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Top Shelf Drugs > Opioids > Flashcards

Opioids Flashcards

1
Q

Fentanyl induction dose, onset, peak, duration?

A

dose: 2 - 20 mcg/kg induction as adjunct to Volatile Anesthetic, 50 - 150 mcg/kg induction alone for cardiac surgery
onset: 30 seconds
peak: 5 - 15 minutes
duration: 30 - 60 minutes

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2
Q

Sufentanil induction dose, onset, peak, duration?

A

dose: 0.6 - 4 mcg/kg
onset: 1 - 3 minutes
peak: 3 - 5 minutes
duration: 20 - 45 minutes

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3
Q

Alfentanil induction dose, onset, peak, duration?

A

dose: 8 - 100 mcg/kg induction dose, 0.5 - 3 mcg/kg/min infusion dose
onset: 1 - 2 minutes
peak: 1 - 2 minutes
duration: 10 - 15 minutes

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4
Q

Meperidine dose - intraop

A

2.5 - 5 mg/kg IV

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5
Q

Meperidine dose, onset, peak, duration?

A

dose: 0.5 - 2 mg/kg
onset: 30 - 60 seconds
peak: 5 - 15 minutes
duration: 2 - 4 hours

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6
Q

Morphine induction dose, onset, peak, duration?

A

dose: 0.1 - 1 mg/kg
onset: 5 - 10 minutes
peak: 15 minutes
duration: 2 - 4 hours

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7
Q

Ketorlac IV dose, onset, peak, duration?

A

dose: 30 mg
onset: 10 minutes
peak: 1 - 2 hours
duration: 4 - 6 hours

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8
Q

Dilaudid dose, onset, peak, duration.

A

dose: 0.01 - 0.04 mg/kg IV

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9
Q

Morphine is metabolized primarily by what?

A

hepatic phase II conjugation

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10
Q

Does morphine cause a histamine release?

A

yes

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11
Q

Morphine, sufentanil, and fentanyl are agonists to which receptor? Causing what?

A

mu-opioid receptor

causes:
(1) an inhibition of adenylyl cyclase, leading to a decrease in calcium influx to cytoplasm and out from sarcoplasmic reticulum
(2) inhibition of conductance of presynaptic voltage-gated calcium channels
(3) opens inward rectifying potassium channels, hyperpolarizing post-synaptic neurons

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12
Q

Fentanyl:Morphine conversion

A

100:1 (x100)

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13
Q

Effects of morphine on the pulmonary and cardiac system.

A

Pulmonary - decreased cough reflex, bronchodilation (d/t histamine release), decreased ventilatory drive

Cardiac - decreased HR, decreased MAP (d/t histamine release), decreased CBF

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14
Q

Effects of sufentanil (Sufenta) on the pulmonary and cardiac system.

A

Pulmonary - respiratory depression (potentiated by volatile anesthetic agents), may cause “tight-chest”

Cardiac - hemodynamically stable

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15
Q

How is sufentanil (Sufenta) metabolized?

A

hepatic elimination

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16
Q

Effects of fentanyl (Sublimaze) on the pulmonary and cardiac system.

A

Pulmonary - blunts broncho-constrictive response to stimulation, possible “tight-chest”, decreased ventilatory drive, no broncho-dilation

Cardiac - vagally mediated decreases in HR, venodilation, decrease in CV sympathetic reflexes, decreased MAP and CBF

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17
Q

Receptor for dynorphins

A

Kappa

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18
Q

How is fentanyl (Sublimaze) metabolized?

A

hepatic and pulmonary elimination

19
Q

What is ketorolac’s mechanism of action?

A

inhibition of cyclooxygenase, leading to decreased prostaglandin synthesis

20
Q

How is ketorolac (Toradol) metabolized and eliminated?

A

hepatic metabolism

renal elimination

21
Q

What are the principal effects of opioid receptor activation?

A

a decrease in neurotransmission(intracellularly - increased K conductance [leads to hyperpolarization], calcium channel inactivation, or both)

22
Q

Contraindications to using ketorolac (Toradol).

A
  • may prolong bleeding time (ie. ulcers)
  • parturients (decreases uterine contractility and fetal circulation)
  • CVA
  • asthma (may cause bronchospasm)
  • CHF
  • advanced renal impairment (inhibiting the release of vasoactive substances in CHF and renal failure may cause renal arteriolar constriction)
  • interferes with osteoblasts (not good for ortho surgeries)
23
Q

How is meperidine (Demerol) metabolized, what is the name of its metabolite, and what can that metabolite cause? How is meperidine excreted?

A
  • hepatic
  • normeperidine
  • lowering of seizure threshold
  • excreted through the urine
24
Q

Contraindications to using meperidine (Demerol).

A
  • seizures
  • MAOI
  • incompatible with barbiturates
  • crosses placenta
25
Q

What is produced by activation of kappa receptors?

A

analgesia, dysphoria, sedation, diuresis, and miosis

26
Q

Contraindications to using meperidine (Demerol).

A
  • seizures
  • MAOI
  • incompatible with barbiturates
  • crosses placenta
27
Q

How is alfentanil (Alfental) eliminated?

A

renal

28
Q

Dilaudid:Morphine conversion

A

10:1 (x10)

29
Q

Ketorolac dose, onset, peak, duration.

A

dose: 30 mg IVonset: 10 minpeak: 2 - 3 hoursduration: 6 - 8 hours

30
Q

Mepiridine:Morphine conversion

A

1:10 (x0.1)

31
Q

Alfentanil dose - intraop

A

8 - 100 mcg/kg IV (loading dose)0.5 - 3 mcg/kg/min (maintenance)

32
Q

Sufentanil:Morphine conversion

A

1000:1 (x1000)

33
Q

Receptor for endorphins

A

Mu1 and Mu2

34
Q

Receptor for enkephalins

A

Delta

35
Q

Opioids are unique in producing what, without loss of what?

A

produce analgesia without loss of touch, proprioception, or consciousness

36
Q

Are opioids agonists or antagonists?

A

agonists at opioid receptor sites in the CNS (brainstem and spinal cord) and outside the CNS in peripheral tissues

37
Q

What is produced by activation of mu1 receptors?

A

analgesia, bradycardia, hypothermia, urinary retention

38
Q

What is produced by activation of mu2 receptors?

A

hypoventilation, bradycardia, constipation, and physical dependence

39
Q

What is produced by activation of the delta receptors?

A

analgesia, respiratory depression, physical dependence, constipation, and urinary retention

40
Q

How is remifentanil different from other narcotics?

A

metabolized by plasma esterases, thus resulting in a context-sensitive half-time that is independent of the duration of its infusion.

41
Q

Naloxone (Narcan) dose, onset, peak, duration?

A

dose: 0.4 - 2 mg titrate to effect
onset: 1 - 2 minutes
peak: 5 - 15 minutes
duration: 1 - 2 hours

42
Q

Naloxone (Narcan) mechanism of action.

A
  • non-selective opioid antagonist that displaces opioids from mu receptors
  • has a high receptor affinity.
  • prevents receptor activity
43
Q

How is narcan metabolized and eliminated?

A

hepatic metabolism

renal elimination

44
Q

Can narcan be used for patients in a shock state?

A

yes. a dose of 0.4 - 1.2 mg can increase cardiac output and MAP. (for knowledge!)

Top Shelf Drugs (13 decks)

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