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Opioids-drugs

Demerol,fentanyls,antagonist..

QuestionAnswer
What agonist receptors do Meperidine have? Mu & Kappa
Which is the only opioid that causes atropine-like antispasmotic effects? Cause increase HR Meperidine
What is the duration of Mereridine? 2-4 hours
What are the metabolites of Meperidine? Normeperidine & Meperidinic acid
Main route of elimination of Demerol Urinary
Which of the demerol metabolites causes siezure? Normeperidine
Which drug is indicated for labor & delivery, post op shivering? Meperidine
Anti- shivering effect of meperidine is caused by stimulation of what? Kappa receptors
Which opioid is more frequent in causing hypotension and histamine release? Meperidine
HIGH DOSES of Meperidine will cause? NEGATIVE cardiac inotropic effects plus histamine release... (hypotension)
Which opioid more frequently cause biliary spasms? codeine
Which narcotic causes more ventilatory depression? Meperidine or Morphine? Meperidine
Meperidine effect on the pupils will cause... Mydriasis
Morphine effect on the pupils will cause.... miosis
Fentanyl has a ________onset & ________duration...... rapid/short
the effect site equilibration time for Fentanyl is 6.4 minutes
Fentanyl is metabolized by liver
What is metabolites of Fentanyl? Norfentanyl
The elimination half time for Fentanyl is long b/c it reflects the large Vd
the high solubility of Fentanyl reflects is... high potency & rapid onset
Fentanyls short duration is caused by the redistribution into inactive tissue sites. it undergoes 1st pass lung effect.
How is norfentanyl formed? N-demethylation
You should be cautious in using Fentanyl is_____ pts. Why? Elderly; they have a decreased clearance and decreased hepatic blood flow
Duration of Fentanyl longer than 2 hrs will cause the context half-time to be increased and be longer than which analogue of Fentanyl Sufentanil/sufenta
Which opioids cause a decrease in plasma concentration w/ CABG pts? ALL opioids
What FENTANYL doses is adequate for ANALGESIA effects? 1-2mcg/kg IV
What FENTANYL dose is adequate to blunt tachycardia & HTN associated w/ laryngoscopy 2-20mcg/kg IV
What FENTANYL doses is qdequate for surgical anesthesia? 50-150mcg/kg IV
Are these a PRO or CON for Fentanyl?indirect myocardial depression, suppress of stress response & lack of histamine release PRO/ADVANTAGE
Are these a PRO or CON of Fentanyl?doesnt prevent sympathetic response to painful stimuli, possible patient awareness, post-op resp. depression CON/DISADVANTAGE
Bradycardia is more prominent with which opioid? Fentanyl
Seizure activity has been reported with which opioids? Alfentanyl & fentanyl; there is NO evidence of seizure activity on EEG though
Sufentanil and Fentanyl can cause what changes to the ICP? increased ICP(in head injury pt) by 6-9 mmHg
What is the effecti site equilibration for Fentanyl? 6.4 minutes
What is the effect site equilibration for Sufentanil? 6.2 minutes
What is the effect site equilibration for Alfentanil? 1.4 minutes
Which opioid is the ONLY drug that undergoes ester hydrolysis? Remifentanyl
Which opioid is good for long surgeries and has a rapid induction, early emergence & early extubation? Sufentanil
What analogue of fentanyl can be used for outpatients? Alfentanil
Which opioids can be used for retrobubular blocks & larygoscopy? Remifentanil & Alfentanil
Which opioid would you not prefer to give for a sx that is known to have significant postop pain? Remifentanil
Potency/lipid solubility from highest to lowest is as follows: Sufentanil, Remifentanil, Fentanyl, Alfentanil, Morphine & Mereperidine
Onset of action from highest to lowest is as follows: Alfentanil/Remifentanyl, Sufentanil, Fentanyl, Morphine & Merepidine
Fentanyl has a ________onset & ________duration...... rapid/short
the effect site equilibration time for Fentanyl is 6.4 minutes
Fentanyl is metabolized by liver
What is metabolites of Fentanyl? Norfentanyl
The elimination half time for Fentanyl is long b/c it reflects the large Vd
the high solubility of Fentanyl reflects is... high potency & rapid onset
Fentanyls short duration is caused by the redistribution into inactive tissue sites. it undergoes 1st pass lung effect.
