Opioids

Question 1

Dilaudid is a ___ opioid agonist.

Answer 1

mu

Question 2

Morphine onset:

Answer 2

1 min

Question 3

What is the most rapidly acting opioid currently available?

Answer 3

Remifentanil

Question 4

Some opioids have a low volume of distribution due to high clearance (fentanyl/remifentanil) and/or high protein binding.

Answer 4

remifentanil

Question 5

Dilaudid duration:

Answer 5

2-3 hrs

Question 6

Hydromorphone (___)

Answer 6

(Dilaudid)

Question 7

Remifentanil is ___ times more potent than ___.

Answer 7

100-200; morphine

Question 8

Fentanyl dose (conc.):

Answer 8

2-20 mcg/kg (20 mcg/kg for CARDIAC ONLY)

(50 mcg/cc)
typically given in doses of either 25, 50, 100 mcg

Question 9

Narcan MOA:

Answer 9

displaces opioids from mu receptors

Question 10

Remifentanil dose (conc.):

Answer 10

0.5-1 mcg/kg/min
(1-2 mg –>reconstitute)

Question 11

Common side effects of opioids:

(Relaxation/Contraction) of the sphincter of Oddi

Answer 11

contraction; increases biliary pressure and can be reversed with naloxone or glucagon

Question 12

Narcan duration:

Answer 12

15-45 mins –> requires it to be redosed or administered as a continuous infusion when antagonism is required for long-acting opioids

Question 13

Fentanyl is (able/not able) to cross the blood brain barrier.

Answer 13

able –> due to high lipophilicity

Question 14

Sufentanil is an opioid with (medium/strong) potency.

Answer 14

strong

Question 15

Remifentanil metabolism:

Answer 15

contains a methyl ester side chain that is metabolized by blood and tissue nonspecific esterases.
Allows for rapid clearance of drug and consistently short context-sensitive half time.

Question 16

Dilaudid onset:

Answer 16

10-15 mins

Question 17

Fentanyl is a (natural/semisynthetic/synthetic) opioid.

Answer 17

synthetic

Question 18

Remifentanil (_______)

Answer 18

___ (Ultiva)

Question 19

Adverse effects associated with the reversal of opioids using Narcan (6):

Answer 19

1. sudden pain
2. pulmonary edema
3. cardiac arrhythmias
4. HTN
5. seizures
6. cardiac arrest

Question 20

Remifentanil duration:

Answer 20

3-6 mins

Question 21

Where is Dilaudid most often used perioperatively?

Answer 21

Intraop and in PACU

Question 22

Fentanyl (_______)

Answer 22

___ (Sublimaze)

Question 23

The requirements for inhalational anesthetics and propofol are reduced by about __% when administering ___ IV fentanyl.

Answer 23

50%
1.5-3 mcg/kg IV fentanyl

Question 24

Morphine excretion:

Answer 24

kidneys (careful in renal compromised patients, b/c it can accumulate)

Question 25

Remifentanil is an opioid classified as having (medium/strong) potency.

Answer 25

strong

Question 26

Common side effects of opioids: Pregnancy (___)

Answer 26

placental transfer --> due to lipophilicity

Question 27

Dilaudid is a (natural/semisynthetic/synthetic) opioid.

Answer 27

semisynthetic

Question 28

What are our six primary uses for opioids?

Answer 28

Preoperative medication Monitored Care Anesthesia Induction Intraoperative pain control Adjunct to anesthesia Postoperative pain control

Question 29

Some opioids have a high volume of distribution due to high lipophilicity and low protein-binding affinity, such as (fentanyl/remifentanil)

Answer 29

Fentanyl

Question 30

Common side effects of opioids: (bradycardia/tachycardia)

Answer 30

bradycardia

Question 31

Morphine is a ___ agonist.

Answer 31

mu1, mu2, and kappa

Question 32

The plasma level of remifentanil decreases by __% in as little as __ seconds.

Answer 32

50%; 40 seconds

Question 33

Fentanyl metabolism:

Answer 33

liver --> CYP450 enzymes

Question 34

Fentanyl is about __ times more potent than ___.

Answer 34

100; morphine

Question 35

The clearance of remifentanil is ___ L/min. What does this information tell us?

