Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen Exam 1 > Opioids > Flashcards

Opioids Flashcards

1
Q

How do you treat opioid-induced biliary spasms?

A

Naloxone or glucagon to relax
the sphincter muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which opioid should not be used in patients taking MAOI?

A

Meperidine (demerol) because it can lead to serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If the potency of morphine is 1, what are the relative potencies of meperidine, codeine, methadone, butorphanol, hydromorphone, nalbuphine, alfentanil, fentanyl, and sufentanil?

A

Most —> least potent:
sufentanyl
Fentanyl
Alfentanil
Hydromorphone
Morphine - codeine
meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Are opioids lipid soluble or water soluble?

A

high lipid soluble
rapidly cross BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which opioids are strong? medium?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The lipid solubility of opioids affects their…

A

onset and duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T/F
the lungs can serve as a reservoir of opioid drug molecules

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Opioids are classified on the basis of…

A

their synthesis
chemical structure
potency
receptor binding
effect at the opioid receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Natural opioid

A

morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Semisynthetic opioid

A

hydromorphone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Synthetic opioid

A

fentanyl
alfentanil
sufentanil
remifentanil
meperidine

piperidines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Drugs with high ___ solubility cross the BBB.

A

lipid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Properties affecting the passage of the drug into the brain across the blood-brain barrier

A

o Molecule size
o pKa : affects the degree of ionization of the molecule and depends on the plasma pH
o Protein binding: to albumin and a 1-acid glycoprotein
o Lipid solubility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The piperidines are (natural/semi-synth/synthetic).

A

synthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The piperidines

A
  • Lipophilic opioids that rapidly cross the BBB
    *shared backbone
  • Fentanyl
  • Sufentanil
  • Alfentanil
  • Remifentanil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Fentanyl

A

o x100 more potent than morphine
o Decrease CV responses to noxious stimulation from laryngoscopy, intubation, skin incision and surgical stress
o Lasts abt 10-20 min (dose dependent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sufentanil

A

o a thienyl derivate of fentanyl and about 10-times more potent than fentanyl
o 1000x potent > morphine
o its lipophilicity is two times greater than that of fentanyl
o long acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Remifentanil

A

o Is not metabolized in the liver and is 100 to 200x more potent than morphine
o methyl ester side chain that is metabolized by blood (within the erythrocyte) and tissue nonspecific esterase’s
o Rapid action & clearance (context sensitive half-life of 2-3 minutes)
o Extrahepatic clearance
o Usually infusion; decreases by 50% in as little as 40 seconds
o MAC (minimim alveo. [ ]) is reduced w a remifentanil infusion
o Very fast wake up!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which piperidine is not metabolized in the liver?

A

Remifentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F
Ketamine is a non-opioid that works on opioid receptors.

A

True
it works at NMDA (antagonist) & opioid receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Requirements for inhalational anesthetics and propofol are reduced by about 50% when administering ___ IV fentanyl

A

1.5 to 3 μg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

decreases cardiovascular responses to noxious stimulation

A

Fentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

thienyl derivate of fentanyl

A

Sufentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Longer duration
good for longer cases
bonds stronger than fentanyl

A

Sufentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Benefits of using opioids

A

less volatile anesthetic
faster wake up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Clearance of remifentanil is ____ L/min. Liver blood flow is ___ L/min. This affirms its ____ clearance.

A

3-5 L/min
2-3 L/min
extrahepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Remifentanil plasma levels decrease by 50% in…

A

40 seconds
give as infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MAC (minimum alveolar concentration) is reduced with ____ infusion.

A

remifentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Opioid-induced hyperalgesia (OIH)

A

-paradoxical opioid effect
-pain sensitivity increases during/after escalating opioid treatment
-postop if using remifentanil infusion

-treated/prevented: low dose of ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Treatment of Opioid-induced hyperalgesia (OIH)

A

Antagonism of the NMDA receptor
(low dose Ketamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

various mechanisms for OIH

A

-activation of the central glutaminergic system
-central nitric oxide production
-facilitation of descending pronociceptive systems.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Most piperidines are metabolized by…

A

CYP 450 enzyme system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

most rapidly acting opioid currently available

A

remifentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

T/F
Piperidine can anesthetize patients.

