Exam 1: LA Adjuncts w/ Doses

Question 1

Adjuncts: What do Opioids do with LA

Answer 1

Increase Density and Analgesia

Question 2

Adjuncts: What do A2 Agonists do with LA

Answer 2

Increase Density, Analgesia, duration

Question 3

Adjuncts: What do Vasoconstrictors do with LA

Answer 3

Increase Duration

Question 4

What are the 2 Lipophilic Opioid Adjuncts?

Answer 4

Fentanyl + Sufentanil

Question 5

What are the 3 Hydrophilic Opioid Adjuncts

Answer 5

Morphine + Hydromorphone + Meperidine

Question 6

Adjuncts: Sufentanil
*SAB Dose
*Epidural Dose
*Epidural Gtt

Answer 6

*SAB: 5-10 mcg

*Epidural: 25-50 mcg

*Epidural Gtt: 10-20 mcg/hr

Question 7

Adjuncts: Fentanyl
*SAB Dose
*Epidural Dose
*Epidural Gtt

Answer 7

*SAB: 10-20 mcg

*Epidural: 50-100 mcg

*Epidural Gtt: 25-100 mcg/hr

Question 8

Adjuncts: Hydromorphone
*SAB Dose
*Epidural Dose
*Epidural Gtt

Answer 8

*SAB: NONE

*Epidural: 0.5-1 mg

*Epidural Gtt: 0.1-0.2 mg/hr

Question 9

Adjuncts: Meperidine
*SAB Dose
*Epidural Dose
*Epidural Gtt

Answer 9

*SAB: 10 mg

*Epidural: 25-50 mg

*Epidural Gtt: 10-60 mg/hr

Question 10

Adjuncts: Morphine
*SAB Dose
*Epidural Dose
*Epidural Gtt

Answer 10

*SAB: 0.25-0.30 mg

*Epidural: 2-5 mg

*Epidural Gtt: 0.1-1 mg/hr

Question 11

Adjuncts: Dex Dose

Answer 11

3 mcg

Question 12

Adjuncts: Clonidine Dose

Answer 12

15-45 mcg

Question 13

Adjuncts: Epi Wash Dose

Answer 13

0.2-0.3 mg

Question 14

Adjuncts: Phenylephrine Wash Dose

Answer 14

2-5 mg

Question 15

Where in the spinal cord do opioids work?

Answer 15

Substantia Gelatinosa, Lamina 2

Question 16

At the cellular level, how do opioids work (3)?

Answer 16

Decreased cAMP
Decreased Ca++ conductance
Increased K+ conductance

Question 17

Hydrophilic Opioids Characteristics w/ LA (6)

Answer 17

1. Stays longer in CSF
2. More Rostral Spread in CSF
3. Longer to Onset
4. Longer Duration
5. Less Systemic Absorption
6. LATE respiratory depression

Question 18

Lipophilic Opioids Characteristic w/ LA (6)

Answer 18

1. Shorter duration in CSF
2. Limited Rostral Spread in CSF
3. Fast Onset
4. More Systemic Absorption
5. EARLY respiratory depression

Question 19

Tx for Opioid Induced Pruritis (3)

Answer 19

1. Benadryl 25-50 mg
2. Narcan 0.1 mg
3. Buprenex

Question 20

Prophylaxis for Opioid Induced Pruritis (3)

Answer 20

1. Morphine <300 mcg
2. Zofran 4 mg
3. Nubain 2.5-5 mg

Question 21

If I am giving Intrathecal Morphine, what 3 monitors are needed?

Answer 21

1. Capnography
2. Pulse Ox
3. Alarms

Question 22

How is Intrathecal Opioid Respiratory Depression Reversed?

Answer 22

Narcan 0.1-0.2 mg

Question 23

Tx for PONV d/t Intrathecal Opioids (3)

Answer 23

1. Zofran
2. Narcan 0.1 mg
3. Phenergan 12.5-25 mg

Question 24

What % of Pts have Urinary Retention from Neuraxial Opiate use?

Answer 24

30-40%