Opiods

Question 1

Morphine what happens with a more alkanyzed blood ph?

i.e hyperventilation

Answer 1

blood becomes more non-ionized

crosses BB

Question 2

Morphine is affected by what clearance?

Answer 2

renal clearance

• not affected by hepatic clearance

Question 3

Meperidine

what type of metabolism?

Answer 3

extensive hepatic metabolism

Question 4

What are the metabolites of Morphine?

which one is active?

Answer 4

Question 5

Fentanyl half-time with age?

Answer 5

special population: elderly

• decrease CYP and decrease hepatic blood flow

- may prolong effects

- decrease albumin reduction

Question 6

Alfentanil characteristics?

Question 7

Meperedine has a similar structure with

Answer 7

Atropine

Question 8

Opioids with histamine release

Answer 8

Morphine

Meperedine

Question 9

Receptor that causes

Euphoria

Answer 9

Mu 1 [responds to endorphins]

• Euphoria
• Low Abuse
• Miosis
• Bradycardia

Question 10

Opiod receptor that causes

constipation

Answer 10

Mu2

• Analgesia [spinal]
• Depression of Vent
• Physical Dependence
• Constipation

Question 11

Opioid receptor that causes sedation

Answer 11

Kappa (respond to dynorphins)

• dysphoria
• Sedation
• Low abuse
• Miosis

Question 12

Opiod receptor that respond to Enkaphalins

Answer 12

Delta receptor responds to Enkaphalins

Question 13

Where are the opiod receptors located?

Answer 13

1. Brain
2. Spinal cord [doral horn, interneurons]
3. Periphery [sensory neurons, immune cells]

Question 14

opiod effects in CV

Answer 14

no direct myocardial depression

bradycardia

Question 15

Ventilation Opiod effects

Answer 15

Co2 response curve shift to the right

Question 16

CBF: opiods

Answer 16

increase in PCo2 = increase in CBF

Question 17

Chest wall rigidity on opioids?

Answer 17

its actually from laryngeal musculature contraction treated with paralysis

Question 18

Opiods causes spasm on?

Answer 18

Biliary tract –> sphincter of Oddi

Naloxone or Glucagon

Question 19

Chatacteristics of Tolerance and Dependence

Answer 19

Question 20

Overdose: Manifestation and Treatment

Answer 20

Question 21

Equianalgesic Potency

Answer 21

Meperedine

Morphine

Alfentanyl

Fentanyl

Remifentanyl

Sefentanyl

Question 22

Charateristics of Morphine

Answer 22

• histamine release from mast cells
• dilation of cutaneous blood vessels
• decrease CMRO2

Question 23

Characteristics of Meperedine

CAUTION WITH

Answer 23

• direct effects in contraction in large doses

– should not be used with SSRI, MAO

– seronin syndrome

Caution with: TCA

potentiation of ventilatory depression

Question 24

Characteristics of Fentanyl

Answer 24

Question 25

Opioid used for **transient acute pain**

Answer 25

Question 26

The **most potent opioid** in common clinical use

Answer 26

- may cause hemodynamic instability due to breaducardia - large doses of [10-30 mcg/kg]

Question 27

useful for treatment of moderate to severe pain

Answer 27

**Hydromorphone**

Question 28

Useful for tx of chroninc opiod abise and withdrawal chronic pain syndrome and cancer pain

Answer 28

Methadone

Question 29

Characteristics of partial opioid agonists

Answer 29

Question 30

Opioid Antagonist Naloxone potent SE

Answer 30

SE: CV stimulation, tachycardia, HTN, dysrhythmmias, pulmonary edema, N/V - slow titration every two mins to minimize SE - CROSSES THE PLACENTA

Question 31

Characteristics of Naltrexone

Answer 31

Question 32

Equipotent with Naloxone?

Answer 32

Question 33

* Quaternary ammonium opioid receptor antagonist * used for constipation

Answer 33