Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm exam 2 > Pharm exam II- opiods > Flashcards

Pharm exam II- opiods Flashcards

0
Q

What is the induction dose for Alfentanil?

A

50-300mcg/kg

think approx 150mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

What is the induction dose for Morphine?

A

1mg/kg (titrated to 1mg/kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the induction dose for Fentanyl?

A

5-40mcg/kg

Think approx 20mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the induction/loading dose for Remifentanil (Ultiva)?

A

0.5-1mcg/kg over 30 sec

Think approx 0.75mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the induction dose for Sufentanil?

A

2-10mcg/kg

Think approx 6mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the induction dose for Etomidate (Amidate)?

A

0.1-0.4mg/kg

Think approx 0.2mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the induction dose for Ketamine (Kerolar)?

A

1-2.5mg/kg

Think approx 1.75 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the induction dose for Propofol (Diprivan)?

A

2-2.5mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the induction dose for Methohexital (Brevital)?

A

1.5-2.5mg/kg

Think approx 2mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the induction dose for Thiopental (Pentothal)?

A

3-5mg/kg

Think approx 4 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the induction dose for Diazepam (Valium)?

A

0.3-0.5mg/kg

Think 0.4mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the analgesic dose for Ketamine (Kerolar)?

A

0.5-1mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the analgesia dose for Afentanil (Afental)?

A

250-500mcg
or
5-10mcg/kg

(Think 375mcg or 7mcg/kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the analgesia dose for Fentanyl?

A

0.7-2mcg/kg

Think 1mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the analgesia dose for Meperidine (Demerol)?

A

25-100mg

12.5-25 for post-op shivers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the analgesia dose for Acetaminophen (Tylenol) IV?

A

1000mg IV q6hr (give infusion over 15min)

650mg IV q4hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the analgesia dose for Morphine?

A

2-15mg

titrate in increments of 1-2mg doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the analgesia dose for Ketorlac (Toradol)?

A

15-30mg q6hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the analgesia dose for Hydromophone (Dilaudid)?

A

0.2-0.6mg IV (q2-3hrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the infusion dosing for Sufentanil?

A

0.1-0.5mcg/kg/min

Think approx 0.3mcg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What supplement bolus dose would you give for Sufentanil?

A

0.6mcg-4mcg/kg

Think 2mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the infusion dosing for Remifentanil (Ultiva)?

A

0.05 - 2mcg/kg (supplemented with prop, N2O, or Forane because such short acting)

(Think approx 1mcg/kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the infusion dosing for Propofol (Diprivan)?

A

20-75mcg/kg/min (titrate to response)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What dosage would you give for a Propofol bolus for sedation?

A

25-50mg
or
0.5 - 1mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the infusion dosing for Methohexital (Brevital)?

A

50-150mcg/kg/min

Think approx 100mcg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the TIVA dose for Propofol?

A

100-200 mcg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the TIVA dose for Fentanyl?

A

50-150mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the TIVA dose for Sufentanil?

A

10-30mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the induction dose for Midazolam (Versed)?

A

0.1-0.2mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the sedation dose for Midazolam (Versed)?

A

0.5 - 5mg (titrated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the infusion dosing for Midazolam (Versed)?

A

0.25 - 5mcg/kg/min

Think approx 2mcg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What dose of Versed would you give to stop a seizure?

A

2-5mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What Lorazepam (Ativan) dose would you give?

A

0.5 - 1mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is Clonidine when considering receptor type to cause its effects?

A

Alpha 2 agonist (presynaptic = neg feedback)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What effects can be seen with Clonidine?

A

Analgesia (useful to augment morphine and LA blocks)
Sedation (hyperpolarizes A2 receptor)
bradycardia
hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a N-methyl-D-aspartate receptor?

A

It is the receptor that glutamate binds to to cause excitatory pain response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does Ketamine cause it analgesic effects?

A
  • It is a noncompetitive antagonist at the NMDA receptor which blocks glutamate and pain transmission
  • Also interacts with mu, delta, and kappa opiod receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What type of surgical case should ketamine not be used during?

