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Anaesthesiology > Opiods > Flashcards

Opiods Flashcards

(106 cards)

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1
Q

What are opioids

A

These are narcotic analgesics

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2
Q

Where in the body are opioid receptors more concentrated?

A

Limbic system
Thalamus
Hypothalamus
Striatum
Reticular Activating System
Midbrain
Substantia Gelatinosa of spinal cord
Nerve plexus of intestines

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3
Q

What are the five species of opioid receptors?

A

Mu, Delta, Kappa, sigma, epsilon

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4
Q

What are the two general mechanisms of analgesic action

A

Supraspinal
Spinal

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5
Q

What are the sites of action of analgesics in the Supraspinal system

A

PeriAqueductal gray (found in the midbrain)

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6
Q

What are the sites of action of analgesics in the Spinal system

A

The site of action is receptors in the Substantia Gelatinosa region of the spinal cord (upper dorsal portion of spinal cord)

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7
Q

What are the general effects of morphine on the central nervous system?

A

Morphine has both depressive and stimulatory effects

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8
Q

What are the signs of depressive effects that morphine has on central nervous system?

A

Analgesia.
Sedation.
Mood changes.
Alveolar hypo ventilation

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9
Q

What are the stimulatory effects that morphine has on the central nervous system?

A

Pupillary constriction
Nausea and vomiting
Hyperactive spinal reflexes.
Convulsions

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10
Q

Why is morphine not a good anesthetic agent but a good analgesic?

A

This is because morphine and other. Agonist are selective analgesics because they can produce profile so with no effect on other sensory modalities i.e. unconsciousness.

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11
Q

True or false morphine is a complete anesthetic agent

A

False it is not a complete anesthetic agent. It has poor anesthetic properties.

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12
Q

How does morphine cause alveolar hypo ventilation?

A

This is a result of the direct action of morphine on respiratory centers in the brainstem.

The respiratory rate is diminished, and minute volume is reduced

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13
Q

When does the maximum respiratory effect of morphine occur with an IV dose versus an IM dose?

A

It occurs 5 to 10 minutes after an IV dose and between 30 and 60 minutes after an IM dose

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14
Q

True or false morphine is contraindicated in patients with respiratory insufficiency

A

True

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15
Q

In relation to the eyes, list one side effect of morphine

A

Pupillary constriction
Pinpoint pupils are the hallmark of an overdose of morphine

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16
Q

What causes miosis in morphine use?

A

Miosis is due to the stimulation of parasympathetic component of the third cranial nerve nucleus (Edinger- Westphal)

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17
Q

How does morphine cause, nausea and vomiting?

A

It directly stimulates the chemo receptor trigger zone at the Medulla

(Delayed SE, potentiated by ambulation)

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18
Q

What causes truncal rigidity with morphine administration?

A

Hyperactive spinal reflexes

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19
Q

Convulsions are usually a rare side effect of morphine when do they occur

A

With extremely high doses of morphine

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20
Q

What is the effect of morphine on the cardiovascular system?

A

It causes a dependent bradycardia by direct stimulation of the vagus nucleus however, it does not depress myocardial contractility

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21
Q

How can morphine cause orthostatic hypotension?

A

Morphine causes vasodilation of peripheral vessels, such as arteries and veins, and during the ambulatory patient orthostatic, hypertension can occur due to pooling of blood, in the more peripheral vessels from the vessels in the brain.

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22
Q

List two respiratory contraindications for morphine

A

Patients with asthma, or bronchitis, having an acute episode of bronchospasm

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23
Q

Why is morphine contraindicated in patients with asthma and bronchitis?

A

This is because morphine causes a histamine release which causes bronchoconstriction , and this can exacerbate bronchospasms experienced by patients with asthma and bronchitis

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24
Q

What is the effect of morphine on the physiology of the gastrointestinal tract?

A

Morphine stimulates, the smooth muscle of the G.I. tract but propulsive peristalsis is diminished and segmental tonic contraction is increased

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25
What are the effects of morphine on the gastrointestinal tract?
Constipation. Biliary colic in patients with gallbladder disease
26
How can morphine cause biliary colic in patients with gallbladder disease?
This is as a result of spasm of OD sphincter, and an increase in pressure in the biliary tree
27
How can you reverse the spasm of the gall bladder sphincter in patients with gall disease who are being treated with morphine?
This can be reserve first with administration of naloxone or nitroglycerin
28
Often times patients with gallbladder disease, who are being treated with morphine will get a sudden onset of pain, and that can be confused with acute myocardial ischemia which drug can relieve only morphine induced biliary colic, and which drug will relieve the pain of the morphine induced vary and the pain of myocardial ischemia
Naloxone will relieve morphine induced biliary colic Nitroglycerin will relieve morphine induce, the biliary colic, and the pain of myocardial ischemia
29
What is the effect of morphine on the genito urinary tract?
It can cause spasm of the bladder, sphincter and lead to urinary retention
30
What is the effect of morphine on the intracranial pressure?
Morphine can cause hypercapnia, which can increase cerebral blood flow and cause rise and intracranial pressure in patients with intracranial space occupying lesions
31
Define tolerance
Tolerance to a drug is characterized by the need for increasing doses, to obtain the same therapeutic effect after repeated exposure
32
Tolerance to morphine is reversible when does sensitivity to therapeutic dose return to normal for a person with increased tolerance?
Returns to normal after an abstinence of one to two weeks
33
What is addiction?
Addiction is a state of psychological and physical dependence that manifest itself in the withdrawal syndrome
34
When do the signs of withdrawal of an opioid appear in long-term addict?
8hrs after the last dose Peaks is 48-72 hours Runs a 5-10 day course
35
What are the signs and symptoms of opioid withdrawal syndrome?
Lacrimation, rhinorrhea, diaphoresis, vomiting and diarrhea, incessant, yawning, goosebumps, dilated pupils, hypertension, tachycardia, abdominal cramps, muscle aches
36
Which drug is known to counteract the emetic effects of morphine, but potentiates, its analgesic, sedative and respiratory depressant effects
Phenothiazines (chlorpromazine)
37
True or false allergic reactions to morphine are very common
False Wheels and itch at the site of injection are local reactions to histamine release, and should not be considered sign of true allergy
38
What is the difference between nociceptive and neuropathic pain?
Nociceptive pain is the results of stimulation of nose, receptors by noxious stimuli, whilst neuropathic pain is the result of dysfunction of the nervous system
39
What are the two afferent nerve fibers that conduct pain stimuli?
Small myelinated- A delta fibers : sharp pain and Unmyelinated C Delta fibers : dull pain
40
What is the oral dose of morphine?
5 - 20 mg every 4 hrs
41
What is the intramuscular dose of morphine?
0.1-0.2 mg/kg every 4 hrs
42
True or false morphine is particularly effective for sharp, superficial pain less effective for visceral pain
False Morphine is particularly effective for visual pain and less effective for sharp superficial pain
43
What drug can you administer to reverse meiosis seen as a side effect of morphine administration?
Meiosis occurs in morphine administration due to stimulation of the Edinger Westfall nucleus, and can be reversed by using atropine
44
What could be the possible cause of morphine poor anesthetic effect?
Morphine is poorly, lipid soluble, and only a small fraction of a given dose, crosses the blood brain barrier to act as an opioid receptor
45
What is the main pathway for elimination of morphine?
Conjugation in the liver with glucuronic acid Excretion of water soluble, metabolites by the kidneys 90% excreted in urine 10% excreted in bile and appears as faeces
46
How much more potent is diamorphine than morphine
Twice (x2)
47
Dimorphine is commonly used to treat what kind of pain and in want dose?
Dyspnoea associated with pulmonary edema at 2.5 - 10 mg
48
Which opioid produces the greatest degree of euphoria and subsequently, has become a drug of abuse?
Diamorphine
49
How much less potent is codeine to morphine?
10x less
50
What are the common uses of codeine?
Antitussive Ant diarrhea Hypnotic. Anxiolytic
51
What is the dose given for IV fentanyl
1.5 µg per kilogram
52
What is the duration of analgesic action of fentanyl?
30mins
53
What is the use of Alfentanil
It is given in incremental doses to supplement inhalational anesthesia, or in a continuous infusion together with an intravenous anesthetic in total intravenous anesthesia
54
How much more potent is fentanyl than morphine and how much more potent is it than fentanyl?
Sufentanil is 100 times more potent than morphine and 10 times more potent than fentanyl 
55
Which opioid is widely used as an oral analgesic
Codeine
56
List 3 groups of analgesics
Acetominophen NSAIDS OPIOIDS
57
What are the 3 steps to pain management
Step 1: non-opioid: acetaminophen or NSAIDS Step2: weak opioid: Codeine, Tramadol Step 3 : strong opioid: Morphine, Oxycodone, Fentanyl
58
List two examples of Acetaminophen drugs
Tylenol Panadol (paracetamol)
59
What type of pain is acetaminophen used for
Acute Mild pain
60
What is a side effect of acetaminophen
Liver toxicity in high doses
61
List 4 NSAIDS
Aspirin Diclofenac Ibuprofen Naproxen
62
NSAIDS are used to manage what type of pain?
Mild- Moderate
63
What is the moa of NSAIDs
Cox 1 & Cox 2 inhibitor Reducing pro inflammatory and prostaglandin synthesis
64
List 5 complications or side effects of NSAIDs
Gastric Ulcer Decreased Renal Perfusion Photosensitivity Premature closure of ductus arteriosus in pregnancy CI in dengue due to reduced platelet count
65
List 3 examples of oral opioids
Codeine Oxycodone Morphine
66
List 3 examples of parentéral opioids
Morphine Hydromorphone Fentanyl
67
Opioids are used in the management of what type of pain?
Moderate acute pain (oral) Moderate- severe acute pain (parenteral)
68
What is the moa of opioids
Dampens nociceptive transmission between 1st and 2nd order neurons in the dorsal horn
69
List 8 SEs of opioids
(HECK OF A DREAM) H- histamine release E- emesis C- CVS (hypotension) D- depression of cough reflex, decreased GI motility, depression of CNS = analgesia R- respiratory depression E- euphoria A- analgesia M- miosis
70
List 7 Opioid Agonists
Codeine Morphine Oxycodone Fentanyl Remifentanil Methadone Pethidine
71
What is the dose given for Codeine
15-30mg PO
72
What is the dose given for Meperidine for postoperative shivering
20-25mg
73
Which drug is commonly used to treat post operative shivering
meperidine 20-25mg
74
What is the dose given for Morphine IM and IV
IM- 0.1-0.2mg/kg q4hr IV- 0.2-0.3 mg/kg
75
What is the dose given for Fentanyl
2-3 micrograms/kg IV
76
What is the dose given for Pethidine
0.5-1mg/kg
77
List 3 opioids with a rapid onset of action
Fentanyl (<5mins) Remifentanil (1-3mins) Pethidine (<5mins)
78
What is the onset of action of Morphine?
5-10mins
79
What is the onset of action of Codeine?
30-60mins
80
What is the duration of action of Codeine?
4-6hrs
81
What is the duration of action of Morphine?
2-4hrs
82
What is the duration of action of Oxycodone (controlled release)?
8-12 hrs
83
What is the duration of action of Fentanyl?
0.5-1hr
84
What is the duration of action of Remifentanil
<10mins
85
What is the duration of action of Pethidine?
2-3hrs
86
What is the effect of codéine on BP
Significant decrease in BP
87
Why isn’t Meperidine commonly used for pain management?
Due to potential toxicity compared with other opioids
88
Contraindications for Meperidine
MAOI (antidepressant) use
89
What is the effect of Morphine on the CVS
Decreased BP
90
What are the main uses for Codeine
Post operative pain Antitussive Anti diarrheal Anxiolytic
91
Morphine is mainly used to manage what type of pain?
Visceral Pain (Less effective for sharp superficial pain)
92
What is the main side effect seen in Fentanyl with high doses?
Transient muscle rigidity
93
What is the effect of fentanyl on BP
No significant effect
94
What type of pain is Fentanyl used to manage?
Pain associated with minor surgery
95
High doses of what opioid is used to obtund the CVS effects of Laryngoscopy
Fentanyl
96
When is Remifentanil used ?
During induction and maintenance of anaesthesia
97
What is the effect of Remifentanil on BP
Reduces BP
98
What is the most common use for Meperidine?
Slow weaning programmed for Opioid Addicts
99
Pethidine is commonly used in the management of what pain?
Pain during labour
100
What is the effect of Pethidine on CVS
Inc. BP Inc. HR initially Followed by a fall after 10-15 mins
101
What are some contraindications for Pethidine use?
Use with MAOI (antidepressants) leading to coma , convulsions, hyperpyrexia
102
What is patient controlled analgesia?
This involves the use of computerized pumps that can deliver a constant infusion and bolus breakthrough doses of parentally administered opioid analgesics under the patient’s control
103
What are the most common drugs used in PCA - patient controlled analgesia
Morphine Hydromorphone
104
List 4 advantages of PCA
- improved patient satisfaction - fewer side effects - accommodates patient variability - accommodates changes in opioid requirements
105
List 2 opioid antagonists
Nalaxone Naltrexone
106
Between nalaxone and naltrexone (opioid antagonists) which is long acting and which is short acting?
Nalaxone is short acting (repeated doses may have to be given since the half life is shorter than the half life or morphine- so when Nalaxone wears off the effects of the opioid may return is a second dose is not administered) Naltrexone is long acting

Anaesthesiology (10 decks)

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