1
Q
what is sublimaze
A
fentanyl
2
Q
fentanyl
class/ category
A
Opioid agonist, synthetic (phenylpiperadine)
3
Q
fentanyl
uses
A
- Analgesia,
- adjunct for general anesthesia,
- MAC
4
Q
fentanyl
MOA
A
Opioid μ receptor agonist
5
Q
fentanyl
dose (induction, balanced),
A
2-6 mcg/kg IV LBW
6
Q
fentanyl
Bolus (analgesia)
A
1-2 mcg/kg IV LBW
7
Q
fentanyl
Infustion (maintenance)
A
0.5-5 mcg/kg/hr LBW (associated with accumulation of drug)
8
Q
Fentanyl
Onest, Peak, Duration
A
Onset: 30-60 sec
Peak: 3-4 min
Duration: 30-60 min
9
Q
fentanyl
Metabolism, elimination, excretion
A
Metabolism: Hepatic
Elimination: Pulmonary (75%), Hepatic
Excretion: Renal
10
Q
fentanyl
protein binding, VD, pKa
A
Protein binding: 84%
VD: 4 L/kg
pKa: 8.4
11
Q
Fentanyl, remifentanil, Alfentanil, hydromorphone
CV effects
A
- ↓ HR, ↓ BP
- Orthostatic hypotension, syncope
12
Q
Fentanyl, remifentanil, Alfentanil
Pulm Effects
6
A
- Skeletal muscle, “chest wall” rigidity with rapid administration of large doses – Treat with naloxone or neuromuscular blocker
- Typically ↓ RR, ↑ TV
- Ventilatory depression
- ↓ ventilatory response to CO2 → ↑ PaCO2 – Shifts CO2 response curve to the right
- Irregular breathing
- High doses may result in apnea
13
Q
fentanyl
CNS effects
6
A
- ↓/↔ CBF, ↓/↔ CMRO2 ↓ ICP (if ventilation normal)
- ↓/↔ CPP
- Miosis
- Euphoria
- Sedation
- Dystonic reaction (with rapid administration)
14
Q
Fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine
GI effects
A
- N/V
- Constipation
- Biliary spasm
- Delayed gastric emptying
15
Q
T/F fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine can cause urinary retention and decrease in body temperature
A
TRUE!
16
Q
Can fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine cause myoclonus?
A
Yes!
17
Q
fentanyl, remifentanil, sufentanil, Alfentanil, hydromorphone, morphine can cause ‘x’ especially where?
A
Pruritus, especially around the nose
18
Q
caution using fentayl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine with this injury, what could they cause?
A
Use caution with head injury – Effects on wakefulness, miosis, and ventilatory depression with ↑ PaCO2
19
Q
What does Fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine do to MAC requirements?
A
Synergistically reduces MAC requirements
20
Q
Fentanyl, remifentanil is how many more times potent than morphine?
A
100x more potent than Morphine
21
Q
T/F fentanyl has a cross-reaction with morphine allergy
A
FALSE! No cross-reaction with Morphine allergy
22
Q
do fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine have additive potential?
A
YES
23
Q
fentanyl can trigger what syndrome?
A
- May trigger serotonin syndrome
24
Q
what is Ultiva
A
Remifentanil
25
remifentanil
| class
Opioid agonist, synthetic (phenylpiperadine)
26
remifentanil
| uses
* Analgesia
* adjunct for general anesthesia
* MAC
27
remifentanil
| MOA
Opioid μ receptor agonist
28
remifentanil
| bolus (induction, balanced)
0.5-1 mcg/kg IV LBW, administered slowly, over 1-2 min
29
remifentanil
| Bolus (analgesia)
0.25-1 mcg/kg IV LBW, administered slowly, over 1-2 min
30
remifentanil
| Infustion (maintenance)
0.1-1 mcg/kg/min IV, may extend up to 2 mcg/kg/min LBW
31
remifentanil
| onset, peak, duration
Onset: 30-60 sec
Peak: 1 min
Duration: 5-10 min
32
remifentanil
| metabolism, protein binding
Metabolism: Nonspecific plasma and tissue esterases
Protein binding: 93%
33
remifentanil
| VD, pKa
VD: 0.39 L/kg
pKa: 7.2
34
remifentanil, Sufentanil
| CNS effects
* ↓/↔ CBF, ↓/↔ CMRO2, ↓ ICP (if ventilation normal)
* ↓ CPP
* Miosis
* Euphoria
* Sedation
35
remifentanil is associated with opioid-induced 'what'
Associated with opioid-induced hyperalgesia
36
prolonged administration of remifentanil can cause what?
