Exam 2 Flashcards
1
Q
Factors that accentuate ventilatory depression (6)
A
Older age >60 years
Occurrence of natural sleep/sleep disorders
Opioid naivety
Male
Chronic heart failure
Intra-articular morphine
2
Q
Factor that attenuates ventilatory depression (1)
A
pain of surgery
3
Q
Re-narcanization immediately post op (2 reasons)
A
1) Mobilization of opioids from other compartments (e.g., muscles, fat group) increased blood flow, increased movement, warming
2) Reduction in stimulation post-extubation
4
Q
how large of a dose of fentanyl is required to blunt sympathetic response
A
5-8 mcg/kg: will totally blunt sympathetic response from laryngoscopy
Takes a massive amount to truly eliminate the autonomic response, but normal dose can help a little it (1-2 mcg/kg: analgesia)
5
Q
Design two anesthetic techniques to provide reliable amnesia during an “opioid
anesthetic.”
A
volatile agents
benzodiazepine (such as versed)
6
Q
neuraxial opioids, order the speed of ONSET (fastest to slowest) (morphine vs fentanyl)
A
fentanyl > morphine
7
Q
what neuraxial drug can travel further cephalad and cause greater issues
A
morphine (low lipid solubility)
8
Q
Lipid Solubility (most lipid > least lipid)
A
Sufentanil > Fentanyl > Alfentanil > Demerol > Morphine
9
Q
neuraxial opioids, order the DURATION (shortest to longest) (morphine vs fentanyl)
A
Fentanyl (50-100 mcg) lasts 1-3 hours
Morphine (2-5 mg) lasts 4-24 hours
10
Q
what drug can cause myocardial depression and what is the dose
A
Demerol
2 mg/kg (not much more than the max dose)
11
Q
what 2 drugs can cause histamine release
(increased HR, bronchoconstriction (B2), decreased BP, decreased SVR, welts, itching)
A
morphine
demerol
12
Q
what metabolite can cause seizures and what is the dose
A
Normeperidine (from demerol)
> 5 mg/kg can cause seizures
13
Q
what 2 drugs cause direct relaxation of aortic (arterial) smooth muscle
A
sufentanil and alfentanil
14
Q
what drug causes a weak alpha blockade
A
sufentanil
15
Q
what opioid causes tachycardia (the only one!)
how does the tachycardia occur
A
demerol
similar in chemical structure to atropine
16
Q
what is demerol equivalent to 10mg morphine*
A
100 mg
1/10th as potent
17
Q
what is fentanyl equivalent to 10mg morphine
A
100 mcg
100x more potent
18
Q
what is dilaudid equivalent to 10mg morphine
A
1.5 mg
19
Q
what is sufentanil equivalent to 10mg morphine
A
10 mcg
1000x more potent
20
Q
what is the semi-synthetic opioid
A
hydromorphone (dilaudid)
21
Q
what is the naturally occurring opioid
A
morphine
22
Q
what are 3 most common side effects of neuraxial opioids and treatment
A
pruritus (treat with gabapentin or 0.25 mcg/kg/hr Narcan)
resp depression (treat with physostigmine or 0.25 mcg/kg/hr Narcan)
urinary retention (NOT related to opioid dose size)
(treat with Narcan)
23
Q
sufentanil is ____x more potent than fentanyl
A
10x more potent
50 mcg of fent= 5 mcg of sufentanil
24
Q
sufentanil is ______ lipid soluble than fentanyl
A
sufentanil is more lipid soluble than fentanyl
25
what is CSHT of remifentanil
4 minutes always
26
what drug causes opioid induced hyperalgesia
remifentanil
27
what drug is indicated for
Neuro assessments
Craniotomy
Carotid endarterectomy
Procedures with significant pain
Laryngoscopy
Retrobulbar block
L&D
remifentanil
28
what drug is indicated for
infusions
TIVA
sufentanil
29
what drug is indicated for single, brief stimulus
Laryngoscopy
Retrobulbar block (cataract)
alfentanil
30
The degree of drug receptor interaction for a given drug (potency/attraction) differentiate between different agonists that activate the same receptor, can all produce the same maximal response, but at differing concentrations
affinity
31
Intrinsic activity, a drug’s ability to produce the desired response expected by stimulation of a given receptor, the maximum effect that can be achieved with the drug
efficacy
32
the ratio of LD50 (lethal dose) to ED50 (desired effect)
LD50: ED50
therapeutic index
the larger the number, the safer it is!
