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Fentanyl Class
Pharm (Test 2)
| Question | Answer |
|---|---|
| Small doses of fentanyl have a duration of? | 20-40 min |
| Small doses of fentanyl have a duration based on... | redistribution |
| Larger doses of fentanyl have a (longer or shorter?) duration? | longer (>40min) |
| Larger doses of fentanyl have a duration based on... | accumulation |
| Fentanyl (is or isn't) taken up by lungs during first-pass. | is (75% of initial IV dose) |
| What happens to the distribution of repeat doses of fentanyl? | accumulate in muscle and fat (d/t high lipid solubility) |
| What is one reason for prolonged duration of large/repeated doses of fentanyl? | mobilization from storage sites when admin. ceases (especially when used in combination w/ volatiles) |
| For infusions <2hrs, the context sensitive half-time of fentanyl is (greater or less?) than that of sufentanil? | less |
| For infusions >2hrs, the context sensitive half-time of fentanyl is (greater or less?) than that of sufentanil? | greater |
| How is fentanyl metabolized? | by N-demethylation |
| What are fentanyl's metabolites? Are they active or inactive? | 1)norfentanyl (minimal activity; structurally similar to normeperidine); 2)hydroxypropoinyl-fentanyl (inactive) 3)hydroxypropinyl-norfentanyl (inactive) |
| Which of fentanyl's metabolites is the principle metabolite in humans? | norfentanyl |
| How are fentanyl's metabolites metabolized? | excreted by kidneys in the urine (also 10% of fentanyl) |
| Is fentanyl a good drug of choice for renal failure pts? | yes; metabolites that are metabolized renally are inactive |
| What is the eliminiation 1/2 life of fentanyl? | 3.1-6.6 hrs |
| How does fentanyl's eliminiation 1/2 life compare to morphine? | longer than morphine |
| Why does fentanyl have a longer 1/2 life than morphine when it has a shorter duration? | larger volume of distribution; plasma cntn is maintained by redistribution |
| Is the duration of fentanyl prolonged with hepatic cirrhosis? | no |
| What pt variables can prolong the duration of fentanyl? | elderly (decreases in hepatic blood flow; dec. microsomal activity; dec. in albumin production-->highly protein bound); abdominal aortic surgery involving infarenal aortic cross-clamping |
| What is the typical dose of fentanyl given for analgesia? | 1-2mcg/kg IV |
| What is a possible dose of fentanyl given to blunt circulatory responses? | 2-20mcg/kg IV |
| What dose of fentanyl blocks the sympathetic response during laryngoscopy? | 5-8mcg/kg |
| What is a dose of fentanyl to blunt circulatory responses when given with N2O, midazolam, or volatiles? | bolus of 10mcg/kg, then 50-100 mcg/hr |
| What dose of fentanyl can reduce the required dose of propofol for LMA placement? | 0.5mcg/kg |
| Fentanyl is (more or less?) effective in reducing MAC of volatile agents than morphine? | more |
| What dose of fentanyl can reduce MAC by 80%? | 50-150mcg/kg |
| What dose of fentanyl can reduce MAC by 40%? | 1mcg/kg |
| What are 3 advantages of fentanyl? | 1)no direct myocardial depression 2)no histamine release 3)suppresses stress response to surgery |
| What are 3 disadvantages of fentanyl? | 1)sympathetic stim. in response to pain (especially w/ good LV function) 2)unreliable amnesia 3)post-op resp depression (d/t renarcatization) |
| Fentanyl reduces a pt's HR (more or less?) than morphine? | more |
| True or False: Fentanyl can occasionally reduce a pt's BP and CO | True (not r/t contractility; r/t dec. SVR, dec. preload) |
| What are some neuromuscular affects of fentanyl? | 1)myoclonus r/t depression of inhibitory neurons (seizure-like w/ no EEG changes), 2)doses of 30mcg/kg change somatosensory evoke potential, but don't interfere w/ the use and interpretation |
| What affects can fentanyl have on head injury pts? | increases ICP (6-9) even w/ unchanged PaCO2, decreases in MAP and CPP (dec. in BP --> dec. in cerebral vascular resisitance --> vasoldilation -->inc. ICP) |
| What affects of fentanyl are synergistic when given w/ benzo's? | sedation, hypnosis, resp. depression |
| What affect dose fentanyl have on cough? | reflex coughing |
| What is the most potent opioid currently available? | sufentanil |
| Compare sufentanil's potency to fentanyl and morphine. | 10X more potent than fentanyl; 1000X more potent than morphine |
| Compare sufentanil's lipid solubility to fentanyl. | more lipid soluble than fentanyl |
| Is sufentanil taken up by lungs in first pass? | yes; 60% |
| Compare sufentanil's elimination 1/2 time to fentanyl. | shorter (2.5 hrs compared to 3.1-6.6 hrs) |
| Compare sufentanil's protein binding to fentanyl. | greater protein binding (so smaller volume of distribution) |
| How is sufentanil metabolized? | hepatic N-dealkylation |
| Are sufentanil's metabolites active or inactive? | inactive |
| How are sufentanil's metabolites metabolized? | elimination by liver and kidneys |
| What is the effect of a pre-induction dose of sufentanil? | apnea w/o loss of consciousness |
| What dose of sufentanil is commonly associated w/ stiff chest? | 10-15mcg |
| Compare sufentanil's sedative quality to fentanyl. | more sedative than fentanyl |
