pain controlled continued, demerol and on Flashcards

(45 cards)

1
Q

what kind of drug is meperidine

A

synthetic opiod agonist at mu and kappa

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2
Q

what is the downfall of meperidine

A

has normeperidine as its metabolite

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3
Q

what does normeperidine cause

A

toxicity . cns, delirium. myoclonus. sz. hallucinations

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4
Q

whats the half life of demerol

A

3-5h.

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5
Q

is meperidine protein bound?

A

yes, highly. 60%

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6
Q

who is meperidine esp bad for

A

renal pt. >35h elimination half time.

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7
Q

cardiac effects of demerol

A

orthostatic htn, increased HR

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8
Q

what is meperidine good for

A

post op shivering

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9
Q

demerol w SSRI’s causes

A

serotonin syndrome.

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10
Q

what is the dose ceiling on opiates

A

there is none

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11
Q

what is methadones MOA

A

mu agonist with NMDA antagonism

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12
Q

metabolism of methadone

A

CYP

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13
Q

weird thing about methadone

A

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

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14
Q

methadone cardiac effects

A

QT prolongation - torsades - arrthymias.

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15
Q

why were opiod agonist-antagonists made

A

resp depression and OD’s

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16
Q

opiod agonist-antagonist MOA

A

bind to mu, also bind as antagonist

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17
Q

examples of agonist-antagonists

A

pentazocine, Buprenorphine

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18
Q

agonist-antagonists.. can you keep raising the dose

A

no they have a ceiling effect.

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19
Q

tolerance can occur without ___

20
Q

dependence cannot occur without ____

21
Q

opiod antagonists work as noncompetitive or competitive?

22
Q

how are opiod antagonists different?

A

change in structure - substitution of alkyl group

23
Q

examples of antagonists

A

naloxone, naltrexone, nalmefene

24
Q

where do antagonists act

A

mu, kappa, delta.

25
naloxone's half life?
short... 60-90 min.. may have to redose quicker if they took a lipophilic med like fent
26
naloxone MOA
nonselective competitive antagonist at all 3 opiod receptors
27
naloxone DOA
short, 30-45 min
28
neuraxial opioids
placement of opioids in epidural or subarachnoid space.
29
why do we use epi with neuraxial opiods
to reduce systemic absorption, less surface area for the lipophillic agents to cross over
30
the epidural space is
lipohpillic
31
neuraxial opioids can cause
viral reactivation
32
what effects movement in CSF
coughing or straining. NOT positioning
33
toradol works on
NSAID, cox 1&2
34
black box warning of toradol
dont use for more than 5 days
35
side effects of toradol
ARF, GI, CHF, platelet malfunction
36
tylenol onset
15min
37
tylenol Duration
4-6h
38
tylenol causes hepatotoxicity via
napqi
39
max dose of tylenol
3g
40
max dose of tylenol for liver disease
2g
41
tx for NSAID OD
supportive therapy, acetylcysteine (mucomyst) within 8h
42
how are we combatting tylenol OD
anything with >325mg was pulled from prescription
43
Tramadol (ultram) MOA
MU agonist, weak SNRI (serotonin-norepi uptake inhibitor
44
tramadol is contraindicated in
seizure disorder. will lower threshold
45
tramadol metabolism
CYP 3a4, no metabolite