Meperidine

Question 1

What is the trade name of Meperidine?

Answer 1

Demerol

Question 2

What is the formal drug classification of Meperidine?

Answer 2

Synthetic Opioid Agonist
Phenylpiperidine derivative
Analgesic, Narcotic

Question 3

What are the clinical uses of Meperidine?

Answer 3

• Analgesic
• Narcotic
• Used in the management of moderate to severe pain
• adjunct to anesthesia and preop sedation
• analgesia during labor and delivery
• Shares structural features of LAs and has weak local anesthetic properties
• produces same amount of euphoria, sedation, and analgesia as morphine

Question 4

How is Meperidine effective in reducing post-op shivering from general and epidural anesthesia, __________, __________, _________ ________, and administration of _________?

Answer 4

stimulation of Kappa and alpha 2 receptors
Fever
Hypothermia
Transfusion Reactions
Amphotericin B

Question 5

What is Meperidine structurally similar to? What does this do?

Answer 5

• Atropine!!! Possesses mild atropine-like antispasmodic effect; muscarinic effects
• also similar to local anesthetics-blocks Na channels

Question 6

What is the MOA of Meperidine?

Answer 6

• Agonist at the mu & Kappa opioid receptors
• causes inhibition of ascending pain pathways, alters perception of and response to pain
• produces generalized CNS depression
• potent alpha 2 receptor agonist effects

Question 7

How is Meperidine metabolized?

Answer 7

• Extensive Hepatic Metabolism
• about 90% initially undergoes demethylation to NORmeperidine (principal metabolite) and Hydrolysis to meperidinic acid
• 1st pass uptake by lungs is ~65%

Question 8

What is the terminal elimination 1/2 life of Meperidine?

Answer 8

3 - 5 hours

Question 9

What is the principle route of elimination of Meperidine?

Answer 9

urinary excretion, pH dependent

Question 10

What is the active metabolite of Meperidine? What is its elimination half life?

Answer 10

Normeperidine (has analgesic activity)
14 - 21 hours, longer than meperidine! (dr E says lasts 3 days)
likely to accumulate with repeated or prolonged administration
-1/2 as potent, CNS stimulant, Seizures reported!!!!

Question 11

What is the Vd of Meperidine?

Answer 11

3.5 - 5 L/kg

Question 12

Is Meperidine protein bound?

Answer 12

moderately lipid soluble; 40 - 70% protein bound

Question 13

What are the general side effects of meperidine?

Answer 13

Sedation
Euphoria
N/V
Ventilation Depression as morphine

Question 14

What are the CV effects of Meperidine?

Answer 14

Orthostatic Hypotension

Increased Heart rate!!! TACHYCARDIA

Question 15

What are the CNS effects of Meperidine?

Answer 15

Fatigue
Drowsiness
Dizzi
nervous, HA
Sedation
Increased ICP

Question 16

What are the dermatologic SE of Meperidine?

Answer 16

Rash

Urticaria

Question 17

What are the GI/GU SE of Meperidine?

Answer 17

N/V
Constipation
Stomach cramps
Biliary spasm
paralytic ileus
ureteral spasm
decreased urination

Question 18

what are the contraindications to the use of Meperidine?

Answer 18

-recent or concomitant MAOI use leads to life-threatening serotonin syndrome

Question 19

What is the potency of Meperidine compared to Morphine?

Answer 19

1/10 the potency of morphine

Question 20

what is the Oral, IM, SC dose of Meperidine?

Answer 20

50 - 150 mg q2-4 hours PRN

Question 21

What is the IV dose of Meperidine?

Answer 21

5mg IV q 5 minutes…usually need approx 1/2 the IM dose 25 - 75 mg IV

Question 22

What is the Meperidine dose for shivering?

Answer 22

12.5 - 50 mg IV

Question 23

What is the Max dose daily of Meperidine?

Answer 23

1,000mg/ 24 hours due to increased of seizures, even in patients without renal dysfunction

Question 24

What receptors are affected when Meperidine is used to treat shivering?

Answer 24

Kappa

Alpha 2