33
rank therapuetic index (from safest to least safe)
safest:
remifentanil > sufentanil > alfentanil > fentanyl > morphine
34
The time for the plasma drug concentration to decrease by 50% after discontinuing a continuous infusion of a specific duration
Considers distribution, metabolism, and duration of infusion
context sensitive half time
the longer the CSHT, the longer the recovery! (fentanyl has long CSHT, remifentanil has shortest at 4 minutes)
35
The half-time between drug concentration in the blood and the drug effect
Effect Site Equilibration Time
36
what drug is quicker onset
sufentanil or alfentanil
alfentanil
37
what drug has a shorter CSHT and effect site concentration
sufentanil or alfentanil
sufentanil!
this is related to larger Vd, greater redistribution, so it is NOT in the plasma
38
which drug has the SHORTEST CSHT and effect site concentration
remifentanil
39
what is pre-emptive doses of opioids
Prophylactic opioids given before the pain starts
Pre-emptive doses of opioids may decrease the chance of sympathetic response to stimulation
40
G protein coupled receptors result in a __________ in intracellular cAMP
decrease
41
Opioids act like these 3 endogenous peptides/ligands that normally activate receptors***
enkaphalins
endorphins
dynorphins
42
Opioid Agonist: binds to opioid receptors at ______ the ____synaptic and ___synaptic sites in the CNS and peripheral sites (primary __fferent neurons)***
Opioid Agonist: binds to opioid receptors at both the PREsynaptic and POSTsynaptic sites in the CNS and peripheral sites (primary AFferent neurons)
43
The principal effect of opioids binding to specific G protein-coupled receptors is a ____________ in neurotransmission
decrease in neurotransmission
44
Activation of the opioid receptor (OR) causes:
________ of Ca2+ channels: presynaptic
________ of K+ channels: postsynaptic
closing Calcium (reduction in neurotransmitters)
opening K channels (potassium LEAVES the cell; hyperpolarizes the cell, inhibition occurs)
45
what receptors work presynaptically
mu, kappa, delta
46
what receptors work postsynaptically
mu
47
what occurs with the decrease in cAMP
closes voltage-gated calcium channels (decreased neurotransmitters)
opens potassium channels (hyperpolarization), resulting in decreased neuronal activity
48
what is the opioid analgesic effect (2 things)
1) Directly inhibit the ascending transmission of nociception information from the spinal cord dorsal horn to the midbrain
2) Modulation: activate pain control pathways that descend from the midbrain, via the rostral ventromedial medulla to the spinal cord dorsal horn
o Altering pain transmission
49
opioids directly inhibit the ___________ transmission of nociception information from the spinal cord _______ ________ to the ___________
directly inhibit the ascending transmission of nociception information from the spinal cord dorsal horn to the midbrain
50
Modulation: activate pain control pathways that ___________ from the __________, via the rostral ventromedial medulla to the spinal cord dorsal horn
Modulation: activate pain control pathways that descend from the midbrain, via the rostral ventromedial medulla to the spinal cord dorsal horn
51
noxious stimuli (chemical, thermal, mechanical energy) is converted to an electrical impulse in sensory nerve endings
transduction of pain (1st)
52
conduction of electrical impulses (action potential propagation) to the CNS: major connections for these nerves in dorsal horn of the spinal cord (signal transmitted along myelinated __--____ fibers and unmyelinated ___ fibers)
transmission of pain (2nd)
myelinated A-delta fibers and unmyelinated C fibers
53
altering pain transmission
Modulation of pain (3rd)
54
occurs at the thalamus with the cortex important for discrimination of specific sensory experiences
perception of pain (4th)
55
what receptor is found in the spinal cord only
mu 2
56
what receptor is known for the worst respiratory depression
mu 2
57
what receptor has dynorphins and agonists/antagonists
kappa
58
what receptor has endorphins, morphine, and synthetic opioids
mu 1 and mu 2
59
what receptor has enkephalins
delta
60
what receptor creates analgesia AND euphoria
mu 1
61
what receptors cause resp depression (3)
mu 2*, kappa, delta
62
what receptor causes psychotomimetic, dysphoria, and dissociation
kappa
63
what receptor causes hypothermia
mu 1
64
what receptor causes bradycardia
mu 1
65
what receptors cause urinary retention (3)
mu 1, mu 2 and delta
66
what receptors cause constipation and physical dependence (2)
mu 2 (constipation is worse), delta
67
what receptor can reverse mu 2 resp depression
kappa
68
what receptor is used in L&D often
kappa
69
what receptor can cause sedation
kappa
70
what receptors can cause miosis (3)
mu 1, mu 2, kappa
71
Exogenous opioids act on the brain circuits by stimulating the release of ___________ opioid peptides.
