Opioids

Question 1

Pain Impulse

Answer 1

Originates in tissues and nociceptors recognize/produce pain. Response is to release chemicals, send signal up spinal cord into brain. Thalamus is relay center that sends info to all different parts of the brain.
Response sends signal from brain, down spinal tracts, to periphery in order to respond

Question 2

Mu-opioid receptor

Answer 2

B endorphin, met and leu enkephalins

Analgesia
Euphoria/sedation
Physical dependence
Resp. Depression
Constipation
Miosis
Urinary retention
Bradycardia
Pruritus 
Skeletal muscle rigidity
Biliary spasm

Question 3

Delta opioid receptor

Answer 3

Met and leu enkephalins

Physical dependence
Analgesia
Resp. Depression
Constipation
Urinary retention

Question 4

Kappa opioid receptor

Answer 4

Dynorphins

Analgesia
Dysphoria
Low abuse potential
Miosis
Antishivering

Question 5

How Opioids Work

Answer 5

When you give morphine, attaches to opiate receptors and decreases amount of pain chemicals released from presynaptic neuron (just like endorphins). Less binding to post synaptic neuron

Question 6

Phenanthrenes

Answer 6

Morphine
Codeine
Hydrocodone
Oxycodone
Hydro or phone
Butorphanol
Nalbuphine

**histamine release!!! (And meperidine)

**cross allergy within class, not between

Question 7

Piperidine

Answer 7

Meperidine (histamine release)
Fentanyl
Sufentanyl
Alfentanyl
Remifentanyl

Question 8

Diphenylheptanes

Answer 8

Methadone

Question 9

When to dose highest amount of opioids

Answer 9

At the beginning of the case when intubating and during skin incision
Need less for closing

Question 10

CO2 response

Answer 10

Increased CO2/decreased response to CO2 d/t respiratory depression

Need higher amounts of CO2 to cause respiratory response

Question 11

Cause Muscle Rigidity

Answer 11

Fentanyl and derivatives

Thought to be caused by dose of narcotic and speed of administration

Treat with succ

Question 12

Miosis and Constipation

Answer 12

Never develop tolerance

Question 13

Used for Antishivering effect

Answer 13

Meperidine (k receptor)

Question 14

Biliary Pressure

Answer 14

Narcotics increase biliary pressure d/t vagal effect on sphincters.
Sphincter of Oddi is tightened (similar to urinary retention) causing bile/pressure build up and possible biliary colic

Question 15

Treatment of increased biliary pressure

Answer 15

Atropine or glyco
Nitro
Glucagon
Naloxone

Question 16

Opioid Antagonist

Answer 16

Naloxone (Narcan)

Question 17

Codeine after tonsillectomy

Answer 17

Found out codeine is metabolized to morphine and there are genetic differences in the metabolism speed (faster metabolizers such as kids have higher morphine levels and more respiratory depression)

Question 18

Opioid metabolism

Answer 18

In the liver, eliminated as conjugate (liver disease will prolong DOA)

Question 19

Remifentanyl metabolism

Answer 19

Non-specific esterase hydrolysis

Question 20

Meperidine toxicity

Answer 20

Metabolized to CNS toxic metabolite that can cause seizures (normeperedine)
Do not use>24 hours or for prolonged periods
Do not use in renal disease or the elderly

Question 21

Meperidine and MAOIs

Answer 21

Adverse interaction causing seizures and severe cardiac effects that can lead to death

Question 22

Codeine and Tramadol age limit

Answer 22

Contraindicated in kids<12

Question 23

Serotonin Syndromes

Answer 23

Can develop when pt on SSRIs and some phenylpiperidines