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Anesthesia Pharmacology > Opioids and Reversals > Flashcards

Opioids and Reversals Flashcards

1
Q

what is sublimaze

A

fentanyl

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2
Q

fentanyl

class/ category

A

Opioid agonist, synthetic (phenylpiperadine)

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3
Q

fentanyl

uses

A
  • Analgesia,
  • adjunct for general anesthesia,
  • MAC
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4
Q

fentanyl

MOA

A

Opioid μ receptor agonist

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5
Q

fentanyl

dose (induction, balanced),

A

2-6 mcg/kg IV LBW

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6
Q

fentanyl

Bolus (analgesia)

A

1-2 mcg/kg IV LBW

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7
Q

fentanyl

Infustion (maintenance)

A

0.5-5 mcg/kg/hr LBW (associated with accumulation of drug)

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8
Q

Fentanyl

Onest, Peak, Duration

A

Onset: 30-60 sec

Peak: 3-4 min

Duration: 30-60 min

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9
Q

fentanyl

Metabolism, elimination, excretion

A

Metabolism: Hepatic

Elimination: Pulmonary (75%), Hepatic

Excretion: Renal

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10
Q

fentanyl

protein binding, VD, pKa

A

Protein binding: 84%

VD: 4 L/kg

pKa: 8.4

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11
Q

Fentanyl, remifentanil, Alfentanil, hydromorphone

CV effects

A
  • ↓ HR, ↓ BP
  • Orthostatic hypotension, syncope
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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
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13
Q

fentanyl

CNS effects

6

A
  • ↓/↔ CBF, ↓/↔ CMRO2 ↓ ICP (if ventilation normal)
  • ↓/↔ CPP
  • Miosis
  • Euphoria
  • Sedation
  • Dystonic reaction (with rapid administration)
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14
Q

Fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine

GI effects

A
  • N/V
  • Constipation
  • Biliary spasm
  • Delayed gastric emptying
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15
Q

T/F fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine can cause urinary retention and decrease in body temperature

A

TRUE!

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16
Q

Can fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine cause myoclonus?

A

Yes!

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17
Q

fentanyl, remifentanil, sufentanil, Alfentanil, hydromorphone, morphine can cause ‘x’ especially where?

A

Pruritus, especially around the nose

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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

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19
Q

What does Fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine do to MAC requirements?

A

Synergistically reduces MAC requirements

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20
Q

Fentanyl, remifentanil is how many more times potent than morphine?

A

100x more potent than Morphine

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21
Q

T/F fentanyl has a cross-reaction with morphine allergy

A

FALSE! No cross-reaction with Morphine allergy

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22
Q

do fentanyl, remifentanil, sufentanil, alfentanil, hydromorphone, morphine have additive potential?

A

YES

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23
Q

fentanyl can trigger what syndrome?

A
  • May trigger serotonin syndrome
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24
Q

what is Ultiva

A

Remifentanil

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25
Q

remifentanil

class

A

Opioid agonist, synthetic (phenylpiperadine)

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26
Q

remifentanil

uses

A
  • Analgesia
  • adjunct for general anesthesia
  • MAC
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27
Q

remifentanil

MOA

A

Opioid μ receptor agonist

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28
Q

remifentanil

bolus (induction, balanced)

A

0.5-1 mcg/kg IV LBW, administered slowly, over 1-2 min

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29
Q

remifentanil

Bolus (analgesia)

A

0.25-1 mcg/kg IV LBW, administered slowly, over 1-2 min

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30
Q

remifentanil

Infustion (maintenance)

A

0.1-1 mcg/kg/min IV, may extend up to 2 mcg/kg/min LBW

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31
Q

remifentanil

onset, peak, duration

A

Onset: 30-60 sec

Peak: 1 min

Duration: 5-10 min

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32
Q

remifentanil

metabolism, protein binding

A

Metabolism: Nonspecific plasma and tissue esterases

Protein binding: 93%

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33
Q

remifentanil

VD, pKa

A

VD: 0.39 L/kg

pKa: 7.2

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34
Q

remifentanil, Sufentanil

CNS effects

A
  • ↓/↔ CBF, ↓/↔ CMRO2, ↓ ICP (if ventilation normal)
  • ↓ CPP
  • Miosis
  • Euphoria
  • Sedation
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35
Q

remifentanil is associated with opioid-induced ‘what’

A

Associated with opioid-induced hyperalgesia

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36
Q

prolonged administration of remifentanil can cause what?

