Opioids Effects Flashcards
Opioid Clinical Uses (5)
Reduce pain and anxiety
Decreased somatic and autonomic responses (e.g., airway manipulation)
Improved hemodynamic stability
Less inhaled or infused anesthetic agent required
Postop analgesia
Opioid MOA
Opioids bind to Mu1, Mu2, Kappa, and delta receptors located in various supraspinal, spinal and peripheral areas to decrease neurotransmitter release and decreasing adenyl cyclase production and calcium influx of ascending and descending pain pathways
Opioid Supraspinal Receptor Activation Site (2)
Medulla
Midbrain to inhibit neurons in the pain pathway
Opioid Spinal Receptor Activation Site
Activation of presynaptic opioid receptors to decrease calcium influx and decreased release of neurotransmitters related to nociception
Opioid Peripheral Receptor Activation Site (5)
Gastrointestinal (GI)
Vasculature
Lung
Heart
Immune systems
Mu Receptor Effects (8)
Bradycardia
Respiratory Depression
Euphoria, sedation, mild hypothermia
Miosis
Inhibition of peristalsis, N/V
Urinary Retention
Pruritis
Physical Dependence
Kappa Receptor Effects (6)
Possible Respiratory Depression
Sedation, Dysphoria
Miosis
Diuresis (inhibition of vasopressin release)
Low abuse potential
Antishivering
Delta Receptor Effects (4)
Respiratory Depression
Urinary Retention
Pruritis
Physical Dependence
Opioid Respiratory Effects (5)
Cough suppressant (however a rapid bolus can cause a cough)
Depress upper and lower respiratory track reflexes
Decrease ventilatory response to hypercapnia and hypoxia
Onset of apnea occurs before unconsciousness
Potential for skeletal muscle rigidity
Opioid CV Effects (3)
Relatively hemodynamically stable - no effect on myocardial contractility, baroreceptors, autonomic responsiveness
Bradycardia resulting from medullary vagal stimulation with little effect on BP in healthy patients
Dose dependent vasodilation
Histamine induced hypotension
Opioids Causing Histamine Release
morphine, meperidine
Opioids that DO NOT cause Histamine Release
fentanyl, sufentanil, alfentanil, remifentanil
Way to Mediate Histamine Release Effects
H1 and H2 antagonists administered together block CV vasodilation, tachycardia and hypotension
Opioid GI Effects (3)
Decrease gastric and intestinal motility (constipation, ileus)
Prolong gastric emptying time
Reduce GI track secretory activity
Opioid Endocrine Effects (4)
Reduced stress response (immunosuppressive)
Inhibition of hormones (ex corticotropin) from the pituitary gland (HPA axis)
Decreased BMR and temperature by resetting hypothalamus temperature regulation
Inhibition of vasopressin release