A

Neuro cases because it can cause increased cerebral blood flow, increased ICP, and increased CMR02, myoclonus, nystagmous, and seizure-like activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What can you pretreat a patient with to prevent some of the CNS/Delirium side effects of Ketamine?

A

Benzo’s such as versed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which cyclooxygenase enzyme would you want to block to prevent unwanted side effects found in many NSAIDs?

A

COX2 (ex- Celebrex is a COX2 inhibitor and will not cause decreased platelet aggregation, renal dysfunction, and GI ulcers whereas nonselective COX inhibitors will have these side effects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are some of the effects of NSAIDs?

A
  • Decreased pain receptor activation from prostaglandins
  • Reduced inflammation
  • Inhibition of platelet aggregation
  • Inhibition of prostaglandin formation causing reduced protection of GI tract and renal function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How does regional blockades or wound infiltration with local anesthetics prevent pain?

A

They inhibit transmission of nerve impulses by blocking sodium channels. (This slows the rate of depolarization so that threshold is not reached and action potentials are not propagated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What group of drugs can provide anti-inflammatory and analgesic properties to supplement anesthesia?

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the safest NSAID for pts with renal impairment?

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the max daily doses for adults and peds of Acetominophen?

A 
Adults = 4gm/day
Peds= 75mg/kg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What meds should you be cautious of when considering liver toxicity from Acetaminophen?

A

opiod-nonopioid compounds containing acetaminophen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Is Ibuprofen a selective or nonselective COX inhibitor?

A

nonselective (therefore unwanted side effects= bleeding, ulcers, kidney failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What type of NSAID is Ketorolac (Tordal)?

A

Nonselective COX inhibitor (will have unwanted side effects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

In comparison to morphine what does 30mg of Ketorolac equivalent to?

A

9mg morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What patient populations would you not want to use Ketorolac (NSAIDs)?

A
  • Asthmatics
  • Renal impairment
  • Post-op bleeding concerns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is recommended length of use for Ketorolac when considering renal impairment?

A

no longer than 5 days

51
Q

What type of NSAIDs can cause cardiac toxicity?

A

COX-2 selective agents

52
Q

Which two NSAIDS should not be taken together to prevent cardiac toxicity?

A

Aspirin and Ibuprophen

53
Q

How do opioid receptors cause analgesic effects?

A
  • agonists pre-synaptic (A2 neg feedback=decrease Ca++= decrease NT)
  • agonist post synaptic (inhibits membrane depolarization)
54
Q

What side effects are seen with opioid agonist activity (A2 neg feedback)?

A
  • Analgesia
  • Sedation
  • Miosis (pinpoint pupils)
  • Bradycardia
  • Resp depression
  • Euphoria/Dysphoria
55
Q

Where can opioid receptors be found?

A

Supraspinal=brain

Spinal= Spinal cord (dorsal horn)

56
Q

Supraspinal analgesia is mediated by which opioid receptors and which one one is most important?

A
  • All opioid receptors except Mu-2

- Mu-1 is most important in the brain

57
Q

Spinal analgesia is mediated by which opioid receptors and which one is most important?

A
  • All opioid receptors are found in the spinal cord

- Mu-2 is most important

58
Q

Which opioid receptor is more important in the periphery?

A

Delta receptors

59
Q

Which opioid receptor does not contribute to dependence?

A

Kappa

60
Q

What does neuraxial analgesia refer to?

A

Opiates given via Epidural or Spinal (intrathecal) methods

61
Q

Neuraxial analgesia from opioids have same potential side effects as any other route but which side affects seem to be increased?

A

Pruritis and urinary retention (> than when given IV route)

62
Q

Why are smaller doses used when a spinal (intrathecal) opiate is given compared to epidural dose?

A

Venous plexus in epidural space causes systemic absorption

63
Q

What CNS effects can be seen with morphine-like opioids?

A
  • Analgesia
  • Euphoria (when in pain)
  • dysphoria (when not in pain)
  • Sedation
  • Resp depression
  • **decreased stress response to surgical stimulation (incision)
  • **decreased MAC of volatile agents (ED50 of gas)
64
Q

What GI effects can be seen with morphine-like opioids?

