apex opioids

Question 1

tolerance

Answer 1

associated with opioids. due to receptor desensitization and increased synthesis of cAMP.

Question 2

tolerance does not develop

Answer 2

to mitosis or constipation

Question 3

early signs of withdrawal

Answer 3

diaphoresis insomnia restlessness

Question 4

late signs of withdrawal

Answer 4

abdominal cramping n/v

Question 5

most potent opioid

Answer 5

sufentanil

Question 6

least potent opioid

Answer 6

meperidine

Question 7

which opioids have active metabolites

Answer 7

morphine and meperidein

Question 8

remifentanil and dosing

Answer 8

lean body weight for dosin

Question 9

methadone receptor

Answer 9

mu

Question 10

meperidine receptor

Answer 10

mu and kappa

Question 11

mu endogenous ligand

Answer 11

endorphin

Question 12

delta endogenous ligand

Answer 12

enkephalin

Question 13

kappa endogenous ligand

Answer 13

dynorphin

Question 14

mu-3

Answer 14

immune suspression

Question 15

morphine metabolism

Answer 15

morphine 6 glucuronide
very potent if it builds up it will create respiratory depression and toxicity after morphine
patients on dialysis are unable to excrete m6g and are more likely to experience respiratory depression and toxicity after morphine

Question 16

meperidine metabolism

Answer 16

metabolite is normeperidine
half as potent
it reduces the seizure threshold and increases ins excitability. caution in elderly and dialysis.

Question 17

remifentanil metabolism

Answer 17

hydrolyzed in the plasma by erythrocyte and tissue esterase’s. (not pseudocholinesterase)

Question 18

what is meperidine structurally related to ?

Answer 18

atropine and exhibits anticholinergic effects such as tachycardia, mydriasis and dry mouth

Question 19

which opioid does not get metabolized by the liver?

Answer 19

remifentanil

Question 20

which opioid can produce skeletal muscle rigidity

Answer 20

fentanyls

Question 21

what is the treatment for skeletal muscle rigidity

Answer 21

paralysis and intuabtion

Question 22

common characteristics of partial agonists

Answer 22

produce analgesia with a reduced risk of respiratory depression

have a ceiling effect beyond which additional analgesia is not possible

reduce the efficacy of previously administered opoids

can cause acute opioid withdrawal in the opioid dependent patient

can cause dysphoria reactions

carry a low risk of dependence

are used in patients who cannot tolerate a full opioid agonist

Question 23

naloxone (which receptors) which has the greatest affinity

Answer 23

mu has the greatest affinity
kappa
delta receptors.

Question 24

naloxone indications

Answer 24

acute reversal of opioid induced respiratory depression
reversal of respiratory depression in the neonate whose mother received an opioid
treatment of opioid overdose

Question 25

does naloxone cross the placenta

Answer 25

yes it does if giving it to an opioid abusing mother it can precipitate acute opioid with drawl in the neonate

Question 26

naloxone please remember

Answer 26

last 45 minutes- it may be shorter than the opioid you are reversing- remember to tell PACU you gave it. may need an infusion.

Question 27

naloxone side effects

Answer 27

pul edema tachycardia, cardiac death

Question 28

nalmefene who do we give it to?

Answer 28

can be used to maintain recovering opioid abusers.

Question 29

the experience of pain are divided into 4 steps. please name them

Answer 29

transduction transmission modulation perception

Question 30

transduction

Answer 30

peripheral nerves are activated to organize the inflammation response so the brain can interpret a delta fibers- fast sharp c fibers- slow dull

Question 31

transmission

Answer 31

3 neuron pain pathway along the spinothalamic track 1-periphery-drg 2-drg-thalamus 3thalamus-cortex

Question 32

modulation

Answer 32

modulation is at substantial gelatinous in the dorsal horn the descending inhibitory pain pathway begins in the periaqueductal gray and the rostroventral medulla it projects to the substantial gelatinous. pain is inhibited when spinal neurons release gaba and glycine the descending pain pathway releases NE, 5HT, and endorphins . pain is augmented by central sensation and wind up

Question 33

perception

Answer 33

how we feel about pain

Question 34

allodynia

Answer 34

reduced threshold to pain stimulus

Question 35

hyperalgesia

Answer 35

increased response to pain stimulus.

Question 36

gender plays a role in pk/pd differences | how is morphine different for women

Answer 36

greater analgesic potency slower onset of action longer duration of action lower post operative opioid consumption

Question 37

name the opioids most potent to least potent

Answer 37

sufentanil-fentanyl-remifentanil-alfentanil-hydromorphone-morphine-meperidine

Question 38

meperidine is structurally related to?

Answer 38

atropine

Question 39

meperidine is structurally related to atropine meaning it will exhibit what effects

Answer 39

tachycardia, mydriasis, and dry mouth

Question 40

name drugs that cause histamine release

Answer 40

meperidine, morphine, codeine, and oxycodone

Question 41

how quickly does alfentanil equilibrate?

Answer 41

1.4minutes | due to it being 90% unionized- readily crosses the BBB

Question 42

how quickly does fentanyl and sufentanil cross the blood brain barrier

Answer 42

6ish minutes

Question 43

methylnaltrexone

Answer 43

unable to cross the BBB it does not reverse respiratory depression helpful in reversing opioid induced bowl dysfunction

Question 44

nalmefene

Answer 44

used to maintain recovering opioid abusers last 10 hours

Question 45

naltrexone

Answer 45

last 24 hours- DOES NOT UNDERGO SIGNIFICANT FIRST PASS METABOLISM. used to maintain opioid abusers