Opioids Lecture Pearls

Question 1

How does bradycardia occur with morphine

Answer 1

stimulates vagal nuclei in medulla, indirect depression of SA node

Question 2

synergism of opioids with which drugs causes myocardial effects?

Answer 2

benzodiazepines, nitrous oxide

Question 3

which two receptors are responsible for dose dependent depression of ventilation with opioids

Answer 3

mu and delta

Question 4

what is the significance of dextromethorphan

Answer 4

cough suppression without analgesia or respiratory depression

Question 5

Edinger Westphal

Answer 5

miosis due to action on ANS component of oculomotor nerve. can antagonize with atropine (but probably need to give narcan).

Question 6

which drug do we not give following chole surgery

Answer 6

morphine, can contract pancreatic ducts and mimic acute pancreatitis. better choices include dilaudid or fent

Question 7

how to reverse smooth muscle spasm r/t GI

Answer 7

glucagon 2mg

Question 8

which two SE will still be prevalent no matter how tolerant long term users become to opioids

Answer 8

pinpoint pupils and constipation

Question 9

which drug antagonizes constipation and decreased GI motility in opioid users

Answer 9

methylnaltrexone

Question 10

which receptors are responsible for nausea and vomiting in the medulla

Answer 10

serotonin type 3 (5HT3 hydroxytryptamine), dopamine type 2 receptors.

Question 11

histamine release sx

Answer 11

conjunctival erythema, pruritis

Question 12

cholinergic system is a _________ modulator of opioid analgesia

Answer 12

positive

Question 13

ventilatory effects of opioid analgesia can be exaggerated by other drugs:

Answer 13

amphetamines
phenothiazines
MOA's
tricyclics
benzodiazepines

Question 14

triad of OD:

Answer 14

miosis, hypoventilation, coma

Question 15

with which drugs will you see reflex coughing

Answer 15

fentanyl, sufentanil, alfentanil

Question 16

pharmacodynamic tolerance of opioids

Answer 16

receptor desensitization and down regulation, up regulation of cAMP. (2-3weeks, much quicker with more potent drugs)

Question 17

what does physical dependence of opioids look like

Answer 17

initial symptoms: yawning, diaphoresis, lacrimation. insomnia and restlessness common. cramps nausea, diarrhea peak 72h then decline next 7-10 days. during withdrawal, tolerance quickly lost.

Question 18

morphine produces

Answer 18

analgesia, euphoria, sedation, decreased concentration, nausea, body warmth, pruritus (nose), dry mouth, extremity heaviness

Question 19

analogues of meperidine

Answer 19

fentanyl, sufentanil, alfentanil, remifentanil

Question 20

in equal analgesic doses, meperidine produces these similar side effects in comparison to morphine

Answer 20

sedation, euphoria, nausea, vomiting, depression of ventilation

Question 21

fentanyl has a marked synergism with

Answer 21

propofol and versed

Question 22

what causes bradycardia in fentanyl

Answer 22

carotid sinus baroreceptor control

Question 23

which drugs are principally bound to A1 glycoproteins

Answer 23

alfenatnil, sufentanil

Question 24

avoid this drug in untreated parkinsons

Answer 24

alfent

Question 25

remifentanil benefits include

Answer 25

brief action
titratable
does not accumulate
rapid recovery

Question 26

clinical uses of remifentanil

Answer 26

cases requiring transient profound analgesic effect including retrobulbar block, direct laryngoscopy, tracheal intubation

Question 27

is remifentanil affected by pseudocholinesterase deficiency

Answer 27

no

Question 28

hydromorphone in comparison to morphine

Answer 28

5x more potent, slightly shorter duration of action, less hydrophilic (larger Vd), faster onset, more sedation, less euphoria, can cause agitation and myoclonus.

Question 29

how do tramadol and odansteron interfere

Answer 29

odansteron interferes with analgesic component via reuptake of 5 hydroxytryptamine (serotonin)

Question 30

dont give succinylcholine to

Answer 30

pediatric patients or those with a hx of malignant hyperthermia

Question 31

desirable properties for an induction agent include

Answer 31

1. rapid and smooth onset and recovery
2. analgesia
3. minimal cardiac and respiratory depression
4. antiemetic actions
5. bronchodilation
6. lack of toxicity or histamine release
7. advantageous pharmacokinetics and pharmaceutics