Pain Meds Flashcards
Fentanyl induction dose
0.5-1 mcg/kg
Fentanyl time to peak and duration
5 min
45 minutes
Fentanyl disadvantages
Rigid chest
Respiratory depression
Morphine disadvantages
Histamine release in some patients causing itch and hives
M-6G is more potent metabolite, renally cleared, dangerous respiratory depression
Morphine time to peak and duration
20 min, 4 hours
Hydromorphone (dilaudid) typical dose
0.01 mg/kg
Meperidine dose
12.5 mg, repeated once
Two effects that opioids have on electrolytes at the synapse
Decrease Ca entry presynaptic
Enhance K effluent post synaptic
Which opioids cause histamine release?
Meperidine>morphine
Most opioids cause bradycardia at which part of the brain?
Which opioid is an exception to this rule?
Central vagal nucleus
Meperidine, looks similar to atropine
How does methadone prolong the QT?
Voltage gated K channels in the myocardium
High dose opioid effect on EEG
Which lower the seizure threshold?
Slowing and delta wave
Fentanyl and meperidine
Opioids slightly reduce CBF
What are their considerations in the elderly?
Increased brain sensitivity
Decreased clearance and Vd
Renal insuff. To M6gluc
Stiff chest syndrome: which NTs?
Tx?
Dopamine, gaba
Typical after high potent IV doses
NMB or naloxone
Which have a local anesthetic effect?
Meperidine in the SAB
Hyperalgesia due to what?
What doesn’t develop tolerance?
Stimulation of the NMDA receptor causing more sensitivity to pain and tolerance
Constipation and miosis
Three effects on ventilation
Decrease RR
Decrease response to CO2
Increase apneic threshold ( paCO2)
Blunt hypoxia drive
Does NOT interfere with hypoxic pulmonary vasoconstriction
Name dilaudid active metabolite
Hydromorphone3gluc
Causes excitation cog dysfunction and myoclonus
Which opioids should you avoid with MAOI?
Meperidine and tramadol
Nalbuphine receptors
Mu antagonist
Kappa agonist
Naloxone complete antagonism causes
HTN tachycardia ventricular dysrythm
Plum edema from cathecholamine
