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Barry Opioids

Barry Opioids Study

QuestionAnswer
What is an Opiate derived from opium
What is an opioid natural or synthetic substance that binds to opioid receptors and possess agonist activity
Why are opioids used in anesthesia to decrease the SNS response to laryngoscopy, and for analgesia
What are the 3 types of opioids natral, semi-synthetic and synthetic
Natural opioids morphine and papaverine
Semi-synthetic result from simple modifications to the morphine molecule, heroin, hydromorphone, thebaine
Synthetic Demerol, methadone, su-al-remi-fentanyl
Opioid mech. Of action opioid receptor agonists
Where are opioid receptors found the brain (activation of post-synaptic opiod receptors in midbrain and medulla), dorsal horn of spinal cord(activation of presynaptic opiods receptors), and peripheral tissues (activation of receptors in afferent neurons)
What are endogenous opioid receptor agonists endorphins, enkephalins, dynorphins
Opioid receptors mu 1& mu 2, delta, kappa
Mu-1 location and effects primarily brain(supraspinal), euphoria, miosis, urinary retention
Mu-2 location and effects primarily spinal, resp. depression, bradycardia, physical dependence, constipation, itching
Kappa location and effects spinal, supraspinal, peripheral; sedation, dysphoria
Delta location and effects primarily spinal, resp depression, physical dependence
Opioid effects dose dep. resp depression, do not reliably produce unconsciousness, stimulation of chemo-trigger zone (N/V), biliary smooth muscle spasm
Morphine (MSO4) dose, side effects, metabolism dose intra-op: 0.1-1mg/kg IV, post-op: 0.05- 0.2mg/kg IM or 0.03-0.15 mg/kg IV (2-10mg); Major histamine release(avoid in severe asthma), broken down in liver into Morphine 3-glucuronide and Morphine 6-glucuronide.
What is Morphine 6-glucuronide active metabolite of morphine (more potent and stays longer in renal pt)
What is the E ½ time of morphine 1.5-3 hrs (for 50% of morphine to clear the plasma)
Hydromorphone dose, side effects, metabolism 10x more potent than morphine; 0.2-1mg IV, (less N/V, itching, dysphoria), broken down to non-active metabolite Hydromorphone 3-glucuronide(may cause excitation)
Meperidine dose, side effects, metabolism (Demerol) 1/10th as potent as morphine; 0.5-1mg/kg IM, 0.2-0.5 mg/kg IV (14-35 mg); structurally similar to atropine: increases HR, mydriasis, dry mouth; broken down into normeperidine, excreted by kidneys, and neurotoxic in high [] (seizures, myoclonus)
Meperidine is used post-op for this to decrease shivering
What is the E ½ time of meperidine 3-5 hrs (for 50% of meperidine to clear the plasma)
Do not given Meperidine to pts on MAOIs (nardil) causes severe excitatory state, incr. HR, B/P, temp, seizures
Fentanyl dose, side effects 100x more potent than morphine, dose intra-op: 2-10mcg/kg, CT surg:30-50mcg/kg, Post-op: 0.5-1.5mcg/kg; minimal CV side effects, decrease HR, chest wall rigidity (tx with NMB)
Fentanyl is always in what concentration 50mcg/ml
What is the E ½ time of fentanyl 3-6 hrs (for 50% of fentanyl to clear the plasma)
Sufentanyl dosage 7-10x more potent than fentanyl , dose intra-op: 0.2-0.8 mcg/kg, CT surg: 10-30mcg/kg
What is the E ½ time of sufentanyl 2-4 hrs (for 50% of sufentanyl to clear the plasma)
Alfentanyl dose, onset 1/10th as potent as fentanyl, intra-op dose:10-100mcg/kg, faster onset shorter duration than fent or sufent.
What is the E ½ time of Alfentanyl 1.5 hrs (for 50% of Alfentanyl to clear the plasma)
Remifentanyl dose, onset same potency as fent., extremely rapid onset and recovery, dose: 1mcg/kg IV, dose infusion: 0.05-2mcg/kg/min
What is the E ½ time of Remifentanyl 15-30min (for 50% of Remifentanyl to clear the plasma), no analgesia once infusion is stopped.
Naloxone dose, side effects, mech. of action, onset, duration incremental dose: 0.02mg-0.04mg IV, (Mix narcan 0.4mg/ml in 9ml saline=0.04mg/ml) give in 1cc increments, in this dose it reverses resp. dep.but maintains analgesia; opioid receptor competitive antagonist; Onset 1-2min, duration 30-45min
Abrupt reversal with large doses of narcan can cause increased HR, B/P, N/V, pulm, edema
Naltrexone (trexan), longer acting (upto 24 hrs), given PO
What are 2 common opioid agonists/antagonists Butorphanol (stadol), Nalbuphine (nubain)
Butorphanol dose, side effects (Stadol) dose : 0.5-3mg IV, causes resp. dep. and analgesia similar to 10mg MSO4, more sedation than nalbuphine(nubaine)
Butorphanol (Stadol) can be used to stop post-op shivering
Nalbuphine dose, side effects (nubain) partial agonist at kappa and mu, dose: 5-10mg IV, reverses resp. depression caused by narcotics,but maintains analgesia; antagonizes itching from epidural and intrathecal MSO4
Nalbupine is contraindicated in pts addicted to opioids (do not give to them)
Flumazenil dose, side effects (Romazicon), benzo antagonist, dosed incrementally: 0.2mg IV up to 1mg, reverses effects of benzos, but effect does not last as long as benzo effect
Created by: dupy6