Pharm (Test 2)
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Small doses of fentanyl have a duration of? | 20-40 min
🗑
|
||||
| Small doses of fentanyl have a duration based on... | redistribution
🗑
|
||||
| Larger doses of fentanyl have a (longer or shorter?) duration? | longer (>40min)
🗑
|
||||
| Larger doses of fentanyl have a duration based on... | accumulation
🗑
|
||||
| Fentanyl (is or isn't) taken up by lungs during first-pass. | is (75% of initial IV dose)
🗑
|
||||
| What happens to the distribution of repeat doses of fentanyl? | accumulate in muscle and fat (d/t high lipid solubility)
🗑
|
||||
| What is one reason for prolonged duration of large/repeated doses of fentanyl? | mobilization from storage sites when admin. ceases (especially when used in combination w/ volatiles)
🗑
|
||||
| For infusions <2hrs, the context sensitive half-time of fentanyl is (greater or less?) than that of sufentanil? | less
🗑
|
||||
| For infusions >2hrs, the context sensitive half-time of fentanyl is (greater or less?) than that of sufentanil? | greater
🗑
|
||||
| How is fentanyl metabolized? | by N-demethylation
🗑
|
||||
| What are fentanyl's metabolites? Are they active or inactive? | 1)norfentanyl (minimal activity; structurally similar to normeperidine); 2)hydroxypropoinyl-fentanyl (inactive) 3)hydroxypropinyl-norfentanyl (inactive)
🗑
|
||||
| Which of fentanyl's metabolites is the principle metabolite in humans? | norfentanyl
🗑
|
||||
| How are fentanyl's metabolites metabolized? | excreted by kidneys in the urine (also 10% of fentanyl)
🗑
|
||||
| Is fentanyl a good drug of choice for renal failure pts? | yes; metabolites that are metabolized renally are inactive
🗑
|
||||
| What is the eliminiation 1/2 life of fentanyl? | 3.1-6.6 hrs
🗑
|
||||
| How does fentanyl's eliminiation 1/2 life compare to morphine? | longer than morphine
🗑
|
||||
| Why does fentanyl have a longer 1/2 life than morphine when it has a shorter duration? | larger volume of distribution; plasma cntn is maintained by redistribution
🗑
|
||||
| Is the duration of fentanyl prolonged with hepatic cirrhosis? | no
🗑
|
||||
| What pt variables can prolong the duration of fentanyl? | elderly (decreases in hepatic blood flow; dec. microsomal activity; dec. in albumin production-->highly protein bound); abdominal aortic surgery involving infarenal aortic cross-clamping
🗑
|
||||
| What is the typical dose of fentanyl given for analgesia? | 1-2mcg/kg IV
🗑
|
||||
| What is a possible dose of fentanyl given to blunt circulatory responses? | 2-20mcg/kg IV
🗑
|
||||
| What dose of fentanyl blocks the sympathetic response during laryngoscopy? | 5-8mcg/kg
🗑
|
||||
| What is a dose of fentanyl to blunt circulatory responses when given with N2O, midazolam, or volatiles? | bolus of 10mcg/kg, then 50-100 mcg/hr
🗑
|
||||
| What dose of fentanyl can reduce the required dose of propofol for LMA placement? | 0.5mcg/kg
🗑
|
||||
| Fentanyl is (more or less?) effective in reducing MAC of volatile agents than morphine? | more
🗑
|
||||
| What dose of fentanyl can reduce MAC by 80%? | 50-150mcg/kg
🗑
|
||||
| What dose of fentanyl can reduce MAC by 40%? | 1mcg/kg
🗑
|
||||
| What are 3 advantages of fentanyl? | 1)no direct myocardial depression 2)no histamine release 3)suppresses stress response to surgery
🗑
|
||||