A

False
no amnesia
need other drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

contains a methyl ester side chain that is metabolized by blood & tissue nonspecific esterases

A

Remifentanil
not metabolized in liver

ReMi —> Methyl ester chain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

T/F
Emergence from remifentanil is longer than other opiods.

A

False
fast wake up

“Rapid remi”

37
Q

Heroin

A

AKA diamorphine

-boiling morphine with specific acids
-two −OH groups —> −OCOH3 = heroin

38
Q

Hydromorphone preparation

A

2mg/1 ml vials
mix with 9 cc of NS in a 10 cc syringe
(.2 mg/cc titrated to effect)

39
Q

Hydromorphone is mostly used in which settings?

A

intraop
PACU

40
Q

More frequently associated with nausea/vomiting

A

hydromorphone

41
Q

Which opioid has low lipophilicity?

A

morphine

42
Q

Morphine

A
  • Natural
  • Low lipophilicity (crosses the BBB slowly)
  • Rapid metabolism in the liver
  • Excreted via the kidney (renal dysfunction=accumulation)
  • Most often given in the PACU rather intraoperatively
43
Q

⭐️
How do opioids cause bradycardia?

A

-affect central and peripheral cardiac sites

Central:
-activate vagal nuclei
-depress brainstem vasomotor centers

Peripheral: (supraclinical doses)
-direct myocardial depression
-arterial and venous dilatation

-Morphine additional effects; release of histamine; mild at clinical doses; orthostatic hypotension, mild bradycardia, reduction of systemic & pulmonary resistance

44
Q

Opioid associated with histamine release

A

morphine (mild histamine release)

additional effects:
orthostatic hypotension
mild bradycardia
reduction of systemic & pulmonary resistance

45
Q

Meperidine in cardiac patients may cause

A

tachycardia

46
Q

Opioids can contract the sphincter of Oddi which causes…

A

-increases biliary pressure
can be reversed with either naloxone or
glucagon

47
Q

N/V from opioids is caused by…

A

-stimulates the CTZ-chemoreceptor trigger zone in the
postrema of the brainstem

-increased sensitivity of the vestibular apparatus

-direct effects on the GI tract

-PONV history

48
Q

Opioids during gallbladder surgery

A

not ideal
Contraction of the sphincter of Oddi (increases biliary
pressure)
wont see contrast in choliangiogram

49
Q

Opioids in sleep apnea pts

A

decrease central hypoxic drive to breathe & CO2 sensitivity

short acting, minimum dose

avoid

50
Q

Wooden Chest Syndrome

A

all opioids; esp fentanyl
concomitant use of dopamine altering meds
rapid IV administration

rigid chest
CANNOT VENTILATE

reverse Rx (full dose Narcan) or paralyze

51
Q

Naloxone

A

Narcan
reverse opioid toxicity

short acting 15-45 mins

displaces opioid from Mu receptors

52
Q

Naloxone duration of action

A

15-45 mins

often given as drip

53
Q

Naloxone dosing

A

Titrate (40 mcg at a time every 1-2 minutes until good
respirations/ventilation)

0.4 mg per vial, 1 vial Narcan diluted n 9 cc NS = 40
mcg/cc

(1 mg=1000mcg)

54
Q

Naloxone displaces opioids from ___ receptors. It can do this because…

A

Mu

stronger affinity for receptor than opioids
knocks opioid off receptor

55
Q

Side effects of Naloxone (reversing narcotics)

A

Pulmonary edema
Cardiac arrhythmias
Hypertension
Seizures
Cardiac Arrest
Sudden pain

56
Q

Why notify PACU if you give Narcan?

A

risk of being reintubated in PACU

“re-narcotization” is high with opioids with a longer plasma half-life because the rate of decay in the plasma of naloxone is short

57
Q

Which opioids are metabolized by the liver?

