induction: 1 mcg/kg
Infusion: 0.01 mcg/kg/min
Small dose Bolus: 25 mcg
Fentanyl: Pharmacokinetics
Absorption: IM, IV, epidural/intrathecal, transdermal, transmucosal
Onset: 2 minutes
Duration of Action: 30 minutes
Metabolism: Hepatic
Excretion: Feces and Urine
Fentanyl: Contraindications
Hypersensitivity
Severe Respiratory depression
Fentanyl: Considerations
Decreases ventilatory response to hypoxia and hypercapnia
Bradycardia
Decreased Gastric motility
Reduced Stress response
?Promote cancer cell proliferation
Hydromorphone / Dilaudid: Class
Opioid Agonist
Hydromorphone / Dilaudid: Use
Pain management
Hydromorphone / Dilaudid: Mechanism of Action
Binds to Mu1, Mu2, Kappa and delta receptors
Hydromorphone / Dilaudid: Dose
IV 0.2 mg Bolus
Hydromorphone / Dilaudid: Pharmacokinetics
Absorption: PO, IV, Epidural, Intrathecal
Onset: 15 minutes
Duration of Action: 4 hours
Metabolism: Hepatic
Excretion: Kidneys
Hydromorphone / Dilaudid: Contraindications
Severe Respiratory Suppression
Hypersensitivity
Hydromorphone / Dilaudid: Considerations
Decreases ventilatory response to hypoxia and hypercapnia
Bradycardia
Decreased Gastric motility
Reduced Stress response
?Promote cancer cell proliferation
Meperidine: Class
Opioid Agonist
Meperidine: Use
Post op Shivering
Meperidine: Mechanism of Action
Binds to Mu1, Mu2, Kappa and delta receptors
Meperidine: Dose
IV Bolus 12.5 mg
Meperidine: Pharmacokinetics
Absorption: PO, IV, IM
Onset: 5 minutes
Duration of Action: 2 hours
Metabolism: hepatic
ACTIVE METABOLITE = Normeperidine
Excretion: Kidneys
Meperidine: Contraindications
Hypersensitivity
Patient taking MAOIs
Renal Failure d/t active metabolite
Meperidine: Considerations
Histamine release can cause Hypotension/Bronchoconstriction
Similar structure as Atropine –> Tachycardia
Active metabolite: Normeperidine has longer 1/2 life and lowers seizure threshold
Remifentanil: Class
Opioid Agonist
Remifentanil: Use
Induction
Intraoperative pain management
Remifentanil: Mechanism of Action
Opioids bind to Mu1, Mu2, Kappa, and delta receptors to decrease neurotransmitter release by increasing potassium efflux and MARK cascade and decreasing adenyl cyclase production and calcium influx of ascending and descending pain pathways
Remifentanil: Dose
Induction: 2 mcg/kg
IV Infusion: 0.05 mcg/kg/min
Remifentanil: Pharmacokinetics
Absorption: IV
Onset: 1 minute
Duration of Action: 5 minutes
Metabolism: Ester hydrolysis
Excretion: Kidneys
Remifentanil: Contraindictions
Not for spinal anesthesia
Bradycardia
High risk for Post op Pain
Remifentanil: Considerations
Risk for muscle rigidity
Good Induction drug for when NMB is contraindicated
Induction dose has high risk for Bradycardia –> Pair with ephedrine
A good choice for patients with renal and/or hepatic failure
Post-op Hyperalgesia