A
  • Biliary tract-spasm of sphincter of odi
  • Delayed gastric emptying (constipation)
  • N&V
65
Q

What meds are used to treat biliary sphincter of Odi spasm?

A

Narcan

Glucagon 2mg

66
Q

What GU effects can be seen with morphine-like opioids?

A
  • Urinary retention (Antidiuretic effect)

- Increased detrussor muscle tone and sphincter tone

67
Q

What cutaneous effects can be seen with morphine-like opioids?

A
  • vessel dilation
  • localized histamine (non-allergic) release = decrease bp
  • Pruritis
  • Erythema
68
Q

Do morphine-like opioids cross the placenta/BBB?

A

Yes, morphine (most lipophobic opiod) less than Phenylpiperidines (more lipid soluble)

69
Q

What meds can be given for pruritis from opioids?

A

Nubain
Zofran
Prop 10mg

70
Q

How is morphine metabolized?

A

Conjugation in the liver

71
Q

How is morphine excreted?

A

Mainly Kidney

Biliary (7-10%)

72
Q

What is important to consider when thinking about morphine metabolism and patients with kidney failure?

A

Morphine has active metabolites (morphine-3-etheral sulfate, morphine-3-glucuronide, morphine-6-glucuronide) which can cause prolonged sedation in renal pts

73
Q

What is Codeine metabolized into?

A

Morphine

74
Q

Fentanyl is how much more potent than morphine?

A

100 x’s

75
Q

Which is more lipid soluble morphine or fentanyl?

A

Fentanyl

76
Q

What is fentanyl’s DOA compared to morphine?

A

Fentanyl is DOA is shorter

77
Q

What is Fentanyl’s elimination time compared to morphine?

A

It is longer due to fentanyl’s large Vd and lipid solubility.

78
Q

Why does fentanyl have a rapid onset?

A

Rapid passage of BBB due to highly lipid soluble

79
Q

Which med is more protein bound and has a smaller Vd because of it? Fentanyl or Sufentanil

A 
Sufentanil = 92% protein bound small Vd
Fentanyl= 80-87% protein bound larger Vd than sufentanil
80
Q

What is important to consider when thinking about fentanyl metabolism?

A
  • metabolized in liver by D-methylation into somewhat active metabolite norfentanyl
  • Significant first pass pulmonary effect
81
Q

Fentanyl is excreted by kidneys and can be found present in urine for how long?

A

72 hrs.

82
Q

What causes bradycardia that is sometimes seen with fentanyl?

A

marked depression of carotid sinus reflex

83
Q

What are some important side effects to consider when thinking about fentanyl?

A
  • Rigid chest
  • less histamine release than (morphine)
  • Slight increase in ICP
84
Q

What meds would you give to treat rigid chest?

A

NDMR (give slow)

85
Q

How much more potent is Sufentanil compared to Fentanyl?

A

10 x’s

86
Q

What side effects are commonly seen in Sufentanil?

A

Basically same as fentanyl:

-Brady, increased ICP, respiratory depression, rigid chest, decreased cmrO2

87
Q

What opioids have first pass pulmonary uptake?

A

Fentanyl

Sufentanil

88
Q

Fentanyl is approximately how much more potent than Alfentanil?

A

10 x’s

89
Q

How is Alfentanil’s context sensitive half time different than Sufentanil’s and why?

A

It is longer due to its smaller Vd and less redistribution out of plasma

90
Q

Alfentanil is more likely to cause what side effect in comparison to other phenylpiperdines?

A

Rigid chest

91
Q

What types of surgical cases is Remifentanil commonly used?

A

Neuro cases (Dr’s like to see pt awake shortly after surgery)

92
Q

What is unique about Remifentanil?

A

It is ultra short acting due to its ester linkage which allows for hydrolysis by plasma/tissue

93
Q

When comparing Remifentanil to Alfentanil and fentanyl what is its potency?

A

Remifentanil is about 15-20 x’s more potent than Alfentanil and about the same potency as fentanyl

94
Q

Since Remifentanil is hydrolyzed in the plasma so rapidly what characteristics does it have?