exogenous opioids (drugs) stimulate endogenous ligands (endorphins, enkaphalins, dynorphins)
72
what happens with patients with:
debilitated
or
increased sympathetic tone (increased HR, increased SVR) due to trauma, hypovolemic) when given opioids
This leads to exaggerated MAJOR decrease in BP
due to ATTENuation of compensation
73
______________ responsiveness to PaCO2, the CO2 response curve shifts to the ______
Decreased responsiveness to PaCO2, the CO2 response curve shifts to the right
Takes a higher PaCO2 to make the patient want to breathe!
74
opioids cause:
___________ respiratory rate, compensation occurs in the body with ___________tidal volumes
decreased respiratory rate,
compensation occurs with increased tidal volumes
75
If patient is manual ventilated (so hypercarbia is avoided):
opioids are cerebral vaso___________
vasoconstrictors, decreased ICP
normal situations!
manual ventilation!
76
if patient is spontaneously breathing and is hypoventilating:
opioids are cerebral vaso___________
vasodilators, increased ICP
increased PaCO2 results in cerebral vasodilation
77
consciousness, amnesia,
and response to stimulation
low doses =
Mild sedation, NO amnesia, YES response to stimulation
consciousness, amnesia,
and response to stimulation
78
consciousness, amnesia,
and response to stimulation
moderate doses =
Moderate sedation, NO amnesia, some response to stimulation
79
consciousness, amnesia,
and response to stimulation
massive doses =
unconciousness, NO amnesia, some response to stimulation
80
true or false
pupillary changes are NOT effective during general anesthesia as a tool to assess opioid effects
true
do not use it!
81
how do opioids work at the biliary
narrows the sphincter of Oddi; causes increasing intrabiliary pressure and epigastric distress
82
opioids work by _________ stimulation of _______________ trigger zone in floor of the _________ ventricle
opioids act like partial __________ at __________ receptors!
direct stimulation of chemoreceptor trigger zone in floor of the fourth ventricle
Opioids act like partial agonists at dopamine receptors!
83
what is the treatment for biliary spasm
glucagon, then narcan
84
avoid what 4 things to help reduce N/V for patients getting opioids
Ambulation
Extreme pain
PCA pumps
Epidurals
85
Stiff Chest Syndrome/Trunchal Rigidity
cause:
LARGE, RAPID doses of highly lipid-soluble opioids (fentanyl, sufentanil, alfentanil)
86
Stiff Chest Syndrome/Trunchal Rigidity:
__________ of GABA; ___________ in dopamine
Inhibition of GABA; increase in dopamine
Intensification of tone of large muscles of the thorax and abdomen
87
Stiff Chest Syndrome/Trunchal Rigidity
treatment
NMBs
88
If patient is asleep, what might indicate biliary spasm at the sphincter for a cholangiogram
the surgeon cannot get the dye to make it in because it is spasming
89
true or false
opioids CAN pass the placental barrier
true
90
are opioids teratogenic
no, opioids CAN be used for non-deliveries
91
True or false
you give opioids once the cord is clamped in a c-section
true
92
termination of effect
small/single dose of opioid
redistribution
93
termination of effect
large/repeated doses of opioids
metabolism
94
which drug and its metabolite is eliminated solely through the kidneys
Meperidine/Demerol
Normeperidine
95
which drugs are eliminated through the kidneys and bile
Morphine, Fentanyl, Sufentanil, Remifentanil, Alfentanil
96
what opioid is metabolized by plasma esterases
remifentanil (very short half time)
97
what benzodiazepine is metabolized by tissue esterases
byfavo (ultra short acting)
98
opioid induced hyperalgesia:
Potent pain relief during case, then once they don’t have that, they are ______ sensitive to their pain
more likely to occur with ________ doses
Possibly due to alteration in _______ receptor
Potent pain relief during case, then once they don’t have that, they are MUCH MORE sensitive to their pain
more likely to occur with LARGE doses
Possibly due to alteration in NMDA receptor
99
what is treatment for opioid induced hyperalgesia
Ketamine and magnesium (NMDA blockers)
100
what is the most potent opioid, can cause stiff chest syndrome, glottic obstruction (laryngospasm), and weak alpha blockade of aorta
sufentanil
apnea upon induction! make sure you are giving slow and splitting it up! sit there!
