Pain Management + Local Anesthetics - Midterm Wrap Up Flashcards Preview

Spring 2020 - Pharmacology 1 > Pain Management + Local Anesthetics - Midterm Wrap Up > Flashcards

Flashcards in Pain Management + Local Anesthetics - Midterm Wrap Up Deck (91)
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1

Meperidine

Opioid Agonist at Mu & Kappa

Derived from Phenylepiperidine

2

Meperidine's structure is similiar to...

Atropine

3

What analogues were developed from Meperidine?

All the Fentanyl's

4

Meperidine Metabolism

90% Hepatic

Demethylation to Normeperidine --> Meperidinic Acid

Excreted by Kidneys

Renal Impairment = Buildup

5

Meperidine Pharmacokinetics

3-5 hr. Half-Life

Protein Bound

6

Normeperidine

1/2 Analgesia of Meperidine

15 hr. Half-life;  > 35 hrs. for renal pts.

CNS Stimulation & Toxicity - myoclonus + seizure

Demerol Delirium

7

Meperidine CV Effect

Decrease SNS Reflex

Orthostatic Hypotension > Morphine

Tachycardia (Atopine-like)

Big Dose = ↓Inotropy

8

Meperidine Respiratory Effect

Ventilation depression > Morphine

9

Meperidine Serotonin Syndrome

Autonomic Instability

  • HTN
  • ↑HR
  • ↑Temp + Diaphoresis
  • Rigidity
  • Hyperreflexia
  • Confusion
  • Coma, Seizure
  • Coagulopathy
  • Metabolic Acidosis

10

What to give for Post-Op Shivering?

Demerol: 12.5 - 25 mg

Sufentanil, Ultram, Clonidine, Ketamine

11

Slide 77

12

Methadone

Mu Agonist + NMDA Antagonist

Variable 8-60 hr. Half-life
(Unpredictable)

QT Prolongation

13

Opioid Agonist-Antagonist Meds

 

Pentazocine

Bremazocine

Dezocine

Naluphine

Buprenorphine

Nalorphine

Butorphanol

 

14

Opioid Agonist-Antagonist

Binds to Mu (+ delta, kappa)

Part Agonist: limited Mu effect

Part Competitive Antagonist: no mu effect

Effects subsequent Opioid administration

 

15

Opioid Agonist-Antagonist Advantages

Pain relief w/ limited ventilation depression

Low addiction risk

Effect Ceiling, but can still die

For pts. who cant tolerate pure opiates

16

Opioid tolerance can occur ______ dependence. 

Opioid dependence cannot occur ________ tolerance

Tolerance can occur without dependence

Dependence cannot occur without tolerance = addiction

17

Opioid Antagonists

Small structural changes convert agonist into antagonist

Subbing alkyl for methyl group

18

What is the N-alkyl derivative of Oxymorphone?

Naloxone

19

What are the Pure Opioid Antagonists?

Naloxone

Natrexone

Nalmefene

20

Opioid antagonists and the Receptor

High receptor affinity

Bumps off agonist and binds to mu receptor for antagonism

21

Naloxone

Nonselective Antagonist at all 3 Opioid Receptors

 

22

What does nalaxone do?

Treats ventilation depression

(also treats newborn with opioid mom)

Reverses Overdose

Detects Physical Dependence

23

Naloxone Duration of Action

30-45 min

24

Naloxone Metabolism

Liver Enzymes

60-90 min Half-life

May redose

25

Naloxone Side Effects

Return of Pain

NV r/t Injection Speed

Sympathetic Outflow

(Tachy, HTN, P. Edema, Dysrhythmias)

26

Tramadol

Mu Agonist

Weak SNRI

No metabolite

Interacts with SSRIs

27

Tramadol Contraindication

Seizure Disorder

Can also cause new onset Seizure

28

NSAIDs MOA = COX Inhibition

(Cyclo-Oxygenase Enzyme)

Platelet Inhibition + GI Mucosal Thinning = Bleed

29

Toradol

COX2 Inhibitor - Celecoxib - no mucosal thinning effect, but still has platelet inhibition

  • Black Box Warning - GI Bleeds, Peptic Ulcers, Bleeding in General
  • Contracindicated for Labor & Deliver - inhibits fetal circulation

30

Toradol Side Effects

ARF

GI

CHF

Platelet Malfunction