Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Barry Opioids
Barry Opioids Study
| Question | Answer |
|---|---|
| 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
Popular Nursing sets