101
The development of increased dose needed to achieve the same analgesia as previously with a smaller dose
tolerance
Usually requires 2-3 weeks to develop with morphine, but can develop more quickly with highly potent opioids
102
which drug is more potent than fentanyl, and patients can still be extubated sooner
sufentanil
103
context sensitive half time (shortest to longest)
Remifentanil > sufentanil > alfentanil > Fentanyl
104
what 2 drugs have a high synergistic effect
fentanyl and versed
(respiratory depression, sedation, hemodynamic changes)
105
true or false
You can give normeperidine to a patient with a seizure disorder
true
UNLESS you are giving repeated doses or the patient has renal failure
106
what is the most potent amnesia benzo
lorazepam
107
what is the most hemodynamically stable benzo
diazepam
108
what benzo has the fastest clearance rate
versed
109
what metabolite (elimination half life) is 48-96 hours and is only slightly less potent than its parent drug
dezmethyldiazepam
(elderly are sensitive)
110
what is termination of action for benzodiazepines
redistribution
111
MOA:
Moderate affinity for mu receptors; weak activators of kappa and delta
This creates less respiratory depression
Inhibits reuptake of norepi and serotonin
Inhibits release of presynaptic release of serotonin
tramadol
112
MOA:
Competes with benzos and displaces them for the benzodiazepine receptor site on the GABA receptor
Reverses respiratory depressant effect
flumazenil
113
MOA:
Displaces the opioid from the receptor, binds to receptor, inactivates it
Narcan
114
MOA:
Stimulates hypoxic drive via activation of ______________________ in the __________
1 mg/kg = PaO2 of 38 mmHg (tricks the body into thinking this, does NOT change it)
Doxapram
Stimulates hypoxic drive via activation of chemoreceptors in the carotid
115
MOA:
Diffuse across the dura to affect ____ receptors on the spinal cord AND are absorbed to produce the effects like IV opioids
neuraxial opioids
mu receptors
116
MOA:
Bind to ____________ receptors (part of the GABA receptor), which enhance the affinity of binding of GABA to its receptor, opening of chloride channel, hyperpolarization of the neuron, and inhibition of the neuron to excitation
benzodiazepines
117
do H1 and H2 blockers alter the RELEASE of histamine
no
they just block the receptors so they cannot attach
118
Opioids cause bradycardia by:
___ node ___________, ________ conduction through ___ node
SA node depression, slowed conduction through AV node
119
agonists and antagonists:
cause antagonistic effect of what 2 receptors (helpful for pain management)
mu and kappa
120
true or false
agonists and antagonists limit toxicity of drug (ceiling effect, so the patient cannot overdose on it)
TRUE
121
true or false
agonists and antagonists cause no significant increase in interbiliary pressure
TRUE
122
agonists and antagonists
Maintain an analgesic effect (_) while simultaneously reversing respiratory depression (_) of opioid overuse
Maintain an analgesic effect (к) while simultaneously reversing respiratory depression (µ) of opioid overuse
123
reversibly binds receptor at SAME site as agonist but does NOT activate receptor
competitive antagonist
124
IRreversibly binds receptor at SEPERATE site from agonists (disables receptor)
non-competitive antagonist
125
true or false
Subsequent doses of agonist after opioid agonists and antagonists may NOT provide adequate analgesia
true
efficacy is reduced
126
what receptor causes withdrawal with agonists antagonists
µ receptor antagonist
127
which 2 agonists antagonists cause CV effects
Talwin
Stadol
128
which agonist antagonist is best for chronic pain and moderate pain
Talwin
129
which agonist antagonist is best for migraine headaches, post op pain, and shivering
Stadol
130
↑Cardiac Output and cardiac workload
↑SBP and pulmonary artery pressure
Caution when using on patients with CHF or MI
Talwin and Stadol
131
why is suboxone effective in regards to chronic pain patient who is opioid dependent
suboxone may reverse opioid-induced hyperalgesia (like ketamine and magnesium)
132
Neural plasticity occurs
Pain spreads beyond the site of injury
Pain is exaggerated and prolonged in response to noxious stimuli
hyperalgesia
133
what are the 5 effects of benzos
* Sedation
* Antegrade amnesia***
* Anxiolysis
* Anticonvulsant actions (good for seizures)
* Skeletal muscle relaxation
(barbiturates also bind to GABA, so they will have a synergistic effect!)