A

Prolonged administration may result in tachyphylaxis

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37
Q

remifentanil has similar potency to which medication?

A

Potency similar to Fentanyl

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38
Q

what is sufenta

A

Sufentanil

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39
Q

Sufentanil

class

A

Opioid agonist, semi-synthetic (phenylpiperadine)

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40
Q

Sufentanil

use

A

Analgesia, adjunct for general anesthesia

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41
Q

Sufentanil

A

Opioid μ, κ, δ receptor agonist

42
Q

Sufentanil

Bolus (induction, balanced)

A

0.3 mcg/kg IV LBW

43
Q

Sufentanil

bolus (analgesia)

A

0.1-0.25 mcg/kg IV LBW

44
Q

Sufentanil

Infusion (maintenance)

A

0.5-1.5 mcg/kg/hr IV LBW

45
Q

Sufentanil

onset, peak, duration

A

Onset: 30-60 sec

Peak: 3-4 min

Duration: 30 min, Dose-dependent

46
Q

Sufentanil

Metabolsim, elimination, active metabolite

A

Metabolism: Hepatic

Elimination: Pulmonary (~60%) / Hepatic

Active metabolite: Desmethylsufentanil (10% of parent drug activity)

47
Q

Sufentanil

CV effects

A
  • ↓ HR (profound ↓ may lead to ↓ CO) , ↓ BP,
  • Orthostatic hypotension, syncope
47
Q

Sufentanil

protein binding, VD, pKa

A

Protein binding: 93%

VD: 2 L/kg

pKa: 8.0

48
Q

sufentanil

pulm effects

7

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
  • Antitussive
49
Q

Fentanyl, remifentanil, sufentanil can cause histamine release?

A
  • No histamine release
50
Q

sufentanil is how many more times potent than morphine

A

1,000x more potent than Morphine

51
Q

which medication is 10x more potent than fentanyl

A

sufentanil

52
Q

what is Alfenta

A

Alfentanil

53
Q

Alfentanil

class

A

Opioid agonist, synthetic

54
Q

Alfentanil

uses and MOA

A

Uses: Analgesia, adjunct for general anesthesia, MAC

Mechanism of Action: Opioid μ receptor agonist

55
Q

Alfentanil

Bolus (induction, balanced)

A

15-30 mcg/kg IV

56
Q

Alfentanil

Bolus (analgesia)

A

5-10 mcg/kg IV

57
Q

Alfentanil

Infusion (maintenance)

A

0.5-2 mcg/kg/min IV

58
Q

Alfentanil

Onset, Peak, Duration

A

Onset: 30-60 sec

Peak: 1-2 min

Duration: < 10 min

59
Q

Alfentanil

metabolism, elimination

A

Metabolism: Hepatic

Elimination: Hepatic, Renal

60
Q

Alfentanil

Protein binding, VD, pKA

A

Protein binding: 92%

VD: 0.6 L/kg

pKa: 6.5

61
Q

Alfentanil

CNS effects

A
  • ↓/↔ CBF, ↓/↔ CMRO2[4] ↓ ICP (if ventilation normal)
  • ↓ CPP
  • Miosis
  • Euphoria
  • Sedation
  • Dystonic reaction (with rapid administration)
62
Q

Alfentanil is how many more times potent than morphine

A

10x

63
Q

Alfentanil is 1/10th as potent as which medication?