How is norfentanyl formed? N-demethylation
You should be cautious in using Fentanyl is_____ pts. Why? Elderly; they have a decreased clearance and decreased hepatic blood flow
Duration of Fentanyl longer than 2 hrs will cause the context half-time to be increased and be longer than which analogue of Fentanyl Sufentanil/sufenta
Which opioids cause a decrease in plasma concentration w/ CABG pts? ALL opioids
What FENTANYL doses is adequate for ANALGESIA effects? 1-2mcg/kg IV
What FENTANYL dose is adequate to blunt tachycardia & HTN associated w/ laryngoscopy 2-20mcg/kg IV
What FENTANYL doses is qdequate for surgical anesthesia? 50-150mcg/kg IV
Are these a PRO or CON for Fentanyl?indirect myocardial depression, suppress of stress response & lack of histamine release PRO/ADVANTAGE
Are these a PRO or CON of Fentanyl?doesnt prevent sympathetic response to painful stimuli, possible patient awareness, post-op resp. depression CON/DISADVANTAGE
Bradycardia is more prominent with which opioid? Fentanyl
Seizure activity has been reported with which opioids? Alfentanyl & fentanyl; there is NO evidence of seizure activity on EEG though
Sufentanil and Fentanyl can cause what changes to the ICP? increased ICP(in head injury pt) by 6-9 mmHg
What is the effecti site equilibration for Fentanyl? 6.4 minutes
What is the effect site equilibration for Sufentanil? 6.2 minutes
What is the effect site equilibration for Alfentanil? 1.4 minutes
Which opioid is the ONLY drug that undergoes ester hydrolysis? Remifentanyl
Which opioid is good for long surgeries and has a rapid induction, early emergence & early extubation? Sufentanil
What analogue of fentanyl can be used for outpatients? Alfentanil
Which opioids can be used for retrobubular blocks & larygoscopy? Remifentanil & Alfentanil
Which opioid would you not prefer to give for a sx that is known to have significant postop pain? Remifentanil
Potency/lipid solubility from highest to lowest is as follows: Sufentanil, Remifentanil, Fentanyl, Alfentanil, Morphine & Mereperidine
Onset of action from highest to lowest is as follows: Alfentanil/Remifentanyl, Sufentanil, Fentanyl, Morphine & Merepidine
What opioid antagonist is helpful to prevent constipation & delayed gastric motility? Methylnatroxene Bromide Relistor
What drug is used for withdrawal symptoms of Opioids? Clonidine
Methylnatrexone Bromide blocks which opioid receptor? Mu
What condition is methylnatrexone bromide is CONTRAINDICATED in? bowel obstruction
Which opioid agonist has an antitussive effect? Codeine
True or False: It is fine to give Codeine IV? False, Why?
True of False: Dilaudid is a derivative of Morphine and is more potent? True;
What happens if you give codeine IV? significant histamine release & hypotension
Which opioid agonist will you give if you want to suppress a cough but not have any analgesic effects Dextromethorphan
What medicine do you want to give to control withdrawals from Opioids? Methadone
What opioid agonist will you give to someone who has mild-moderate pain unrelieved by ASA or acetamenophine? Darvon
What centrally acting analgesic has a low affinity to MU receptors? Tramadol; Ultram
Partial agonist- antagonist binds to what receptors? Mu,Kappa & Delta
What are the ceiling effects for Morphine? 65%
What is the ceiling effect for Sufentanil? 70-90%
What is the ceiling effect for Alfentanil 70%
What is the ceiling effect for Remifentanil 50-91%
What is the ceiling effect for Fentanyl? 50%
Naloxone, Naltrexone, & Nalmefene are examples of________ Opioid Antagonist
Petazocine, Dezocine, Nalbuphine, Buprenorphine & Butophanol are examples of_________ Opioid Agonist-Antagonist
Which antagonist treats opioid depression, itching & overdose? Naloxone
Which antagonist has a longer duration than Naloxone? Nalmefene
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