pain controlled continued, demerol and on

Question 1

what kind of drug is meperidine

Answer 1

synthetic opiod agonist at mu and kappa

Question 2

what is the downfall of meperidine

Answer 2

has normeperidine as its metabolite

Question 3

what does normeperidine cause

Answer 3

toxicity . cns, delirium. myoclonus. sz. hallucinations

Question 4

whats the half life of demerol

Answer 4

3-5h.

Question 5

is meperidine protein bound?

Answer 5

yes, highly. 60%

Question 6

who is meperidine esp bad for

Answer 6

renal pt. >35h elimination half time.

Question 7

cardiac effects of demerol

Answer 7

orthostatic htn, increased HR

Question 8

what is meperidine good for

Answer 8

post op shivering

Question 9

demerol w SSRI’s causes

Answer 9

serotonin syndrome.

Question 10

what is the dose ceiling on opiates

Answer 10

there is none

Question 11

what is methadones MOA

Answer 11

mu agonist with NMDA antagonism

Question 12

metabolism of methadone

Answer 12

CYP

Question 13

weird thing about methadone

Answer 13

variable half life so builds up easily 8-60hours. causes resp depression.

Question 14

methadone cardiac effects

Answer 14

QT prolongation - torsades - arrthymias.

Question 15

why were opiod agonist-antagonists made

Answer 15

resp depression and OD’s

Question 16

opiod agonist-antagonist MOA

Answer 16

bind to mu, also bind as antagonist

Question 17

examples of agonist-antagonists

Answer 17

pentazocine, Buprenorphine

Question 18

agonist-antagonists.. can you keep raising the dose

Answer 18

no they have a ceiling effect.

Question 19

tolerance can occur without ___

Answer 19

dependence

Question 20

dependence cannot occur without ____

Answer 20

tolerance

Question 21

opiod antagonists work as noncompetitive or competitive?

Answer 21

COMPETITIVE!

Question 22

how are opiod antagonists different?

Answer 22

change in structure - substitution of alkyl group

Question 23

examples of antagonists

Answer 23

naloxone, naltrexone, nalmefene

Question 24

where do antagonists act

Answer 24

mu, kappa, delta.

Question 25

naloxone’s half life?

Answer 25

short… 60-90 min.. may have to redose quicker if they took a lipophilic med like fent

Question 26

naloxone MOA

Answer 26

nonselective competitive antagonist at all 3 opiod receptors

Question 27

naloxone DOA

Answer 27

short, 30-45 min

Question 28

neuraxial opioids

Answer 28

placement of opioids in epidural or subarachnoid space.

Question 29

why do we use epi with neuraxial opiods

Answer 29

to reduce systemic absorption, less surface area for the lipophillic agents to cross over

Question 30

the epidural space is

Answer 30

lipohpillic

Question 31

neuraxial opioids can cause

Answer 31

viral reactivation

Question 32

what effects movement in CSF

Answer 32

coughing or straining. NOT positioning

Question 33

toradol works on

Answer 33

NSAID, cox 1&2

Question 34

black box warning of toradol

Answer 34

dont use for more than 5 days

Question 35

side effects of toradol

Answer 35

ARF, GI, CHF, platelet malfunction

Question 36

tylenol onset

Answer 36

15min

Question 37

tylenol Duration

Answer 37

4-6h

Question 38

tylenol causes hepatotoxicity via

Answer 38

napqi

Question 39

max dose of tylenol

Answer 39

3g

Question 40

max dose of tylenol for liver disease

Answer 40

2g

Question 41

tx for NSAID OD

Answer 41

supportive therapy, acetylcysteine (mucomyst) within 8h

Question 42

how are we combatting tylenol OD

Answer 42

anything with >325mg was pulled from prescription

Question 43

Tramadol (ultram) MOA

Answer 43

MU agonist, weak SNRI (serotonin-norepi uptake inhibitor

Question 44

tramadol is contraindicated in

Answer 44

seizure disorder. will lower threshold

Question 45

tramadol metabolism

Answer 45

CYP 3a4, no metabolite