pharm 5

Question 1

steps of experiencing pain

Answer 1

transduction, transmission, modulation, perception

Question 2

what is transduction

Answer 2

chemicals activate peripheral nerves, cause immune cells to release proinflam compounds

turn into an AP

Question 3

what nerve fibers transmit pain

Answer 3

a dela- fast pain (sharp and well localized)
c fibers- slow pain (dull and poor localized)

Question 4

what is pain moulation

Answer 4

modulated as it goes towards cerebral cortex

most important sitte: substantia gelatinosa in dorsal horn

Question 5

perception

Answer 5

processing of afferent signals in cerebral cortex and limbic system

Question 6

MOA of opioids

Answer 6

reduces adenylate cyclase and camp

Question 7

mu1, mu2, m3

Answer 7

mu1- analgesia, bradycardia, euphoria, low abuse, hypothermia
mu2- analgesia, bradycardia, constipation, dependence, resp depression
mu3- immune suppression

Question 8

kappa receptor

Answer 8

antishivering, diuresis, dysphonia, delerium, hallucination

Question 9

do opioids affect bp and contractility

Answer 9

minimally; hypotension seen with moprhine and meperidine are likely from histamine release

contracility is not affected

Question 10

when there is decreased vent respose which way oes co2 curve shift

Answer 10

right

Question 11

gi effects from opioids

Answer 11

biliary pressure: contraction of sphincter of oddi- increases biliary pressure

reversed by narcan of glucagon

gastric emptying prolonged

peristalsis slowed

Question 12

gu effects from opioids

Answer 12

mu and delta

urinary sphincter contraction (relaxation causes voiding)
detrusor relaxation (contraction causes voiding)

Question 13

what opioids have histamine release

Answer 13

morphine, meperidine, codeine

Question 14

what are the immunologic effects of opioids

Answer 14

inhibition of cellular and humoral immune function

suppression of natural killer cell function

Question 15

how do opioids affect thermoregulation

Answer 15

opioids reset hypothalmic temp set point

decrease core body temp

Question 16

IV opioids most to least potent

Answer 16

sufentanil > fentanyl = remi > alfentanil > hydromorphone > morphine > meperidine

Question 17

what opioids have an active metabolite

Answer 17

morphine and meperidine

Question 18

how are opioids metabolized

Answer 18

except for remi- all of the opioids undergo hepatic biotransformation

Question 19

morphines active metabolite

Answer 19

morphine-> m6p -> resp depression

Question 20

active metabolite of meperidine

Answer 20

normeperidine-> seizures

Question 21

what opioid has the fastest onset of action

Answer 21

alfentanil (b/c of its pka 6.5)

Question 22

what opioid has the largest vs smallest vd

Answer 22

largest- fentnayl
smallest- femi

Question 23

how do you calculate remi infusion (what weight)

Answer 23

LBW - b/c it does not distribute through body fat- metabolized too fast

Question 24

remi contains a __ linkage

Answer 24

ester

Question 25

even though remi is ___ it behaves as though it has a small vd

Answer 25

highly lipophilic

Question 26

what can help prevent the hyperalgesia from remi

Answer 26

ketamine or mag

Question 27

how does methadone reduce pain

Answer 27

mu agonist
nmda antagonist
inhibits monoamines in synaptic cleft

Question 28

what opioid is most likely to cause QT prolongation

Answer 28

methadone - can lead to torsades

Question 29

etiology of skeletal muscle rigidity with opioids

Answer 29

rapid IV administration- think chest wall and fentanyl

Question 30

tx of skeletal muscle rigidity from opioid

Answer 30

paraylsis and intubation

Question 31

naloxones duration

Answer 31

30-45 mins (might need to redose)

Question 32

does naloxone cross placenta

Answer 32

yes

Question 33

methylnatrexone

Answer 33

good for opioid induced bowel dysfunction- but doesnt pass blood brain barrier so wont help with resp depression