Opioid Agonists/Antagonists, Multimodal

Question 1

Morphine:
Dose
Onset
Peak
Duration

Answer 1

Dose: 1-10 mg IV
Onset: 10 to 20 mins (IV and IM)
Peak: 45 to 90 mins IM; 15 to 30 mins IV
Duration: 4-5 hours

Question 2

How is Morphine metabolized?

Answer 2

Glucorinic acid conjugation

Question 3

What are the two metabolites of morphine? Which is active? Inactive?

Answer 3

Morphine-3-glucoronide (Inactive)
Morphine-6-glucoride (Active)

Question 4

Which active metabolite of Morphine contributes to late respiratory depression?

Answer 4

Morphine-6-Glucoronide

Question 5

Which receptors does Meperidine/Pethidine agonize?

Answer 5

Mu and Kappa

Question 6

What are the four analogues of Meperidine?

Answer 6

Fentanyl
Sufentanil
Alfentanil
Remifentanil

Question 7

Meperidine
Dose:
Duration:
E 1/2 Time:
Metabolism:

Answer 7

Dose: 12.5 mg (Post-op shivering)
Duration: 2-4 hours
E 1/2 Time: 3-5 hours (35 hours with renal failure)
Metabolism: 90% Hepatic (Normeperidine)

Question 8

Fentanyl dose for…
Analgesia?
Induction?
Adjunct with inhaled anesthetics?

Answer 8

Analgesia - 1 to 2 mcg/kg IV
Induction - 1.5 to 3 mcg/kg IV
Adjunct with inhaled anesthetics - 2 to 20 mcg/kg IV

Question 9

Fentanyl dose for…
Surgical Anesthesia (Solo)
Intrathecal
Transmucosal (Oral)
Transdermal

Answer 9

Surgical Anesthesia (Solo): 50-150 mcg/kg IV
Intrathecal - 25 mcg
Transmucosal (Oral) - 5 to 20 mcg/kg
Transdermal - 75 to 100 mcg (18 hours steady delivery)

Question 10

Sufentanil doses

Answer 10

Analgesia - 0.1 to 0.4 mcg/kg IV
Induction - 18.9 mcg/kg IV

Question 11

Alfentanil dose for…
Induction laryngoscopy
Induction alone
Maintenance

Answer 11

Induction laryngoscopy - 15 to 30 mcg/kg IV
Induction alone - 150 to 300 mcg/kg IV
Maintenance - 25 to 150 mcg/kg/hours IV

Question 12

Remifentanil induction dose? Maintenance?

Answer 12

Induction - 0.5 to 1.0 µg/kg IV over 30-60 secs
Maintenance - 0.25 to 1 µg/kg IV or 0.005 to 2 µg/kg/min IV

Question 13

Hydromorphone dose?

Answer 13

0.5 mg IV (1 to 4 mg)

Question 14

Codeine
E 1/2 Time
Metabolism
Cough suppressant dose
Analgesia dose

Answer 14

E 1/2 Time - 3 to 3.5 hours
Metabolism - Liver
Cough suppressant dose - 15 mg
Analgesia dose - 60 mg

Question 15

120 mg of Codeine is equal to…

Answer 15

10 mg of Morphine

Question 16

Fentanyl is ____ - ____ times more potent than morphine?

Answer 16

75 to 125

Question 17

Pentazocine elimination 1/2 time?

Answer 17

2-3 hours

Question 18

Pentazocine moderate chronic pain dose? What dose can cause analgesia, sedation, and depression of ventilation?

Answer 18

Moderate Pain Dose - 10 to 30 mg IV or 50 mg PO (Equivalent to Codeine 60 mg)

20 to 30 mg IM can cause analgesia, sedation, and depression of ventilation (SImilar to 10 mg of Morphine)

Question 19

Butorphanol dose? Half-time? Metabolism?

Answer 19

2 to 3 mg IM or 0.5-2mg IV (Equal to 10 mg of Morphine)
2.5 to 3.5 hours
Hepatic

Question 20

Which opioid agonist-antagonist is equally potent to Morphine?

Answer 20

Nalbuphine (10 mg = 10 mg)

Question 21

Which dose of Buprenorphine is equal to 10 mg of Morphine?

Answer 21

0.3 mg IM/IV

Question 22

Buprenorphine dose? Onset? Duration?

Answer 22

0.3 mg IM/IV
Onset - 30 mins
Duration - 8 hours

Question 23

Dezocine dose?

Answer 23

0.15 mg/kg IM

Question 24

100 mg of what drug is equal to 8 mg of Morphine?

Answer 24

Meptazinol (Duration < 2 hrs)

Question 25

Naloxone dose? Continuous infusion? Shock? Epidural?

Answer 25

1 to 4 µg/kg IV (or 40-80mcg) Continuous - 5 µg/kg IV Shock - > 1 mg/kg IV Epidural - 0.25 µg/kg/hour IV

Question 26

Naloxone duration? Metabolism? E 1/2 time?

Answer 26

30 to 45 mins Liver (Glucoronic Acid) 60-90 min half-time

Question 27

Naltrexone duration? Use?

Answer 27

24 hours Alcoholism

Question 28

Nalmefene dose? E 1/2 time?

Answer 28

15 to 25 mcg IV q 2 to 5 mins 10.8 hours

Question 29

Which drugs are given pre-op and post-op?

Answer 29

Acetaminophen Gabapentin

Question 30

Gabapentin dose for preemptive analgesia?

Answer 30

300 to 1200 mg PO 1-2 hours before OR

Question 31

Celebrex dose? Peak?

Answer 31

200-400 mg PO QD 3 hours

Question 32

Ofirmev Dose? Peak? Duration?

Answer 32

Dose: 1000 mg IV q4-6H (Max 3000-4000 mg QD) Peak: PO (1-3 hours), IV (30 mins to 1 hour) Duration: 6-8 hours

Question 33

Ketorolac dose? Max dose?

Answer 33

15-30 mg IM q6H Max 60-120 mg QD

Question 34

Ibuprofen dose? Peak?

Answer 34

200 to 800 IV over 30 mins q6 hours (3200 mg/day max) Peak - 1 to 2 hours

Question 35

Lidocaine initial bolus dose? Continuous drip?

Answer 35

Initial = 1 to 2 mg/kg IV Drip = 1 to 2 mg/kg/hour (Terminated in 12 to 72 hours)

Question 36

Magnesium dose?

Answer 36

50 mg/kg IV preop 8 mg/kg/hr intraoperatively

Question 37

Zofran dose?

Answer 37

4 mg IV (Up to 8) 0.1 mg/kg IV (Pediatric)

Question 38

Dexamethasone (Decadron) dose?

Answer 38

8 to 10 mg

Question 39

What two meds should you give before administering Ketamine?

Answer 39

Glycopyrrolate (Antisialagogue) Versed (To prevent emergence delirium)

Question 40

What is the active metabolite of Ketamine?

Answer 40

Norketamine

Question 41

Which opioid agonist has the largest Vd?

Answer 41

Fentanyl

Question 42

What is Fentanyl's E 1/2 time? Why is that significant?

Answer 42

3.1-6.6 hrs It's the longest among the opioid agonists.

Question 43

Which opioid agonist has the lowest lipid solubility and the lowest clearance (300 mL/min)?

Answer 43

Alfentanil

Question 44

Alvimopan is metabolized in the...

Answer 44

Gut flora - prevents/treats illeus

Question 45

Which opioid receptor has the following effects? -Analgesia (Supraspinal, spinal) -Euphoria -Low abuse potential -Miosis -Bradycardia -Hypothermia -Urinary retention

Answer 45

Mu-1

Question 46

Which opioid receptor has the following effects? -Analgesia (Spinal) -Depression of ventilation -Physical Dependence -Constipation (marked)

Answer 46

Mu-2

Question 47

Which opioid receptor has the following effects? -Analgesia (Supraspinal, spinal) -Dysphoria, sedation - Low abuse potential -Miosis -Diuresis

Answer 47

Kappa Agonist - Dynorphins

Question 48

Which opioid receptor has the following effects? -Analgesia (Supraspinal, spinal) -Depression of ventilation -Physical Dependence -Constipation (minimal) -Urinary Retention

Answer 48

Delta (Agonist - Enkephalins)