Opioid and non-opioid analgesics 4

Question 1

Which are expected to increase during an episode of opioid-induced muscle rigidity? (select 3)
a. oxygen consumption
b. thoracic compliance
c. pulmonary vascular resistance
d. intracranial pressure
e. functional residual capacity
f. mixed venous oxygen saturation

Answer 1

a. oxygen consumption
c. pulmonary vascular resistance
d. intracranial pressure

Question 2

Rapid IV administration of opioids can cause

Answer 2

skeletal muscle rigidity

Question 3

Skeletal muscle rigidity from opioids is more common with

Answer 3

liphophilic compounds such as sufentanil, fentanyl, remifentanil, and alfentanil

Question 4

The best treatment for opioid-induced skeletal muscle rigidity is

Answer 4

paralysis and intubation

Question 5

Historically, skeletal muscle rigidity has been described as ____________ however current evidence suggests that the greatest resistance to ventilation occurs in the

Answer 5

chest wall rigidity or stiff chest syndrome; larynx

Question 6

Opioid-induced muscle rigidity is believed to result from

Answer 6

mu receptor stimulation in the CNS (ultimately influencing dopamine and GABA motor pathways)

Question 7

Can naloxone be used to reverse rigidity?

Answer 7

yes but it would be counterproductive for surgery

Question 8

What are the CV complications of opioid-induced muscle rigidity?

Answer 8

increased CVP, increased PAP, increased PVR

Question 9

What happens to ICP and gastric pressure with opioid-induced muscle rigidity?

Answer 9

both increased

Question 10

What happens to the respiratory system with opioid-induced muscle rigidity?

Answer 10

hypoxia
hypercapnia
increased oxygen consumption
decreased SvO2, thoracic compliance, FRC, and minute ventilation

Question 11

What 4 opioids are most likely to cause skeletal muscle rigidity?

Answer 11

sufentanil
fentanyl
remifentanil
alfentanil

Question 12

Opioid partial agonists can never

Answer 12

achieve the same intensity of effect at a specific receptor as a full agonist

Question 13

Partial opioid agonists produce

Answer 13

analgesia with a reduced risk of respiratory depression

Question 14

Partial opioid agonists have a ___________ beyond which additional analgesia is not possible.

Answer 14

ceiling effect

Question 15

Examples of partial opioid agonists include

Answer 15

buprenorphine, nalbuphine, and butorphanol

Question 16

Partial opioid agonists reduce the

Answer 16

efficacy of previously administered opioids

Question 17

Can partial opioid agonists cause acute opioid withdrawal?

Answer 17

yes, they can do so in the opioid-dependent patient

Question 18

Partial opioid agonists _________ dependence

Answer 18

carry a low risk of

Question 19

What is the MOA of buprenorphine?

Answer 19

Mu agonist (partial)

Question 20

What is the analgesic effect of buprenorphine compared to morphine?

Answer 20

greater

Question 21

Can buprenorphine be reversed by naloxone?

Answer 21

difficult d/t high affinity for mu receptor

Question 22

What are key features of buprenorphine?

Answer 22

long duration (8 hours)
available via transdermal route

Question 23

What is the mechanism of action of nalbuphine?

Answer 23

kappa agonist
mu antagonist

Question 24

What are the analgesic effects of nalbuphine compared to morphine?

Answer 24

similar

Question 25

Can nalbuphine be reversed by narcan?

Answer 25

yes

Question 26

What are the key features of nalbuphine?

Answer 26

does not increased BP, PAP, HR, or RAP useful with h/o heart disease

Question 27

What is the mechanism of butorphanol?

Answer 27

kappa agonist mu antagonist (weak)

Question 28

What is the analgesic effect of butorphanol compared to morphine?

Answer 28

greater

Question 29

Can butorphanol be reversed by naloxone?

Answer 29

yes

Question 30

What are key features of butorphanol?

Answer 30

useful for postop shivering available via intranasal route

Question 31

What are 4 disadvantages of using partial agonist opioids?

Answer 31

1. reduces the efficacy of previously administered opioids 2. can cause acute opioid withdrawal in the opioid-dependent patient 3. can cause dysphoric reactions 4. has a ceiling effect beyond which additional analgesia is not possible

Question 32

An opioid-dependent patient is scheduled for a cesarean section. Side effects of naloxone administration in this patient include all of the following EXCEPT: a. pulmonary edema b. bradycardia c. nausea d. neonatal withdrawal syndrome

Answer 32

b. bradycardia

Question 33

Naloxone competitively antagonizes

Answer 33

mu, kappa, and delta receptors

Question 34

Naloxone has the greatest affinity at the

Answer 34

mu receptor

Question 35

The dose of naloxone is _______

Answer 35

1-4 mcg/k

Question 36

Naloxone duration of action is

Answer 36

30-45 minutes

Question 37

If a long acting opioid is the cause of respiratory depression, then a

Answer 37

narcan infusion should be considered

Question 38

This drug is useful for mitigating the peripheral effects of opioids such as opioid-induced bowel dysfunction

Answer 38

methylnaltrexone- doesn't cross the BBB

Question 39

In the patient with pain, analgesic reversal activates

Answer 39

the SNS

Question 40

Activation of the SNS with narcan can lead to

Answer 40

neurogenic pulmonary edema, tachycardia, cardiac dysrhythmias, and sudden death

Question 41

What are the indications for using naloxone?

Answer 41

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

Question 42

How is naloxone metabolized?

Answer 42

liver (significant first-pass metabolism)

Question 43

_____________ minimizes the effects of naloxone activating the SNS

Answer 43

slow titration

Question 44

Does naloxone cross the placenta?

Answer 44

yes- if given to an opioid abusing mother it can precipitate acute opioid withdrawal in the neonate

Question 45

Other side effects of naloxone include

Answer 45

nausea & vomiting- slow titrating can lessen

Question 46

Naloxone infusion can relieve____________ in a patient receiving neuraxial opioids

Answer 46

severe pruritus