| What are 3 disadvantages of fentanyl? | 1)sympathetic stim. in response to pain (especially w/ good LV function) 2)unreliable amnesia 3)post-op resp depression (d/t renarcatization)
🗑
|
||||
| Fentanyl reduces a pt's HR (more or less?) than morphine? | more
🗑
|
||||
| True or False: Fentanyl can occasionally reduce a pt's BP and CO | True (not r/t contractility; r/t dec. SVR, dec. preload)
🗑
|
||||
| What are some neuromuscular affects of fentanyl? | 1)myoclonus r/t depression of inhibitory neurons (seizure-like w/ no EEG changes), 2)doses of 30mcg/kg change somatosensory evoke potential, but don't interfere w/ the use and interpretation
🗑
|
||||
| What affects can fentanyl have on head injury pts? | increases ICP (6-9) even w/ unchanged PaCO2, decreases in MAP and CPP (dec. in BP --> dec. in cerebral vascular resisitance --> vasoldilation -->inc. ICP)
🗑
|
||||
| What affects of fentanyl are synergistic when given w/ benzo's? | sedation, hypnosis, resp. depression
🗑
|
||||
| What affect dose fentanyl have on cough? | reflex coughing
🗑
|
||||
| What is the most potent opioid currently available? | sufentanil
🗑
|
||||
| Compare sufentanil's potency to fentanyl and morphine. | 10X more potent than fentanyl; 1000X more potent than morphine
🗑
|
||||
| Compare sufentanil's lipid solubility to fentanyl. | more lipid soluble than fentanyl
🗑
|
||||
| Is sufentanil taken up by lungs in first pass? | yes; 60%
🗑
|
||||
| Compare sufentanil's elimination 1/2 time to fentanyl. | shorter (2.5 hrs compared to 3.1-6.6 hrs)
🗑
|
||||
| Compare sufentanil's protein binding to fentanyl. | greater protein binding (so smaller volume of distribution)
🗑
|
||||
| How is sufentanil metabolized? | hepatic N-dealkylation
🗑
|
||||
| Are sufentanil's metabolites active or inactive? | inactive
🗑
|
||||
| How are sufentanil's metabolites metabolized? | elimination by liver and kidneys
🗑
|
||||
| What is the effect of a pre-induction dose of sufentanil? | apnea w/o loss of consciousness
🗑
|
||||
| What dose of sufentanil is commonly associated w/ stiff chest? | 10-15mcg
🗑
|
||||
| Compare sufentanil's sedative quality to fentanyl. | more sedative than fentanyl
🗑
|
||||
| Compare sufentanil's analgesia to fentanyl. | longer lasting analgesia than fentanyl
🗑
|
||||
| Compare sufentanil's respiratory depression to fentanyl. | less respiratory depression
🗑
|
||||
| Compare sufentanil's affinity to receptors to fentanyl. | greater
🗑
|
||||
| Typically, pt who received sufentanil are extubated (sooner or later?) than those who received fentanyl. | 20 min sooner
🗑
|
||||
| Sufentanil can reduce the MAC of volatiles by up to _______%. | 70%
🗑
|
||||
| This MAC reduction of sufentanil is (more or less?) than an equipotent dose of fentanyl. | more
🗑
|
||||
| Compare a dose of sufentanil than that of fentanyl. | 1/10th the dose of fentanyl
🗑
|
||||
| What is a typical dose of sufentanil? | loading dose of 1mcg/kg, then 1mcg/kg/hr
🗑
|
||||
| You must turn off an infusion of sufentanil __________min prior to emergence. | 30-45 min
🗑
|
||||
| Using what group of meds can necessitate decreasing the infusion rate of sufentanil. | benzo's
🗑
|
||||
| Compare sufentanil's context sensitive 1/2 life to that of fentanyl. | after infusion for 3 hrs, sufentanil will dec. by 80% more rapidly than fent; after infusion for 8hrs, sufentanil will dec. by 50% more rapidly than fent.