134
versed has a ___________ ring which makes it water soluble in pH of < 3.5
imadazole
135
which benzo has a cardioprotective effect
versed
136
versed: reduction of seizure activity:
alpha activity (resting) ___________
beta activity (attentiveness) ____________
alpha activity (resting) decreased
beta activity (attentiveness) increased
137
what is a drawback of using diazepam
dezmethyldiazepam (48-96 hours elimination half life) causes prolonged effects
138
which benzo has the slowest onset
lorazepam
139
negative side effects of narcan (6)
pulm edema
N/V
sympathetic stimulation (tachy, vfib ventricular irritability, HTN)
neonatal (withdrawal)
precipitation of abstinence syndrome
140
which drug do you use first: flumazenil or narcan
flumazenil (less side effects!)
141
which drug increases Vt (and a little RR) resulting in increased minute ventilation
Doxapram
142
where does NEGATIVE expectancy of analgesia occur
hippocampus
143
where does POSITIVE expectancy of analgesia occur
endogenous ligands
144
what receptor causes diaresis
kappa
145
works DIRECTLY on myocardium (protective)
kappa and delta
146
works PROXIMAL/noncardiac on myocardium (protective)
mu 1 and mu 2
147
what are the 3 supraspinal descending pathways for modulation
Rostral __________ ___________
Locus ___________
Midbrain _______________ ______ area
Rostral ventral medulla
Locus caeruleus
Midbrain periaqueductal gray area
148
as a result of the HPA axis, ______________ plasma cortisol levels occurs with _________ opioids
as a result of the HPA axis, decreased plasma cortisol levels occurs with chronic opioids
149
what is the overdose triad
miosis
hypoventilation
coma
150
which opioid should be used for ERAS protocol
fentanyl
151
which 2 drugs have first pass in the lungs
fentanyl and sufentanil
152
An active morphine metabolite that is toxic for renal failure patients, leads to prolonged duration
Morphine 6 Glucuronide
153
GABA is what 2 things
Anticonvulsant
Sedation
154
Glycine is what 2 things
muscle relaxant
anxiolytic
155
glycine
muscle relaxant:
spinal cord
156
glycine
anxiolytic:
brainstem
157
GABA
anticonvulsant:
brain motor circuits
158
GABA
sedation:
cortex
159
good drug for respiratory depression reversal
physostigmine
increases Ach available, does not displace the opioid off the receptor
160
high doses of opioids cause: apnea __________ loss of consciousness
high doses of opioids cause: apnea without loss of consciousness
161
what 2 side effects never develop tolerance
miosis
constipation
162
EPIDURAL:
_______________ added for ____________ absorption
SLOWER absorption: epinephrine added
163
SPINAL:
_______________ added to morphine for _____________ analgesia
epinephrine added to morphine for ENHANCED analgesia:
164
which side effect is not dose dependent for neuraxial opioids
urinary retention
165
MOA: interacting with opioid receptors in the trigeminal nucleus to cause:
pruritus
treatment: narcan or gabapentin
166
neuraxial decreased risk of vent depression
OB patients
167
neuraxial
MOA: cephalad migration and interaction with non-opioid receptors in the brainstem or basal ganglia; blocking the inhibitory neurotransmitters: glycine and GABA
CNS excitation
168
which drug can cause Serotonin syndrome
HTN, tachycardia, diaphoresis, hyperthermia, hyperreflexia, confusion, agitation, coma, seizures, coagulopathy, metabolic acidosis
demerol
169
which drug is used for
Suppression of postoperative shivering
Pediatrics (tonsillectomy)
demerol
170
fentanyl
_______________ stress response (when given WITH inhalation agent)
Suppresses stress response (when given WITH inhalation agent)
171
fentanyl
______________ stimulation (when given WITHOUT inhalation agent)
Sympathetic stimulation (when given WITHOUT inhalation agent)
172
More intense analgesia, LESS respiratory depression, extubated sooner
sufentanil
173
o Moderate pain
o Chronic pain
o Increased risk of physical dependence
agonist antagonist
talwin
174
agonist antagonist
o Migraines
o Post-op shivering and pain
stadol
175
agonist antagonist
Analgesia more potent than morphine!