Prolonged administration may result in tachyphylaxis
37
remifentanil has similar potency to which medication?
Potency similar to Fentanyl
38
what is sufenta
Sufentanil
39
Sufentanil
| class
Opioid agonist, semi-synthetic (phenylpiperadine)
40
Sufentanil
| use
Analgesia, adjunct for general anesthesia
41
Sufentanil
Opioid μ, κ, δ receptor agonist
42
Sufentanil
| Bolus (induction, balanced)
0.3 mcg/kg IV LBW
43
Sufentanil
| bolus (analgesia)
0.1-0.25 mcg/kg IV LBW
44
Sufentanil
| Infusion (maintenance)
0.5-1.5 mcg/kg/hr IV LBW
45
Sufentanil
| onset, peak, duration
Onset: 30-60 sec
Peak: 3-4 min
Duration: 30 min, Dose-dependent
46
Sufentanil
| Metabolsim, elimination, active metabolite
Metabolism: Hepatic
Elimination: Pulmonary (~60%) / Hepatic
Active metabolite: Desmethylsufentanil (10% of parent drug activity)
47
Sufentanil
| CV effects
* ↓ HR (profound ↓ may lead to ↓ CO) , ↓ BP,
* Orthostatic hypotension, syncope
47
Sufentanil
| protein binding, VD, pKa
Protein binding: 93%
VD: 2 L/kg
pKa: 8.0
48
sufentanil
| pulm effects
## Footnote
7
* Skeletal muscle, “chest wall” rigidity with rapid administration of large doses – Treat with naloxone or neuromuscular blocker
* Typically ↓ RR, ↑ TV
* Ventilatory depression
* ↓ ventilatory response to CO2 → ↑ PaCO2 – Shifts CO2 response curve to the right
* Irregular breathing
* High doses may result in apnea
* Antitussive
49
Fentanyl, remifentanil, sufentanil can cause histamine release?
* No histamine release
50
sufentanil is how many more times potent than morphine
1,000x more potent than Morphine
51
which medication is 10x more potent than fentanyl
sufentanil
52
what is Alfenta
Alfentanil
53
Alfentanil
| class
Opioid agonist, synthetic
54
Alfentanil
| uses and MOA
Uses: Analgesia, adjunct for general anesthesia, MAC
Mechanism of Action: Opioid μ receptor agonist
55
Alfentanil
| Bolus (induction, balanced)
15-30 mcg/kg IV
56
Alfentanil
| Bolus (analgesia)
5-10 mcg/kg IV
57
Alfentanil
| Infusion (maintenance)
0.5-2 mcg/kg/min IV
58
Alfentanil
| Onset, Peak, Duration
Onset: 30-60 sec
Peak: 1-2 min
Duration: < 10 min
59
Alfentanil
| metabolism, elimination
Metabolism: Hepatic
Elimination: Hepatic, Renal
60
Alfentanil
| Protein binding, VD, pKA
Protein binding: 92%
VD: 0.6 L/kg
pKa: 6.5
61
Alfentanil
| CNS effects
* ↓/↔ CBF, ↓/↔ CMRO2[4] ↓ ICP (if ventilation normal)
* ↓ CPP
* Miosis
* Euphoria
* Sedation
* Dystonic reaction (with rapid administration)
62
Alfentanil is how many more times potent than morphine
10x
63
Alfentanil is 1/10th as potent as which medication?
