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Anes. Pharm I Test 2

neuraxial opioids

Describe anatomically how a CRNA would give an epidural neuraxial opioid dose? Needle would go through the ligamentum flavum but not through the drug mater; it is a theoretical space
Describe anatomically how a CRNA would give a spinal neuraxial opioid dose? Needle would go though the dura mater and into the subarachnoid space; you would know you have reach subarachnoid space r/t aspiration of CSF
Which receptors are present in high concentrations in the dorsal horn of the spinal cord? mu, kappa, and delta
Which are the main receptors present in the substantial gelatinosa? mu
The epidural dose should be _____ the subarachnoid dose 5x - 10x
What is the epidural dose of morphine? The spinal dose? epidural: up to 5 mg; spinal: 0.25 - 1 mg
Neuraxial analgesia is specific for ______ pain rather than _______ pain visceral; somatic
True or false: neuraxial opioid analgesia does NOT include a sympathetic denervation, skeletal muscle weakness, or loss of perception of pressure True!
If you are going to give morphine in the epidural space or subarachnoid space, you must ensure that it is what? preservative free
What is the mechanism of action of opioids placed in the epidural space? they diffuse across the dura to affect mu receptors on the spinal cord and are absorbed systemically to produce effects like IV opioids
The higher the lipid solubility of an opioid given epidurally, the _____ absorption systemically more
Why is morphine typically the drug of choice for epidural administration? lower lipid solubility means slower onset, but longer duration
The more lipid soluble, the _______ the diffusion into the CSF faster
When does epidural fentanyl reach peak CSF concentration? 20 minutes after epidural administration
When does epidural Sufentanil reach peak CSF concentration? 6 minutes after epidural administration
When does epidural morphine reach peak CSF concentration? 1 - 4 hours after epidural administration
What percentage of epidural dose of morphine enters the CSF? only 3%
When does fentanyl reach peak blood concentration after epidural administration? 5 - 10 minutes
When does sufentanil reach peak blood concentration after epidural ministration? < 5 minutes
When does morphine reach peak blood concentration after epidural administration? 10 - 15 minutes
How can you decrease vascular absorption of epidural opioid? by injecting epinephrine into the epidural space along with the opioid; vasoconstriction = less absorbed into vasculature
If epinephrine is added to the morphine solution injected into the subarachnoid space, what happens to the analgesic effect? it is enhanced compared with the injection of morphine alone because it stays there longer and is not taken up into the vasculature as readily r/t vasoconstriction
What is the dose and duration of epidural fentanyl? 50 - 100 mcg; duration: 1 - 3 hours
What is the dose and duration of epidural morphine? 2 - 5 mg; duration: 4 - 24 hours
___________ affects the degree of cephalad movement of opioids in the CSF lipid solubility (higher lipid solubility limits movement)
True of false: body position accelerates cephalad movement of opioids in CSF False! coughing or straining can accelerate movement
Are side effects of neuraxial opioids due to the presence of them in the CSF or in systemic circulation? either in CSF or systemic circulation
What are the four classic side effects of neuraxial opioids? pruritis, N/V, urinary retention, depression of ventilation
What can occur 2 - 5 days post epidural administration of morphine? reactivation of herpes virus; r/t cephalad movement of opioid and interaction of trigeminal nucleus
Created by: Mary Beth