Pain Meds

Question 1

Fentanyl induction dose

Answer 1

0.5-1 mcg/kg

Question 2

Fentanyl time to peak and duration

Answer 2

5 min

45 minutes

Question 3

Fentanyl disadvantages

Answer 3

Rigid chest

Respiratory depression

Question 4

Morphine disadvantages

Answer 4

Histamine release in some patients causing itch and hives

M-6G is more potent metabolite, renally cleared, dangerous respiratory depression

Question 5

Morphine time to peak and duration

Answer 5

20 min, 4 hours

Question 6

Hydromorphone (dilaudid) typical dose

Answer 6

0.01 mg/kg

Question 7

Meperidine dose

Answer 7

12.5 mg, repeated once

Question 8

Two effects that opioids have on electrolytes at the synapse

Answer 8

Decrease Ca entry presynaptic

Enhance K effluent post synaptic

Question 9

Which opioids cause histamine release?

Answer 9

Meperidine>morphine

Question 10

Most opioids cause bradycardia at which part of the brain?

Which opioid is an exception to this rule?

Answer 10

Central vagal nucleus

Meperidine, looks similar to atropine

Question 11

How does methadone prolong the QT?

Answer 11

Voltage gated K channels in the myocardium

Question 12

High dose opioid effect on EEG

Which lower the seizure threshold?

Answer 12

Slowing and delta wave

Fentanyl and meperidine

Question 13

Opioids slightly reduce CBF

What are their considerations in the elderly?

Answer 13

Increased brain sensitivity
Decreased clearance and Vd
Renal insuff. To M6gluc

Question 14

Stiff chest syndrome: which NTs?

Tx?

Answer 14

Dopamine, gaba

Typical after high potent IV doses

NMB or naloxone

Question 15

Which have a local anesthetic effect?

Answer 15

Meperidine in the SAB

Question 16

Hyperalgesia due to what?

What doesn’t develop tolerance?

Answer 16

Stimulation of the NMDA receptor causing more sensitivity to pain and tolerance

Constipation and miosis

Question 17

Three effects on ventilation

Answer 17

Decrease RR
Decrease response to CO2
Increase apneic threshold ( paCO2)
Blunt hypoxia drive

Does NOT interfere with hypoxic pulmonary vasoconstriction

Question 18

Name dilaudid active metabolite

Answer 18

Hydromorphone3gluc

Causes excitation cog dysfunction and myoclonus

Question 19

Which opioids should you avoid with MAOI?

Answer 19

Meperidine and tramadol

Question 20

Nalbuphine receptors

Answer 20

Mu antagonist

Kappa agonist

Question 21

Naloxone complete antagonism causes

Answer 21

HTN tachycardia ventricular dysrythm

Plum edema from cathecholamine