1/10th as potent as Fentanyl
64
what is dilaudid
Hydromorphone
65
hydromorphone
| class
Opioid agonist, semi-synthetic
66
hydromorphone
| uses
Analgesia, adjunct for general anesthesia
67
Hydromorphone
| MOA
Opioid μ, κ, δ receptor agonist
68
Hydromorphone
| Bolus
0.01-0.02 mg/kg IV
69
Hydromorphone
| onset, peak, duration
Onset: 5 min
Peak: 10-20 min
Duration: 4-5 hr
70
hydromorphone
| metabolism, elimination
Metabolism: Hepatic
Elimination: Renal
71
hydromorphone, morphine
| pulm effects
* Typically ↓ RR, ↑ TV
* Ventilatory depression
* ↓ ventilatory response to CO2→ ↑ PaCO2 – Shifts CO2 response curve to the right
* Irregular breathing
* High doses may result in apnea
72
hydromorphone
| CNS effects
* ↓ CBF, possible ↓ ICP (if ventilation normal)
* Miosis
* Euphoria
* Sedation
* Agitation
73
hydromorphone is how many more times potent than morphine
7x more potent than Morphine
74
what is Duramorph or astromorph
morphine
75
morphine
| class/ category
Opioid agonist, natural (phenanthrene)
76
Morphine
| uses
Analgesia, adjunct for general anesthesia
77
morphine
| MOA
Opioid μ, κ, δ receptor agonist
78
Morphine
| dose
Bolus: 0.03-0.2 mg/kg IV TTE
79
Morphine
| onset, peak, duration
Onset: 15-30 min
Peak: 30-90 min
Duration: 4-5 hr, dose-dependent
80
Morphine
| metabolism, elimination
Metabolism: Hepatic and extrahepatic Renal
Elimination: Renal
81
morphine
| protein binding, VD, pKa
Protein binding: 35%
VD: 2.8 L/kg
pKa: 7.9
82
morphine
| active metabolites
## Footnote
2 and effects
Morphine-3-glucuronide (~60%): no analgesic or antianalgesic action)
Morphine-6-glucuronide (5-10%): full mu agonist → analgesia and ventilatory depression
-Longer duration than Morphine itself
-Binds with comparable affinity, 650x more analgesic potency)
-May accumulate with renal dysfunction
83
morphine
| CV effects
* ↓ HR, ↓ BP, positional changes can lead to ↓ CO, ↓ venous return
* Orthostatic hypotension, syncope
84
morphine
| CNS
## Footnote
5
* ↓/↔ CBF, ↓/↔ CMRO2 ↓ ICP (if ventilation normal)
* ↑/↓ CPP
* Miosis
* Euphoria
* Sedation
85
does morphine cause histamine release
YES!
86
morphine should be used cautionsly with patients with what condition
Use caution in patients with renal dysfunction
87
what is Narcan
Naloxone
88
Naloxone
| class/ category
Opioid antagonist
89
Naloxone
| use
Reversal of opioid-induced respiratory depression
90
Naloxone
| MOA
Competitive antagonist at μ, κ, δ opioid receptors
91
Naloxone
| Bolus, infusion
Bolus: 1-4 mcg/kg/ IV; titrated in 40 mcg increments every 2 min
Infusion: 2-4 mg/hr
92
Naloxone
| onset, peak
Onset: 1-2 min
Peak: 5-15 min
93
Naloxone
| duration, metabolism
Duration: 30-45 min
Metabolism: Hepatic
94
Naloxone
| CV effects
**SNS surge**
* ↑ BP, ↑ HR
* Dysrhythmias
* Cardiac ischemia
95
Naloxone
| Pulm effects
Pulmonary edema
96
Naloxone
| GI effects
N/V with awakening
97
Naloxone may precipitate what kind of symptoms
May precipitate withdrawal symptoms in opioid-dependent patients
98
Naloxone may cause reversal of what?
May cause reversal of analgesia, dose-dependent
99
When giving Naloxone, what do you monitor for, and what may you need to do?
Monitor for recrudescence – May require repeat doses or continuous infusion for sustained opioid antagonism
