Anesthesia Drug Test Quick Facts > Opiods > Flashcards

Opiods Flashcards

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1
Q

how is alfentanil supplied

A

500 mcg/mL

2mL vial

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2
Q

what are the principal uses of alfentanil

A

anesthetic induction
maintenance
monitored anesthesia care MAC

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3
Q

what is the MOA of alfentanil

A

Mu-1(supraspinal)
Mu-2(spinal)
receptor agonism

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4
Q

endogenous opioid ligand ekephalin’s receptor

A

delta

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5
Q

endogenous opioid ligand endorphin’s receptor

A

mu

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6
Q

endogenous opioid ligand dynorphin’s receptor

A

kappa

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7
Q

how do opiods work?

A

Mu-1(supraspinal)
Mu-2(spinal)
receptor agonism

inhibition of ascending transmission of nociceptive information from the spinal cord dorsal horn

activation of pain control circuits that descend from the midbrain, via rostram ventromedial medulla
to the spinal cord dorsal horn

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8
Q

mu-1 location

A

supraspinal

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9
Q

mu-2 location

A

spinal

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10
Q

mu-1 effects

A 
euphoria
miosis
bradycardia
hypothermia
urinary retention
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11
Q

mu-2 effects

A

respiratory depression
constipation
physical dependence

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12
Q

potency order of opioids greatest to least

A 
Sufentanil
Remifentanil-Fentanil
Alentanil
hydromorphone
Morphine
Meperidine

“Susan/Robert Formed A Happy Monique
MARS least to greatest without fent and hydro”

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13
Q

Vd of alfentanil

A

0.4-1 L/kg in adults

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14
Q

1/2 life of alfentanil

A

90-111 minutes

context sensitive 1/2 life

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15
Q

metabolism of alfentanil

A

hepatic metabolism via CYP-450
Ndealklation
glucuronide formation

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16
Q

peak of alfentanil

A

1-3 min

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17
Q

onset of alfentanil

A

60 seconds

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18
Q

duration of alfentanil

A

20 min

dose dependent

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19
Q

contraindicaions/adverse rxn alfentanil

A

hypersensitivity
N/V
chest wall rigidity

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20
Q

physiologic effects of alfentanil

A

CNS depressoin

respiratory depression

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21
Q

protein binding % of alfentanil

A

92%

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22
Q

how does acidosis/alkalosis affect protein binding?

A

protein binding increases with alkalosis

decreases with acidosis

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23
Q

Varies purpose:

Incremental injection: alfentanil

A

5-15 mcg/kg q 5-20 minutes

Max 75 assisted vent required

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24
Q

Continuous Infusion alfentanil

A

50-75 mcg/kg induction/ maintenance 1-1.5 mcg/kg/min procedure dependent

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25
Induction of Anesthesia: alfentanil
130-245 – maintenance 0.5-1.5 mcg/kg/min *reduce concentration of inhaled agents by 30-50 for first hour
26
MAC dose alfentanil
3-5 mcg/kg q 5-20 min OR 0.25-1 mcg/kg/min initial dose 3-8 TOTAL dose 3-40
27
how is sufentanil supplied
50 mcg/mL 100 mcg/2mL 250 mcg/5mL
28
MOA of sufentanil
Mu-1 and Mu-2 receptor agonism Binds to opiod receptors throughouts CNS. Opening K channels- inhibiting Ca++ channels Increase pain threshold Alters pain perception Inhibit ascending pain pathways Inhibition of catecholamine release- controls sympathetics response to surgical stress (up to 30 mg/kg)
29
trade name of sufentanil
sufenta
30
protein binding % of sufentanil
91-93%
31
1/2 life elimination of sufentanil
2-4 hr
32
1/2 Context Sensative of sufentanil
25 min 3 hour infusion | 40 min 6 hour infusion
33
metabolism of sufentanil
CYP3A4 liver small intestine
34
excretion of sufentanil
urine
35
first pass uptake of sufentanil- pulmonary %
60
36
peak of sufentanil
5 min
37
onset of sufentanil
10 seconds
38
duration of sufentanil
30-60 minutes
39
contraindications of sufenanil
chest wall rigidity | hypersensitivity
40
Premed: sufenta
2-5 mcg
41
Induction: w/60-70% N2O sufenta
1.5-2.5 mcg/kg/hr
42
High Dose Opiod: sufenta
1-30 mcg/kg induction & 1-2 mcg/kg/hr
43
Balanced Anes: sufenta
0.1-0.3 mcg/kg bolus w/0.005-0.015 mcg/kg/min infusion
44
TIVA: sufenta
0.25-2 mcg/kg, 2.5-10 mcg bolus, 0.5-1.5 mcg/kg/hr
45
Analgesia: sufenta
0.1-0.3 mcg/kg or 0.0015-0.01 mcg/kg/min infusion
46
MAC: sufenta
2.5-10 mcgbolus
47
trade name of remifentanil
Ultiva
48
MOA of remifentanil
binds to mu-opiod receptors within CNS increases pain threshold alters pain reception inhibits asscending pain pathways
49
how is remifentanil supplied
1 mg 2 mg 5 mg when reconstituted is 1mg/mL
50
% protein bound of remifentanil
70%
51
High Dose Opioid: remifentanl
1-3 mcg/kg/min infusion w/propofol 3 mg/kg/hr
52
Induction w/hypnotic: remifentanil
0.5-1 mcg/kg bolus 0.1-1 mcg/kg/min
53
Balanced: anesthesia remifentanil
0.1-1 mcg/kg/min
54
TIVA: remifentanil
1-2 mcg/kg, 0.1-1 mcg/kg bolus
55
Analgesia: remifentanil
0.05-0.25 mcg/kg/min
56
MAC remifentanil
12.5-25 mcgbolus or 0.01-0.2 mcg/kg/min infusion
57
1/2 life context sensitive remifentanil
0-5 minutes | no matter how long the infusion
58
half life elimination remifentanil
dose dependent terminal 10-20 effective 3-20
59
metabolism remifentanil
rapid via blood and tissue esterases
60
excretion remifentanil
urine
61
peak remifentanil
1-3 min
62
onset remifentanil
60 seconds
63
duration remifentanil
10 min
64
contrainications/AE remifentanil
Hypersensitivity chest wall rigidity N/V
65
trade name fentanyl
duragesic | sublimaze
66
how is fentanyl supplied
100 mcg/2mL 250 mcg/5mL 500 mcg/10 mL 1000mcg/20mL
67
MOA of fentanyl
Binds to stereospecific receptors at many sites within the CNS Relief of pain Pre-operative medication Adjunt to general or regional anesthesia
68
% first pass uptake by the lungs of fentanyl
75%
69
elimination half life fentanyl
2-4 hours
70
Context sensitive half time fentaynl
75 minutes
71
peak fentanyl
5 min
72
onset fentanyl
10 sec
73
duration fentanyl- post bolus
30-60 min for full recovery
74
contraindications/AE fentanyl
hypersensitivity | chest wall rigidity
75
Premed: fentanyl
25-50 mcg
76
High Dose Opiod Anes: fentanyl
25-50 mcg/kg induction dose with 0.5mcg/kg/min infusion
77
Induction w/hypnotic fentanyl
1/5-5 mcg/kg
78
Induction w/60-70% N2O: fentanyl
8-20 mcg/kg
79
TIVA: fentanyl
5-20 mcg/kg, 25-100 mcg bolus 2-10 mcg/kg/hr
80
Balanced:fentanyl
25-100 mcg bolus or 0.5-5 mcg/kg
81
Analgesia fentanyl
1-3 mcg/kg bolus or 0.01-0.05 mcg/kg/min
82
MAC: fentanyl
12.5-50 mcg bolus
83
IV infusion rate fentanyl
10mcg/mL concentration
84
trade name of naloxone
narcan | evzio
85
how is naloxone supplied
0.4 mg/mL
86
MOA naloxone
Non-specific opiod receptor competitive antagonist (mu, delta, kappa) Pure opioid antagonist Compete and displaces opioids at receptor sites Greatest affinity for mu-receptor
87
use of naloxone
Reverses opioid effects: RD, overdose, dependence, prurities, relax sphincter of Oddi spasm, urinary retention
88
onset naloxone
2 minutes
89
duration of action naloxone
15-45 minutes OFTEN SHORTER THAN THE HALF LIFE OF THE OPIOID- REDOSE POTENTIAL HIGH
90
half life naloxone
0.5-1.5 hours
91
excretion of naloxone
Urine as metabolites- adjust dose for renal pt
92
metabolism naloxone
Primarily hepatic via glucuronidation (inactive metabolites) no dose adjustment with liver dz
93
A/E of naloxone
MANY CV- HTN, V-tach/fib, hypotension, flushing, fever CNS- agitation/coma/pain/seizure/restless/hallucination GI- N/V/Diarrhea crams NMS- aches, paresthesias, piloerection, tremorn weakness PULM- Dysp, hypoxia, pulm edema, MISC- diaphoresis, sweating, hot flash, shiver, yawn, injection site rsn * withdrawal symptoms induction of sympathetic excess- catecholamines abrubt reversal may cause acute N/V/sweat/tachy is given post op – seizures, htn, pulmonary edema and arrhythmias- caution
94
concerns with naloxone
Renarcotization No need with remifentanyl gtts- just turn it off Buprenorphine- need much larger dose 2-4 mg/hr because high affinity for opioid receptor May have methyl or propylparabens in formulation
95
dilution how to & | dose for naloxone
0.4mg/10mL = 40 mcg/mL or 0.04 mg/mL = most common dose
96
IV push: naloxone
1st dose= naloxone 0.04-0.4mg | repeat for effect
97
Infusion for pruritis naloxone
= 0.25 mcg/kg/hour
98
IF no response at 0.8 mg consider?
total consider other causes of RD
99
Heroin overdose naloxone
0.4-2 mg/dose repeat 2-3 min for effect
100
order from most lipophilic to least lipophilic (hydrophilic) or opiods
She F'd All My Random House Mates ``` Sufentanil- lipophilic Fentanyl Altenanil Meperidine Remifentanil Hydromorphone Morphine- hydrophils ```
101
properties of lipophilic neuroaxial opioids
``` Rapid onset sort duration limited rostral spread good for PCA less side effects ```
102
properties of hydrophilic neuroaxial opioids
``` prolonged single dose analgesia cephalic spread- concern for 2nd RD 6-12 hours later slow onset long lasting thoracic analgesia with lumbar admin NOT good for PCA side effects ```
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