🗑
|
||||
| Why is an overdose of sufentanil difficult to diagnose? | the BP at the minimum effective dose and the BP at 5X that dose will be the same
🗑
|
||||
| What are 2 reasons sufentanil can cause difficult ventilation? | 1)stiff chest, 2)glottis obstriction
🗑
|
||||
| What dose of sufentanil can cause seizures? | 1000X effective dose
🗑
|
||||
| Compare alfentanil's potency to fentanyl. | 1/5 as potent as fentanyl
🗑
|
||||
| Compare alfentanil's volume of distribution to fentanyl. | Smaller (4-6X) than fent
🗑
|
||||
| Compare alfentanil's lipid solubility to fentanyl. | lower lipid solubility
🗑
|
||||
| Compare alfentanil's elimination 1/2 life to fentanyl. | shorter (1.1-1.6 hrs)
🗑
|
||||
| What percent of alfentanil is in ionized form at physiologic pH? | 10%
🗑
|
||||
| Compare alfentanil's onset time to fentanyl. | faster
🗑
|
||||
| What dose of alfentanil gives maximum catecholamine blunting for laryngoscopy? | 30mcg/kg
🗑
|
||||
| What is one indication for use of alfentanil? | retrobulbar block (eye cases)
🗑
|
||||
| Compare alfentanil's liability of producing stiff chest to fentanyl. | more liable
🗑
|
||||
| Compare alfentanil's ability to produce euphoria to fentanyl | more euphoria
🗑
|
||||
| Describe the metabolism of alfentanil into its metabolites? | N-dealkylation to noralfentanil; amine N-dealkylation to N-phenylpropionamide
🗑
|
||||
| Are alfentanil's metabolites active or inactive? | inactive
🗑
|
||||
| _____% of alfentanil is cleared w/in 60 min of administration. | 96%
🗑
|
||||
| What can make standard infusion and dosing of alfentanil difficult? | interindividual variability r/t P-450 and CYP3A enzymes
🗑
|
||||
| For an infusion <8hrs, alfentanil's context sensitive 1/2 time is (greater or less?) than sufentanil. | less
🗑
|
||||
| For an infusion >8hrs, alfentanil's context sensitive 1/2 time is (greater or less?) than sufentanil, | greater
🗑
|
||||
| Alfentanil infusions should be discontinued _______min before emergence | 15-25 min
🗑
|
||||
| What dose of alfentanil blunts SBP and HR response to laryngoscopy? | 15mcg/kg 90 sec before
🗑
|
||||
| What is a typical induction dose of alfentanil? | 150-300mcg/kg rapidly
🗑
|
||||
| What is a typical infusion dose of alfentanil? | 150mcg/kg/hr
🗑
|
||||
| Alfentanil should be given (before or after?) incision. | Before: BP can be decreased w/ a dose after painful stimulation
🗑
|
||||
| Compare incidence of PONV of alfentanil to sufentanil and fentanyl/ | lower than both
🗑
|
||||
| Compare remifentanyl's potency to fentanyl. | 5X more potent
🗑
|
||||
| What is the eliminiation 1/2 t of remifentanyl? | 6-10 min
🗑
|
||||
| Describe how remifentanil is metabolized into its metabolites. | nonspecific plasma and tissue esterases into inactive metabolites
🗑
|
||||
| How are remifentanil's metabolites metablized? | excreted by the kidneys
🗑
|
||||
| True or False: Remifentanil's duration is affected by plasmacholinesterase deficiency. | False
🗑
|
||||
| Hypothermia slows the clearance of remifentanil by ______%. | 20%
🗑
|
||||
| _____% of remifentanil is eliminated during distribution? | 99.8
🗑
|
||||
| How long dose redistribution of remifentanil take? | 0.9 min
🗑
|
||||
| What is the elimination 1/2 t of remifentanil? | 6.3 min
🗑
|
||||
| True or False: Remifentanil's context sensitive half-time is independent of infusion time. | True
🗑
|
||||
| What is remifentanil's context sensitive half time? | 4 min
🗑
|
||||
| Pt who received remifentanil have a _____% dec in SBP 2 min after administration. | 30%
🗑
|
||||
| Does remifentanil cause histamine release? | no
🗑
|
||||
| How long is remifentanil's equilibration time? | 10 min
🗑
|
||||
| The effect site concentration of remifentanil decreases by 50% in ______min. | 4
🗑
|
||||
| Compare remifentanil's volume of distribution to the rest of the fentanyl class. | smallest volume of distribution
🗑
|
||||
| Which opioid of the fentanyl class has the smallest volume of distribution? | remifentanil
🗑
|
||||
| What are some clinical uses for remifentanil? | laryngoscopy, retrobulbar block, LandD, desire rapid recovery for quick neuro exam (craniotomy, carotid endarterectomy)
🗑
|
||||
| What is the infusion dose of remifentanil? | 0.5mcg/kg/min
🗑
|
||||
| What is the induction dose of remifentanil? | 1mcg/kg over 60-90 sec
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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
Created by:
lindseymontgomery
Popular Nursing sets