| Compare sufentanil's analgesia to fentanyl. | longer lasting analgesia than fentanyl |
| Compare sufentanil's respiratory depression to fentanyl. | less respiratory depression |
| Compare sufentanil's affinity to receptors to fentanyl. | greater |
| Typically, pt who received sufentanil are extubated (sooner or later?) than those who received fentanyl. | 20 min sooner |
| Sufentanil can reduce the MAC of volatiles by up to _______%. | 70% |
| This MAC reduction of sufentanil is (more or less?) than an equipotent dose of fentanyl. | more |
| Compare a dose of sufentanil than that of fentanyl. | 1/10th the dose of fentanyl |
| What is a typical dose of sufentanil? | loading dose of 1mcg/kg, then 1mcg/kg/hr |
| You must turn off an infusion of sufentanil __________min prior to emergence. | 30-45 min |
| Using what group of meds can necessitate decreasing the infusion rate of sufentanil. | benzo's |
| Compare sufentanil's context sensitive 1/2 life to that of fentanyl. | after infusion for 3 hrs, sufentanil will dec. by 80% more rapidly than fent; after infusion for 8hrs, sufentanil will dec. by 50% more rapidly than fent. |
| Why is an overdose of sufentanil difficult to diagnose? | the BP at the minimum effective dose and the BP at 5X that dose will be the same |
| What are 2 reasons sufentanil can cause difficult ventilation? | 1)stiff chest, 2)glottis obstriction |
| What dose of sufentanil can cause seizures? | 1000X effective dose |
| Compare alfentanil's potency to fentanyl. | 1/5 as potent as fentanyl |
| Compare alfentanil's volume of distribution to fentanyl. | Smaller (4-6X) than fent |
| Compare alfentanil's lipid solubility to fentanyl. | lower lipid solubility |
| Compare alfentanil's elimination 1/2 life to fentanyl. | shorter (1.1-1.6 hrs) |
| What percent of alfentanil is in ionized form at physiologic pH? | 10% |
| Compare alfentanil's onset time to fentanyl. | faster |
| What dose of alfentanil gives maximum catecholamine blunting for laryngoscopy? | 30mcg/kg |
| What is one indication for use of alfentanil? | retrobulbar block (eye cases) |
| Compare alfentanil's liability of producing stiff chest to fentanyl. | more liable |
| Compare alfentanil's ability to produce euphoria to fentanyl | more euphoria |
| Describe the metabolism of alfentanil into its metabolites? | N-dealkylation to noralfentanil; amine N-dealkylation to N-phenylpropionamide |
| Are alfentanil's metabolites active or inactive? | inactive |
| _____% of alfentanil is cleared w/in 60 min of administration. | 96% |
| What can make standard infusion and dosing of alfentanil difficult? | interindividual variability r/t P-450 and CYP3A enzymes |
| For an infusion <8hrs, alfentanil's context sensitive 1/2 time is (greater or less?) than sufentanil. | less |
| For an infusion >8hrs, alfentanil's context sensitive 1/2 time is (greater or less?) than sufentanil, | greater |
| Alfentanil infusions should be discontinued _______min before emergence | 15-25 min |
| What dose of alfentanil blunts SBP and HR response to laryngoscopy? | 15mcg/kg 90 sec before |
| What is a typical induction dose of alfentanil? | 150-300mcg/kg rapidly |
| What is a typical infusion dose of alfentanil? | 150mcg/kg/hr |
| Alfentanil should be given (before or after?) incision. | Before: BP can be decreased w/ a dose after painful stimulation |
| Compare incidence of PONV of alfentanil to sufentanil and fentanyl/ | lower than both |
| Compare remifentanyl's potency to fentanyl. | 5X more potent |
| What is the eliminiation 1/2 t of remifentanyl? | 6-10 min |
| Describe how remifentanil is metabolized into its metabolites. | nonspecific plasma and tissue esterases into inactive metabolites |
| How are remifentanil's metabolites metablized? | excreted by the kidneys |
| True or False: Remifentanil's duration is affected by plasmacholinesterase deficiency. | False |
| Hypothermia slows the clearance of remifentanil by ______%. | 20% |
| _____% of remifentanil is eliminated during distribution? | 99.8 |
| How long dose redistribution of remifentanil take? | 0.9 min |
| What is the elimination 1/2 t of remifentanil? | 6.3 min |
| True or False: Remifentanil's context sensitive half-time is independent of infusion time. | True |
| What is remifentanil's context sensitive half time? | 4 min |
| Pt who received remifentanil have a _____% dec in SBP 2 min after administration. | 30% |
| Does remifentanil cause histamine release? | no |
| How long is remifentanil's equilibration time? | 10 min |
| The effect site concentration of remifentanil decreases by 50% in ______min. | 4 |
| Compare remifentanil's volume of distribution to the rest of the fentanyl class. | smallest volume of distribution |
| Which opioid of the fentanyl class has the smallest volume of distribution? | remifentanil |
| What are some clinical uses for remifentanil? | laryngoscopy, retrobulbar block, LandD, desire rapid recovery for quick neuro exam (craniotomy, carotid endarterectomy) |
| What is the infusion dose of remifentanil? | 0.5mcg/kg/min |
| What is the induction dose of remifentanil? | 1mcg/kg over 60-90 sec |
Created by:
lindseymontgomery
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