stadol
176
o Good for CV patients!
o Relieves pruritis for OB patients
o “Lingering fentanyl induced respiratory depressant effects”
agonist antagonist
nubain
177
“Lingering fentanyl induced respiratory depressant effects”
Cancer pain
Opioid dependence
narcan does NOT work
buprenex
178
o “Lingering fentanyl induced respiratory depressant effects”
o Cancer pain
o Opioid dependence
agonist antagonist
buprenex
179
Buprenorphine + Narcan (___:____ratio)
4:1 suboxone
180
agonist antagonist for opioid induced hyperalgesia
suboxone
181
benzo
indications include long cases, CV cases, cases where patient will be intubated post op
ativan
182
benzo
indications include endoscopy, bronchoscopy, organ failure (due to tissue esterases)
byfavo
183
4 Beneficial Properties of Opioids
* Analgesia
* Preservation of blood flow autoregulation (CNS, heart, kidneys)
* Minimal cardiac depression with maintenance of hemodynamics
* Blunting of autonomic responses to sympathetic stimulation
184
which 2 drugs have cardiac protective effect
Morphine and remifentanil
185
4 mild withdrawal symptoms
o Yawning
o Diaphoresis
o Lacrimation
o Coryza: severe nasal congestion
186
which opioid is likely to cause respiratory depression (especially opioid naïve patients)
dilaudid
187
o Great for patients with renal failure
o Terminally ill patients
dilaudid
188
o Interacts with Zofran and Coumadin
o Seizures
o N/V
tramadol
189
Potency (most potent > least potent)
Sufentanil > Fentanyl > Alfentanil > Morphine > Tramadol > Demerol
190
Produces more euphoria
Interindividual variability related to P-450 CYP3A
alfentanil
191
which agonist antagonist is resistant to narcan
buprenex
192
Opioid Agonist: binds to opioid receptors at ______ the ____synaptic and ___synaptic sites in the CNS and peripheral sites (primary __fferent neurons)***
Opioid Agonist: binds to opioid receptors at both the PREsynaptic and POSTsynaptic sites in the CNS and peripheral sites (primary AFferent neurons)
193
Opioids act like the endogenous peptides/ligands that normally activate these receptors***
enkaphalins
endorphins
dynorphins
194
The principal effect of opioids binding to specific G protein-coupled receptors is a ___________ in neurotransmission***
DECREASE in neurotransmission
195
KNOW THIS
activation of opioid receptor causes
___________ of voltage-gated Ca2+ channels on PREsynaptic nerve terminals to cause a _______________ of the release of neurotransmitters (glutamate, acetylcholine, dopamine, norepinephrine, serotonin, and substance P)
____________ of K+ channels to hyperpolarize the cell (conductance), thus causing ______________ of the POSTsynaptic neurons***
CLOSURE of calcium channels= REDUCTION in neurotransmitters
OPENING of potassium channels= inhibition of POST
196
G protein coupled receptor:
_____________ adenylate cyclase
this results in ____________ in intracellular cAMP
INHIBITION of adenylate cyclase
results in DECREASE in cAMP
197
little opioid CV response occurs (safe to use) for these (3) occasions***
healthy
supine
normovolemic
198
with opioids, there is a ___________ responsiveness to PaCO2, so CO2 response curve shifts to the _________ and __________***
DECREASED responsiveness to PaCO2
shift to the RIGHT and FLATTENS
199
primary RESPIRATORY response of opioids***
decreased respiratory rate
to compensate, increased Vt occurs
200
Factors that accentuate ventilatory depression (6)***
Occurrence of natural sleep/sleep disorders
Older age >60 years
Male
Opioid naivety
Chronic heart failure
Intra-articular morphine
201
opioids cause _____________ ciliary activity***
decreased
makes it harder to clear the airways
202
true or false
opioids are NOT anesthetic***
TRUE
cannot be the only agent used!
203
opioids for normal PaCO2 cause cerebal vaso_____________***
vasoconstriction, leading to decreased ICP
(they are brain-protectant)
204
stiff chest syndrome is relieved by***
NMBs
205
treatment for biliary spasm***
glucogan (causes relaxation of smooth muscle)
206
what causes morphine's slow onset and prolonged duration***
low lipid solubility
207
which 2 drugs have first pass in the lungs***
Fentanyl and sufentanil
208
what causes termination of action for small/single dose of opioids***
redistribution
209
When used with propofol for TIVA, propofol inhibits degradation of alfentanil and sufentanil by ____-____%***
50-60%
210
morphine has increased movement ___________ for neuraxial***
cephalad
211
what is the only side effect that is NOT dose-dependent for neuraxials***
(NOT related to dose size)
urinary retention
212
pruritius
MOA: interacting with OPIOID receptors in the _________ nucleus***
trigeminal
213
what is the treatment for pruritus***
gabapentin
214
how does hypothermia occur with opioids***
inhibition of shivering
215
what opioid causes tachycardia (the only one!)
how does the tachycardia occur***
demerol
Similar in chemical structure to atropine
216
which drug can cause myocardial depression***
demerol
217
which drug is an anticholinergic***
demerol
218
which drug can cause seizures (CNS stimulant) delirium, hallucinations***
normeperidine
219
this drug causes MORE intense analgesia and LESS respiratory depression***
sufentanil
220
drug for neuro assessments***
remifentanil
221
drug that is great for patients with renal failure
and
has a similar metabolism to morphine***
diluadid
222
agonist antagonist that causes
dissociation (kappa)***
talwin
223
agonist antagonist
drug that RARELY causes dysphoria***
stadol
224
agonist antagonist
subsequent morphine doses are less effective
and
good for CV patients***
nubain
225
agonist antagonist
narcan does NOT work on this drug***
buprenex
226
agonist antagonist that is used for hyperalgesia*
suboxone
227
glycine
anxiolytic***
brainstem
228
benzodiazepines
GABA receptor
If the receptor is “acted on” at more than one site, the inhibition of the CNS to excitation is _____________***
synergistic
229
Water soluble
imidazole ring
pH of < 3.5 (becomes lipid-soluble in the body)***
versed
230
versed:
Hypovolemic patients (trauma, extreme dehydration): exaggerated ________ decrease in SVR and BP***
major decrease
231
diazepam causes this resp effect***
decrease in Vt
232
dezmethydiazepam causes drowsiness to return within ___ hours***
6 hours
233
always give flumazenil __________ narcan***
before
234
flumazenil only has 1 side affect***
withdrawal seizures for patients on seizure meds
(NO other side effects (because it is a weak agonist)
235
which drug can cause:
Acute pulmonary edema (increased pressure, permeability)
Sympathetic stimulation due to rapid return of pain (Tachycardia, V fib, HTN)
N/V***
narcan
push slow!
236
drug that increases minute volume (by increasing Vt mostly and some RR)***
doxapram
237
avoid doxapram for these patients (6)***
o Cerebrovascular disease
o Asthma (reactive airways)
o CAD, HTN
o Acute head injury
o Seizures
o Halothane (catecholamines)
238
Things used to prevent histamine release BP drop with morphine***
H1 and H2 blockers
fluid
keep supine
239
what 2 systems are preserved with opioids***
brain
heart
240
how does bradycardia with opioids occur***
vagal stimulation in the medulla
241
what is the greatest factor for duration and onset with opioids***
lipid solubility
