Opioids Flashcards by Gian Roman

What is a unique structural characteristic for meperidine?

Atropine-like structure
Has antispasmodic/tachycardic properties

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What is meperidine metabolized to?

Normeperidine

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What are some issues with meperidine’s metabolite?

Normeperidine:
-Lowers the seizure threshold & induces CNS excitability.
-Has a prolonged half life (15hrs)

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Meperidine should be used cautiously in which patient population?

Renal failure, elderly & cancer patients

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Meperidine has severe drug-drug interactions with:

MAOI’s

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Meperidine doses for Sedation/Analgesia in adults/peds:

Adults: 50-150mg q3-4h
Peds: 0.5-2mg/kg

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Meperidine dose for postop shivering:

12.5-25 mg IV

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What receptor(s) does meperidine act on?

Mu, Kappa & Alpha-2

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What is the most widely used opioid analgesic?

Fentanyl

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Describe the duration of action for a single dose of fentanyl

FAST! [20-40 mins] & terminated by redistribution

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Fentanyl & its derivatives undergo a unique type of metabolism…

Significant first pass uptake in the lungs with temporary accumulation before its release

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What are the routes of administration for Fentanyl?

IV, Intrathecal, epidural, transdermal

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What is the bolus dose of Fentanyl for intubation?

1-3 mcg/kg

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What is the loading dose of Fentanyl for sedation/analgesia?

0.5 mcg/kg

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What is the maintenance dose range of Fentanyl for sedation/analgesia?

0.01-0.04 mcg/kg/hr

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What is the post-operative dose range of Fentanyl?

0.5-1.5 mcg/kg

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What is the epidural dose of Fentanyl?

10-100 mcg (2-10 mcg/mL if mixed with LA)

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What is the PCA dose range for Fentanyl?

10-20 mcg q6-20 min

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What is the bolus dose of Fentanyl as a GA adjunct?

2-20 mcg/kg (high dose: 20-50 mcg/kg)

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What is the maintenance infusion dose range of Fentanyl as a GA adjunct?

2-10mcg/kg/hr

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What is the maximum dose of Fentanyl when used as the sole GA agent in cardiac surgery?

up to 150 mcg/kg

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Fentanyl’s context sensitive half time is:

Relatively long

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Elimination of fentanyl is prolonged in:

Neonates and elderly

Fentanyl’s clearance is dependent on:

hepatic blood flow

What are the routes of administration for morphine?

IM, IV, SC, PO, Intrathecal, Epidural

What is the dosage range of morphine for sedation/analgesia in adults via IV/IM/SC?

2-20 mg [q2-4hrs]

What is the pediatric dose of morphine for sedation/analgesia via IV/IM/SC?

0.1 mg/kg

What is the intrathecal dose of morphine for adults?

0.1-0.5 mg

What is the bolus dose of morphine for epidural administration?

2-6 mg [q8-24h]

What is the infusion dose of morphine for epidural administration?

0.2-1 mg/hr

What is the maximum pediatric dose of morphine for epidural administration?

0.1 mg/kg or 5 mg/24hrs

What is the intrathecal pediatric dose of morphine?

Pediatric dose is 0.01 mg/kg.

What is morphine's active metabolite & what are some of the problems associated with it?

MG6 prolonged & increased effects especially in elderly & renal patients

Morphine causes an effect on tissue mast cells:

Histamine release which can cause decreases in SVR, hypotension & tachycardia

What receptors does morphine act on?

Mu, Kappa, Delta

Morphine is better at treating this type of pain:

Continuous dull visceral pain

What type of drug is Hydromorphone?

Semisynthetic | derived from morphine

What are the routes of administration for Hydromorphone?

IV, PO, Rectally

What is the adult [analgesic] dose range for Hydromorphone?

0.4 - 2 mg

What is the pediatric [analgesic] dose range for Hydromorphone?

0.005 - 0.02 mg/kg (5 mcg - 20 mcg)

True or False: Hydromorphone is suitable for patients with renal failure.

True

What receptors does Remifentanil act on?

Mu receptors

What is the onset and duration of Remifentanil?

Rapid & ultra-short

What is the half-life of Remifentanil?

8-20 mins (probably 8) ## Footnote The short half-life contributes to its rapid recovery profile.

How is Remifentanil metabolized?

Easily and rapidly metabolized by blood and tissue esterases ## Footnote This metabolism pathway is significant for its rapid elimination from the body.

What can a bolus of Remifentanil lead to?

Significant bradycardia

What risks are associated with Remifentanil?

Hyperalgesia, chest rigidity with bolus ## Footnote Chest rigidity may necessitate paralysis and intubation for airway management.

For what type of pain is Remifentanil considered good?

Sharp pain versus dull

What is the induction dose of Remifentanil?

1-3 mcg/kg over 1 min ## Footnote This dosing is critical for achieving effective anesthesia induction.

What is the loading dose for Remifentanil as a GA adjunct?

0.5-2 mcg/kg

What is the recommended bolus dose for Remifentanil?

0.5-1 mcg/kg

What is the maintenance dose range for Remifentanil?

0.05-2 mcg/kg/min

What is the loading dose for sedation using Remifentanil?

0.5-1 mcg/kg over 30-60 seconds

What is the maintenance dose for sedation with Remifentanil?

0.025-0.2 mcg/kg/min