A

Fentanyl, alfentanil, and sufentanil

58
Q

High volume of distribution in lipophilic opioids with
low protein-binding affinity

A

fentanyl

59
Q

Moderate potency opioids

A

morphine
hydromorphone

60
Q

Low volume of distribution due to high clearance and/or high protein binding

A

Remifentanil

61
Q

Morphine is excreted via ____. Careful consideration in ____ patients.

A

kidneys
renal dysfxn (accumulation)

62
Q

How is morphine metabolized?

A

rapid
UGT2B7
liver

Within minutes after admin, hydrophilic metabolites are present in plasma.

60% converts to morphine-3-glucuronide (MG3)

5-10% to morphine-6-glucuronide (M6G)(active).

Slow limited crossover to BBB

63
Q

How remifentanil metabolized?
1/2 life?

A

rapidly metabolized by non-specific blood and tissue esterases. Half life is about 3-10 mins

64
Q

Peak analgesic effects for IV doses?

A

1-2 H

65
Q

Morphine is an agonist for which class of opioid receptors?

A

Full MOR agonist

66
Q

What are the most prominent CNS effects of opioids?

A

Analgesia
sedation
respiratory depression
hypotension
bradycardia

67
Q

What is the proposed site of action of neuraxial opioids?

A

The exact site of action of subarachnoid and epidural anesthesia remains unknown

68
Q

How do opioids affect the CO2 response curve?

A

Decrease in slope and shift to
the right

69
Q

Which morphine metabolite is active?

A

morphine -6-glucuronide

70
Q

How do opioids affect cerebral blood flow?

A

Reduce CBF, usually proportional to
the decrease in CMRO2. (brain blood flow is based on metabolic needs)

71
Q

What are the mechanisms of opioid-induced hypotension?

A

Depression of vasomotor centers in the brainstem, causing vasodilation

72
Q

Which opioid is cardiac depressant and increases heart rate?

A

Meperidine

73
Q

What are the effects of opioids on cerebral metabolic rate?

A

Decreased cerebral metabolic rate, reducing the brains consumption of oxygen.

74
Q

Which opioid is effective in treating shivering?

A

Meperidine (Demerol)

75
Q

Do opioids cross the placenta?

A

Yes; drugs with low molecular weight diffuse
freely

(Drugs that do not cross Heparin, Insulin, Glycopyrrolate, NDNMB, Succinylcholine)

76
Q

How do opioids affect the respiratory pattern?

A

Opioids decrease respiratory rate, and decrease tidal volume

77
Q

What is the mechanism of opioid-induced bradycardia?

A

Activation of the vagal nuclei in the brain stem

78
Q

The receptors where opioids demonstrate effects?

A

Opioid receptors on neuronal tissues (central and peripheral)
𝛍-opioid receptor (MOR) [mu-1 and mu-2]
𝛅-opioid receptor (DOR)
𝛋-opioid receptor (KOR)

79
Q

Weak opioids

A

codeine
tramadol

80
Q

intermediate strength opioids

A

morphine, methadone, oxycodone, and buprenorphine

81
Q

For anesthesia and pain relief, the ___ opioid receptor is most important.

A

MOR
(μ-opioid receptor )

82
Q

context-sensitive half-time (CSt½)

A

time needed for drug plasma concentration to decrease by 50% from a steady-state concentration

83
Q

For most opioids, context-sensitive half-time (CSt½) is dependent on ____ except for the drug ____.

A

duration of infusion

remifentanil is independent of infusion duration due to its rapid elimination from plasma

84
Q

delay between the administration of an opioid and its effect

A

blood–effect site equilibration half-life, or t½ke0

85
Q

When should morphine be given when used for post-op pain relief?

A

give initial bolus dose at least 60 minutes before the end of surgery

t½ke0 (delay between the administration of an opioid and its effect) of morphine is about 90 minutes

86
Q

How can we lower the probability of apnea when giving opioids?

A

careful, slow, infusion of opioids allows the gradual accumulation of arterial CO2, which serves as a respiratory stimulant at the chemoreceptors

87
Q

What kind of drug is nalaxone

A

opioid antagonist

88
Q

required dose of naloxone

A

depends on pharmacokinetic/dynamic properties & dose of the opioid that needs reversal

Gen Exam 1 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions