Opioids

Question 1

Morphine dose (intraop), onset, peak, duration.

Answer 1

dose: 0.1 - 1 mg/kg IV
onset: 1 min
peak: 5 - 20 min
duration: 2 - 7 hours

Question 2

Meperidine dose - intraop

Answer 2

2.5 - 5 mg/kg IV

Question 3

Fentanyl dose (intraop), onset, peak, duration.

Answer 3

dose: 2 - 150 mcg/kg IV
onset: 30 sec
peak: 5 - 15 min
duration: 30 - 60 min

Question 4

Sufentanil dose, onset, peak, duration

Answer 4

dose: 0.25 - 30 mcg/kg IV
onset: 1 - 3 min
peak: 3 - 5 min
duration: 20 - 45 min

Question 5

Dilaudid dose, onset, peak, duration.

Answer 5

dose: 0.01 - 0.04 mg/kg IV

Question 6

Mepiridine:Morphine conversion

Answer 6

1:10 (x0.1)

Question 7

Dilaudid:Morphine conversion

Answer 7

10:1 (x10)

Question 8

Fentanyl:Morphine conversion

Answer 8

100:1 (x100)

Question 9

Sufentanil:Morphine conersion

Answer 9

1000:1 (x1000)

Question 10

Receptor for endorphins

Answer 10

Mu1 and Mu2

Question 11

Receptor for enkephalins

Answer 11

Delta

Question 12

Receptor for dynorphins

Answer 12

Kappa

Question 13

Opioids are unique in producing what, without loss of what?

Answer 13

produce analgesia without loss of touch, proprioception, or consciousness

Question 14

Are opioids agonists or antagonists?

Answer 14

agonists at opioid receptor sites in the CNS (brainstem and spinal cord) and outside the CNS in peripheral tissues

Question 15

What are the principal effects of opioid receptor activation?

Answer 15

a decrease in neurotransmission

intracellularly - increased K conductance [leads to hyperpolarization], calcium channel inactivation, or both

Question 16

What is produced by activation of mu1 receptors?

Answer 16

analgesia, bradycardia, hypothermia, urinary retention

Question 17

What is produced by activation of mu2 receptors?

Answer 17

hypoventilation, bradycardia, constipation, and physical dependence

Question 18

What is produced by activation of kappa receptors?

Answer 18

analgesia, dysphoria, sedation, diuresis, and miosis

Question 19

What is produced by activation of the delta receptors?

Answer 19

analgesia, respiratory depression, physical dependence, constipation, and urinary retention

Question 20

How is remifentanil different from other narcotics?

Answer 20

metabolized by plasma esterases, thus resulting in a context-sensitive half-time that is independent of the duration of its infusion.

Question 21

What is the mechanism of action of ketorolac?

Answer 21

inhibits prostaglandin synthesis by decreasing cyclooxygenase activity

Question 22

Ketorolac dose, onset, peak, duration.

Answer 22

dose: 30 mg IV
onset: 10 min
peak: 2 - 3 hours
duration: 6 - 8 hours

Question 23

Ketorolac metabolism?

Answer 23

hepatic (CYP450)

Question 24

Ketorolac elimination?

Answer 24

in the urine

Question 25

Alfentanil dose - intraop

Answer 25

8 - 100 mcg/kg IV (loading dose)

0.5 - 3 mcg/kg/min (maintenance)

Question 26

Remifentanil dose - intraop

Answer 26

1 mcg/kg IV (loading dose)

0.5 - 3 mcg/kg/min (maintenance)