Opioids

Question 1

Fentanyl: Class

Answer 1

Opioid agonist

Question 2

Fentanyl: Use

Answer 2

Reduce pain
Postoperative analgesia
Decrease Somatic and Autonomic response

Question 3

Fentanyl: Mechanism of Action

Answer 3

Binds to Mu1, Mu2, Kappa and delta receptors

Question 4

Fentanyl: Dose

Answer 4

Induction: 1 mcg/kg
Infusion: 0.01 mcg/kg/min

Small dose Bolus: 25 mcg

Question 5

Fentanyl: Pharmacokinetics

Answer 5

Absorption: IM, IV, epidural/intrathecal, transdermal, transmucosal

Onset: 2 minutes
Duration of Action: 30 minutes

Metabolism: Hepatic

Excretion: Feces and Urine

Question 6

Fentanyl: Contraindications

Answer 6

Hypersensitivity
Severe Respiratory depression

Question 7

Fentanyl: Considerations

Answer 7

Decreases ventilatory response to hypoxia and hypercapnia
Bradycardia
Decreased Gastric motility
Reduced Stress response
?Promote cancer cell proliferation

Question 8

Hydromorphone / Dilaudid: Class

Answer 8

Opioid Agonist

Question 9

Hydromorphone / Dilaudid: Use

Answer 9

Pain management

Question 10

Hydromorphone / Dilaudid: Mechanism of Action

Answer 10

Binds to Mu1, Mu2, Kappa and delta receptors

Question 11

Hydromorphone / Dilaudid: Dose

Answer 11

IV 0.2 mg Bolus

Question 12

Hydromorphone / Dilaudid: Pharmacokinetics

Answer 12

Absorption: PO, IV, Epidural, Intrathecal

Onset: 15 minutes
Duration of Action: 4 hours

Metabolism: Hepatic

Excretion: Kidneys

Question 13

Hydromorphone / Dilaudid: Contraindications

Answer 13

Severe Respiratory Suppression
Hypersensitivity

Question 14

Hydromorphone / Dilaudid: Considerations

Answer 14

Decreases ventilatory response to hypoxia and hypercapnia
Bradycardia
Decreased Gastric motility
Reduced Stress response
?Promote cancer cell proliferation

Question 15

Meperidine: Class

Answer 15

Opioid Agonist

Question 16

Meperidine: Use

Answer 16

Post op Shivering

Question 17

Meperidine: Mechanism of Action

Answer 17

Binds to Mu1, Mu2, Kappa and delta receptors

Question 18

Meperidine: Dose

Answer 18

IV Bolus 12.5 mg

Question 19

Meperidine: Pharmacokinetics

Answer 19

Absorption: PO, IV, IM

Onset: 5 minutes
Duration of Action: 2 hours

Metabolism: hepatic
ACTIVE METABOLITE = Normeperidine

Excretion: Kidneys

Question 20

Meperidine: Contraindications

Answer 20

Hypersensitivity
Patient taking MAOIs
Renal Failure d/t active metabolite

Question 21

Meperidine: Considerations

Answer 21

Histamine release can cause Hypotension/Bronchoconstriction

Similar structure as Atropine –> Tachycardia

Active metabolite: Normeperidine has longer 1/2 life and lowers seizure threshold

Question 22

Remifentanil: Class

Answer 22

Opioid Agonist

Question 23

Remifentanil: Use

Answer 23

Induction
Intraoperative pain management

Question 24

Remifentanil: Mechanism of Action

Answer 24

Opioids bind to Mu1, Mu2, Kappa, and delta receptors to decrease neurotransmitter release by increasing potassium efflux and MARK cascade and decreasing adenyl cyclase production and calcium influx of ascending and descending pain pathways

Question 25

Remifentanil: Dose

Answer 25

Induction: 2 mcg/kg IV Infusion: 0.05 mcg/kg/min

Question 26

Remifentanil: Pharmacokinetics

Answer 26

Absorption: IV Onset: 1 minute Duration of Action: 5 minutes Metabolism: Ester hydrolysis Excretion: Kidneys

Question 27

Remifentanil: Contraindictions

Answer 27

Not for spinal anesthesia Bradycardia High risk for Post op Pain

Question 28

Remifentanil: Considerations

Answer 28

Risk for muscle rigidity Good Induction drug for when NMB is contraindicated Induction dose has high risk for Bradycardia --> Pair with ephedrine A good choice for patients with renal and/or hepatic failure Post-op Hyperalgesia