Answer 35

3-5 L/min; this exceeds liver blood flow and affirms its extrahepatic clearance.

Question 36

Morphine duration:

Answer 36

2-7 hrs

Question 37

Remifentanil context sensitive half-time duration:

Answer 37

2-3 minutes

Question 38

Remifentanil is a (natural/semisynthetic/synthetic) opioid.

Answer 38

synthetic

Question 39

Sufentanil is a ___ derivative of fentanyl and about __ times more potent. It is __ times more liphophilic than fentanyl.

Answer 39

thienyl 10; 2

Question 40

Narcan dose (conc.):

Answer 40

40 mcg at a time, every 1-2 mins until good respirations/ventilation 0.4 mg per vial --> dilute 1 vial (0.4 mg) in 9 cc NS = (40 mcg/cc)

Question 41

Hydromorphone (Dilaudid) is an opioid classified as having (medium/strong) potency.

Answer 41

medium

Question 42

Fentanyl has a much (shorter/longer) context sensitive half-life than Remifentanil.

Answer 42

longer; remifentanil is fastest due to metabolism via tissue nonspecific esterase hydrolysis.

Question 43

Sufentanil is a (natural/semisynthetic/synthetic) opioid.

Answer 43

synthetic

Question 44

Fentanyl acts at the __ opioid receptor, causing the following symptoms:

Answer 44

kappa spinal analgesia, respiratory depression, sedation, miosis

Question 45

MAC is (decreased/increased) with a concurrent remifentanil infusion.

Answer 45

decreased

Question 46

Common side effects of opioids: ___ --> due to histamine release (especially by ___ and ___)

Answer 46

allergies; morphine, meperidine

Question 47

Sufentanil onset:

Answer 47

1-3 mins

Question 48

Common side effects of opioids: respiratory (depression/stimulation)

Answer 48

depression

Question 49

Common side effects of opioids:
______ --> caused by stimulation of the chemoreceptor zone in the medulla and possibly the vestibular apparatus.

Answer 49

nausea and vomiting

Question 50

Remifentanil onset:

Answer 50

1 min`

Question 51

Fentanyl is an opioid classified as having (medium/strong) potency.

Answer 51

strong

Question 52

Fentanyl onset:

Answer 52

30 seconds

Question 53

Sufentanil is (able/not able) to cross the BBB.

Answer 53

able to cross due to high lipophilicity of piperidines

Question 54

Dilaudid dose (conc.):

Answer 54

0.01-0.04 mg/kg (2mg/cc)

Question 55

Sufentanil metabolism:

Answer 55

liver CYP450 enzyme system

Question 56

What are our five opioids classified as piperidines?

Answer 56

Meperidine Fentanyl Sufentanil Alfentanil Remifentanil

Question 57

Common side effects of opioids: Opioid ___

Answer 57

dependence

Question 58

Morphine metabolism:

Answer 58

liver

Question 59

Sufentanil dose (conc.):

Answer 59

0.6-4 mcg/kg (50 mcg/cc)

Question 60

Fentanyl is used during anesthesia to decrease ______ from ______.

Answer 60

cardiovascular responses to noxious stimulation from laryngoscopy, intubation, skin incision, and surgical stress

Question 61

Sufentanil duration:

Answer 61

20-45 mins

Question 62

Morphine is an opioid classified as having (medium/strong) potency.

Answer 62

medium

Question 63

Sufentanil (_______)

Answer 63

___ (Sufenta)

Question 64

Naloxone (_________)

Answer 64

___ (Narcan)

Question 65

Morphine dose (conc.):

Answer 65

0.1 mg/kg (10 mg/cc)

Question 66

Fentanyl duration:

Answer 66

10-20 mins (dose-dependent)

Question 67

Fentanyl duration of action:

Answer 67

10-20 mins, dose-dependent

Question 68

Sufentanil (___)

Answer 68

(Sufenta)

Question 69

Morphine is (able/not able) to cross the blood brain barrier.

Answer 69

able, but has low lipophilicity so it crosses BBB slowly

Question 70

When is morphine most commonly given perioperatively?

Answer 70

Given in PACU rather than intraop

Question 71

Morphine is a (natural/semisynthetic/synthetic) opioid.

Answer 71

natural (can also be called an opiate)