A
  • Small Vd
  • Easily titratable
  • no cumulative effects
  • rapid clearance
  • Rapid recovery
  • context sensitive half time approx 5 mins
95
Q

Are the effects of Remifentanil affected by kidney and liver failure?

A

No, it is mainly metabolized via hydrolysis to an inactive metabolite and excreted by kidney

96
Q

What should be considered postoperatively when Remifentanil is stopped?

A

Need to follow with longer acting analgesic because it does not provide post-op relief of pain

97
Q

Why is Remifentanil not recommended as sole agent for surgery?

A

Uncertain loss of consciousness so usually supplemented with propofol, N2O, or forane.

99
Q

Is Remifentanil used via neuraxial routes?

A

no, due to neurotoxicty caused

100
Q

Meperidine (Demerol) is a synthetic opiate active mainly at which opioid receptors?

A

Mu and Kappa

101
Q

What is the potency of Demerol compared to morphine**?

A

1/10th

102
Q

What is important to consider about dosing when giving Demerol**?

A
  • Should not be used >48hrs

- Max dose is 600mg/24hrs

103
Q

How is Meperidine metabolized?

A

It is extensively metabolized in the liver

104
Q

Demerol’s active metabolite normeperidine can cause what side effects?

A

CNS effects such as seizures by decreasing threshold

105
Q

What other group of meds should not be given with Meperidine?

A

MAO inhibitors (can cause seizures and death)

106
Q

What other side effects can be seen with Demerol?

A

Hyperpyrexia and dysphoria

107
Q

What is Meperidine commonly used for?

A

Post-op shivers and L&D

108
Q

How does Naloxone (Narcan) produce its effects at receptors?

A

It is a pure opioid antagonist at mu, delta, and kappa

109
Q

How can Narcan be used with patients experiencing shock?

A

May reverse hypotension form endogenous endorphins

110
Q

Where is Narcan metabolized

A

In the liver

111
Q

Why is Narcan usually giving IV route?

A

First pass effect orally causes it to be 1/5th as potent

112
Q

What effects/side effects can be seen with Naloxone (Narcan)

A
  • Recurrence of pain
  • N&V from rapid infusion
  • Pulmonary edema
  • Re-narcotization after med wears off
113
Q

Narcan is supplied in 0.4mg/ml how would you draw it up to get 0.1mg/ml solution?

A

Draw up the 1ml of 0.4 solution with 3ml of NS

114
Q

What is the oral opiate antagonist that lasts 24hrs?

A

Naltrexone

115
Q

How is Nalmefene different than Narcan?

A

Its half time is 10hrs so its duration of action is longer due to slower metabolism by liver

116
Q

What is Dilaudid mostly used for?

A

Post-op pain

117
Q

What drug is better for renal patients Dilaudid or Morphine?

A

Dilaudid

118
Q

What is a sedative?

A

Reduces anxiety, has calming effect with little or no effect on motor or mental function

119
Q

What is a hypnotic?

A

Produces drowsiness, encourages the onset and maintenance of sleep

120
Q

Opioid receptors are what type of receptor?

A

G-protein coupled receptor (intermediary in cell communication)

121
Q

Extracellular binding of opioid to G-protein coupled receptor will cause what intracellularly?

A

Inhibition of adenyl cyclase

122
Q

Which opioid receptor subsets add to dependence when activated?

A

Mu-2 & Delta

123
Q

Is Remifentanil’s duration affected when a person has a psuedocholinesterase deficiency (abnormality may be sensitive to certain anesthetic drugs such as muscle relaxants and ester local anesthetics)

A

No

124
Q

What are some excitatory NT’s (EPSP)?

A
  • Acetylcholine
  • NE at Alpha1 and Beta 1 (IPSP at Alpha 2)
  • Serotonin (IPSP also at different sites)
  • Glutamate
125
Q

What NT’s are inhibitory (IPSP)?

A
  • Dopamine
  • NE at Alpha 2 only
  • Serotonin (in some receptors)
  • GABA
  • Nitric Oxide (?)

Pharm exam 2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions