Opioid & non-opioid analgesics 3

Question 1

Which drug is associated with anticholinergic side effects?
a. meperidine
b. naloxone
c. methadone
d. remifentanil

Answer 1

a. meperidine

Question 2

Meperidine stimulates

Answer 2

mu & kappa receptors

Question 3

Co-administration of meperidine with a ____________ can cause serotonin syndrome

Answer 3

MAO inhibitor

Question 4

Meperidine is structurally related to

Answer 4

atropine

Question 5

Because meperidine is structurally related to atropine, the following can be seen

Answer 5

tachycardia, mydriasis, and dry mouth

Question 6

Side effects of meperidine include

Answer 6

histamine release
antishivering effect (kappa receptor)

Question 7

Meperidine is not recommended for

Answer 7

patient-controlled analgesia (PCA)

Question 8

S/sx of serotonin syndrome include

Answer 8

hyperthermia, mental status changes, hyperreflexia, seizures, and death

Question 9

MAO inhibitors include

Answer 9

phenelzine, isocarboxazid, tranylcypromine

Question 10

What 2 opioid receptors are stimulated by meperidine?

Answer 10

Kappa
Mu

Question 11

Which pharmacological characteristic accounts for the rapid onset of action of alfentanil?
a. low protein binding
b. low degree of ionization
c. high potency
d. high lipid solubility

Answer 11

b. low degree of ionization

Question 12

Alfentanil is 90% (non-ionized or ionized)?

Answer 12

non-ionized

Question 13

The _____________- portion of alfentanil can diffuse across the blood brain barrier

Answer 13

non-ionized

Question 14

Alfentanil use useful for

Answer 14

blunting the hemodynamic response to short, intense periods of stimulation such as tracheal intubation or retrobulbar block

Question 15

Alfentanil is a weak

Answer 15

base

Question 16

The pKa of alfentanil is

Answer 16

6.5

Question 17

Alfentanil has the fastest

Answer 17

onset of action compared to other opioids

Question 18

Due it is lower hepatic extraction ratio, alfentanil metabolism is more susceptible to

Answer 18

alterations in CYP3A4 function

Question 19

________________ inhibits alfentanil’s metabolism, and co-administration can result in prolonged respiratory depression

Answer 19

Erythromycin

Question 20

Renal failure ____________ alter alfentanil clearance

Answer 20

does not

Question 21

What opioid has the lowest non-ionized fraction at physiologic pH?

Answer 21

meperidine at 7%

Question 22

Which agents can be used to attenuate opioid-induced hyperalgesia? (select 2.)
a. ketamine
b. clonidine
c. morphine
d. magnesium sulfate

Answer 22

a. ketamine
d. magnesium sulfate

Question 23

Remifentanil is a rapid

Answer 23

on and rapid-off mu agonist

Question 24

The context sensitive half time of remifentanil is

Answer 24

about four minutes, regardless of infusion duration

Question 25

Remifentanil can cause

Answer 25

acute opioid-induced hyperalgesia following discontinuation

Question 26

Remifentanil should not be used for

Answer 26

neuraxial anesthesia- the vial contains glycine that can cause skeletal muscle weakness

Question 27

Remifentanil is highly (liphophilic or hydrophilic)?

Answer 27

liphophilic

Question 28

What is the maintenance infusion of remifentanil?

Answer 28

0.1-1.0 mcg/kg/min.

Question 29

In obese patients, the rate of remifentanil infusion is calculated with

Answer 29

lean body weight

Question 30

Remifentanil is metabolized by

Answer 30

plasma esterases

Question 31

Opioid induced hyperalgesia can be prevented with

Answer 31

ketamine or magnesium sulfate

Question 32

Which opioid has the same potency as remifentanil?

Answer 32

fentanyl

Question 33

How is remifentanil metabolized?

Answer 33

hydrolysis by erthyrocyte and tissue esterases (not pseudocholinesterase)

Question 34

Methadone provides analgesia by all of the following ways EXCEPT:
a. mu receptor agonism
b. NMDA receptor antagonism
c. Monamine reuptake inhibition
d. cholinergic receptor antagonism

Answer 34

d. cholinergic receptor antagonism

Question 35

Methadone is useful in the following circumstances:

Answer 35

chronic treatment of opioid abuse
chronic pain syndromes
cancer pain

Question 36

Methadone decreases pain by three mechanisms:

Answer 36

Mu receptor agonist
NMDA receptor antagonist
inhibits reuptake of monoamines in the synaptic cleft

Question 37

Methadone can prolong

Answer 37

the QT interval

Question 38

Olicerdine is an

Answer 38

IV opioid analgesic that primarily selects for the mu-receptor

Question 39

Oliceridine is indicated for

Answer 39

adults with acute pain when other opioid analgesics and alternative treatments fail to provide adequate pain relief

Question 40

Oliceridine is contraindicated in patients with

Answer 40

GI obstruction or paralytic ileus
significant respiratory depression
acute or severe asthma in an unmonitored setting

Question 41

Key considerations for oliceridine include

Answer 41

mild QT interval prolongation
increased risk of seizures in the patient with a seizure disorder
risk of hypotension when co-administered with a general anesthetic

Question 42

The duration of action of methadone is

Answer 42

3-6 hours

Question 43

The dosing of oliceridine is

Answer 43

loading dose IV: 1-2 mg IV
supplemental IV doses: 1-3 mg every 1-3 hours PRN

Question 44

The cumulative daily dose of oliceridine should not exceed

Answer 44

27 mg

Question 45

Is there dose adjustment needed for patients with renal impairment or mild to moderate hepatic impairment for patients taking oliceridine?

Answer 45

Nope