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Neuraxial Opioids

Pharm (Test 2)

QuestionAnswer
Which opioid receptors are present in high cntns in the dorsal horn of the spinal cord? mu, kappa, delta
Which receptors are present in the substantia gelatinosa? mu
An epidural dose of an opioid is typically ______X the subarachnoid dose. 5-10
Neuraxial opioids are specific for _______ pain. visceral (organ)
Neuraxial opioid administration (is or isn't?) associated with sympathetic denervation? isn't
What is the mechanism of action of epidural opioids? diffuse across dura to affect mu receptors on the spinal cord AND are absorbed to produce the same effects like IV opioids
The (higher or lower?) the lipid solubility of an opioid, the more systemic absorption. higher
Lower lipid soluble morphine has a (faster or slower?) onset and a (longer or shorter?) duration. slower onset, longer duration
What is epidural fentanyl's time of peak CSF concentration? 20 min
What is epidural sufentanil's time of peak CSF concentration? 6 min (most lipid soluble)
What is epidural morphine's time of peak CSF concentration? 1-4 hrs (least lipid soluble)
Only _____% of epidural morphine dose enters CSF. 3%
What is epidural fentanyl's time of peak blood concentration? 5-10 min
What is epidural sufentail's time of peak blood concentration? <5 min
What is epidural morphine's time of peak blood concentration? 10-15 min
True or False: The systemic absorption of epidural opioids produces blood levels similar to those after IM injections. True
What is one way to decrease systemic absorption of epidural opioids? add epinephrine to the solution (constricts the vasculature)
What is one way to enhance the analgesia of subarachnoid opioids? add epinephrine to the solution
Describe the affect of epinephrine to both epidural and subarachnoid opioids. epidural=decreases systemic absorption; subarachnoid=enhances analgesia
What is an epidural dose of fentanyl? 50-100mcg
What is the duration of epidural fentanyl? 1-3 hrs
What is an epidural dose of morphine? 2-5 mg
What is the duration of epidural morphine? 4-24 hrs
What is a spinal dose of morphine? 0.25-1mg
Which opioid is most likely to move cephalad? morphine (least lipid soluble)
What factors can accelerate cephalad mvmt of opioids? coughing, straining (NOT body position)
What are the 4 classic side effects of neuraxial opioids? 1)pruritis, 2)N/V, 3)urinary retention, 4)ventilator depression
What can prevent N/V and pruritis? Narcan 0.25mcg/kg/hr
What is the most common side effect of neuraxial opioids? pruritis
What is the cause of neuraxial opioid-induced pruritis? opioids in CSF moving up to interact w/ OR in the trigeminal nucleus
What patients are most at risk for neuraxial opioid-induced pruritis? obstetric (d/t estrogen effect on OR)
How quickly does neuraxial opioid-induced pruritis occur? within a few hrs (may occur prior to analgesia onset)
What are 2 treatments for pruritis? Narcan 0.25mcg/kg/hr (most effective) or antihistamines (which cause sedation)
What side effect is most common among young males? urinary retention
True or False: Urinary retention is more common with neuraxial opioids than IV or IM. true
True or False: Urinary retention is worse with large doses and increased systemic absorption. False (not related to dose size or systemic absorption)
What causes neuraxial opioid-induced urinary retention? interaction of opioid with OR of the sacral spinal cord (inhibition of sacral parasympathetic outflow causing detrusor muscle relaxation and increased bladder capacity)
What is the onset and duration of neuraxial opioid-induced urinary retention? onset=15min; duration=up to 16hrs
What is the treatment for neuraxial opioid-induced urinary retention? narcan
What is the most serious side effect of neuraxial opioids? ventilation depression
What is the incidence of neuraxial opioid-induced ventilator depression? 1%
What is the onset of neuraxial opioid-induced ventilator depression? unpredictable! may be within minutes, may be 6-12 hrs after administration
Which opioids are responsible for early onset ventilator depression (<2hrs)? fentanyl, sufentanil (high lipid solubility --> dec. risk of cephalad mvmt)
Which opioid is responsible for delayed onset ventilator depression? morphine (low lipid solubility --> inc. risk of cephalad mvmt to OR in ventral medulla)
What are some risk factors for ventilator depression? large doses, geriatric, other opioids or sedatives, prolonged/extensive surgery, co-morbidities, thoracic surgery (?)
What are some risk factors for delayed onset ventilator depression?/ other opioids or sedatives, coughing
Describe the risk of ventilator depression in obstetrics/ decreased risk d/t increased ventilator stimulations from progesterone
What is the most reliable sign of ventilator depression? decreased LOC (possibly caused by hypercarbia)
What is the treatment for ventilator depression? narcan infusion may help; supplemental O2
What opioid is most associated with sedation caused by neuraxial opiois? sufentanil
How soon after admin. does the reactivation of herpes virus occur? 2-5 days
What causes the reactivation of herpes virus? cephalad movement of morphine and interaction of the trigeminal nucleus
Which opioid is associated with the reactivation of herpes? morphine
Why is there a risk of water retention? d/t release of vasopressin
What can cause spinal cord injuries? toxic preservatives
Why is there a risk of dec. body temp? inhibition of shivering