A

1/10th as potent as Fentanyl

64
Q

what is dilaudid

A

Hydromorphone

65
Q

hydromorphone

class

A

Opioid agonist, semi-synthetic

66
Q

hydromorphone

uses

A

Analgesia, adjunct for general anesthesia

67
Q

Hydromorphone

MOA

A

Opioid μ, κ, δ receptor agonist

68
Q

Hydromorphone

Bolus

A

0.01-0.02 mg/kg IV

69
Q

Hydromorphone

onset, peak, duration

A

Onset: 5 min

Peak: 10-20 min

Duration: 4-5 hr

70
Q

hydromorphone

metabolism, elimination

A

Metabolism: Hepatic

Elimination: Renal

71
Q

hydromorphone, morphine

pulm effects

A
  • 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
Q

hydromorphone

CNS effects

A
  • ↓ CBF, possible ↓ ICP (if ventilation normal)
  • Miosis
  • Euphoria
  • Sedation
  • Agitation
73
Q

hydromorphone is how many more times potent than morphine

A

7x more potent than Morphine

74
Q

what is Duramorph or astromorph

A

morphine

75
Q

morphine

class/ category

A

Opioid agonist, natural (phenanthrene)

76
Q

Morphine

uses

A

Analgesia, adjunct for general anesthesia

77
Q

morphine

MOA

A

Opioid μ, κ, δ receptor agonist

78
Q

Morphine

dose

A

Bolus: 0.03-0.2 mg/kg IV TTE

79
Q

Morphine

onset, peak, duration

A

Onset: 15-30 min

Peak: 30-90 min

Duration: 4-5 hr, dose-dependent

80
Q

Morphine

metabolism, elimination

A

Metabolism: Hepatic and extrahepatic Renal

Elimination: Renal

81
Q

morphine

protein binding, VD, pKa

A

Protein binding: 35%

VD: 2.8 L/kg

pKa: 7.9

82
Q

morphine

active metabolites

2 and effects

A

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
Q

morphine

CV effects

A
  • ↓ HR, ↓ BP, positional changes can lead to ↓ CO, ↓ venous return
  • Orthostatic hypotension, syncope
84
Q

morphine

CNS

5

A
  • ↓/↔ CBF, ↓/↔ CMRO2 ↓ ICP (if ventilation normal)
  • ↑/↓ CPP
  • Miosis
  • Euphoria
  • Sedation
85
Q

does morphine cause histamine release

A

YES!

86
Q

morphine should be used cautionsly with patients with what condition

A

Use caution in patients with renal dysfunction

87
Q

what is Narcan

A

Naloxone

88
Q

Naloxone

class/ category

A

Opioid antagonist

89
Q

Naloxone

use

A

Reversal of opioid-induced respiratory depression

90
Q

Naloxone

MOA

A

Competitive antagonist at μ, κ, δ opioid receptors

91
Q

Naloxone

Bolus, infusion

A

Bolus: 1-4 mcg/kg/ IV; titrated in 40 mcg increments every 2 min

Infusion: 2-4 mg/hr

92
Q

Naloxone

onset, peak

A

Onset: 1-2 min

Peak: 5-15 min

93
Q

Naloxone

duration, metabolism

A

Duration: 30-45 min

Metabolism: Hepatic

94
Q

Naloxone

CV effects

A

SNS surge
* ↑ BP, ↑ HR
* Dysrhythmias
* Cardiac ischemia

95
Q

Naloxone

Pulm effects

A

Pulmonary edema

96
Q

Naloxone

GI effects

A

N/V with awakening

97
Q

Naloxone may precipitate what kind of symptoms

A

May precipitate withdrawal symptoms in opioid-dependent patients

98
Q

Naloxone may cause reversal of what?

A

May cause reversal of analgesia, dose-dependent

99
Q

When giving Naloxone, what do you monitor for, and what may you need to do?

A

Monitor for recrudescence – May require repeat doses or continuous infusion for sustained opioid antagonism

Anesthesia Pharmacology (6 decks)

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