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77 Cards in this Set
- Front
- Back
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How do opiods cause dose dependent resp depression
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through direct mu receptor effects on the brainstem respiratory center
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do opiods change HPV
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no
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How does opiods affect hypoxic drive to breath and response to CO2
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Depresses hypoxic drive > CO2 response but does decrese CO2 response
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What is seen with opiod breathing
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Increased TV with decrease RR
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Which isomer is a more effective cough suppressant
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d isomer
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which opiod depresses the trachea mucocilliary action
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morphine
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What do opiods blunt that makes them good to combine with our other drugs for induction
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blunt the autonomic response to ETT placement and the increased IOP with laryngoscopy
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Which opiods have a better airway reaction (antimuscarinic, antihistaminergic, antidopaminergic)
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fentanyl brothers
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What is the hallmark of opiod anesthesia
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Cardiovascular stability
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What do opiods do to the heart
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decrease hr and blood pressure
deccrease SA node firing and decrease AV conduction |
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what do opiods do to someone who is used to an elevated sympathetic tone
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can decrease HR and BP too much
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are opiods cardiac protectors
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no guarentee
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what do opiods do to parasympathetic tone
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enhance it - bradycardia
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how do opiods act with bblockers and/or CCB
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can cause asystolic periods and delayed conduction
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Do opiods protect the heart during an ischemic event
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no, but they do decrease myocardial O2 demand without decreasing the supply
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what do opiods do to the baroreceptors
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depress them
but can cause rebound tachycardia with hypotension |
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which opiod causes the greatest histamine release
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morphine- causes increased vagal activity, slow heart rate, slow AV conduction
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How does demerol affect the heart
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similar to atropine- tachycardia, histamine release, increased O2 demand. the local anesthetic effect may cause direct myocardial depression
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what may be the cause of tachycardia with demerol
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the active metabolite-normeperidine
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Do opiods prevent the stress response
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NO, the do decrease it by depressing the pituitary adrenal axis
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when are opiods better at decreasing the hormonal response to pain
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before the pain starts
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What do you need to do to decrease the stress response in CPB surgery
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give lotsss of opiods
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How do opiods effect diuresis
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mu agonist cause anti-diuresis and decreased electrolyte excretion while kappa effects are just opposite. Net effect is no diuresis
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What do opiods do to the urinary tract
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urinary retention
increase sphincter tone and decrease bladder propulsive ability worse when given subdural or subarachnoid |
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which opiod has the worst effect on the urinary system
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Intrathecal morphine
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What is the best opiod to use with a patient in renal failure
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fentanyl family
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problems with opiods and renal failure
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retention of active metabolites
mess with volume of distribution plasma protein binding not as good |
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What do opiods do to the GI tract
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decrease motility- no coordinated peristalsis
decreased gastric emptying ileus Increase biliary duct pressure |
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how do you treat spasms of sphincter of oddi seen with opiods
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any of these
glucagon- 2mg naloxone 40 mcg (not nice) atropine- 0.2 mg nitroglycerin- 50 mcg |
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do opiods help PONV
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no they can cause it, by binding with the chemoreceptor trigger zone
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how do you protect pts from PONV when giving opiods
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with steriods
zofran |
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Who is sensitive to opiods
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elderly
infants |
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What can be a reason for delayed onset of respiratory depression of opiods
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first pass uptake by the lungs
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Do you need a NMB if you give opiods
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yes
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What are the relative potencies of the opiods
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all compared to morphine
Demerol 0.1 alfentanil 10 fentanyl and remifentanil 100 sufentanil 1000 |
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Which opiod has the least protein binding
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morphine
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Which opiod has the longest Et 1/2
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fentanyl
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Which opiod has the longest CS t 1/2? which has the shortest
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fentanyl- longest
remi- shortest |
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Is morphine water or lipid soluble?
protein binding? VD? |
water
30% large |
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Morphine peaks
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10-20 min IV
45-90 min IM_ dont give IM |
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Duration of morphine
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2 hrs
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When is the resp depression worse with morphine
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when pt is sleeping
can lead to frequent desats obstructive apnea paradoxical breathing slow RR |
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how long must pt be monitored following intrathecal morphine
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24 hrs
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Metabolites of morphine
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Morphine 3 glucoronide- antagonist that is strong enough to protect from...
Morphine 6 glucoronide Get more pain control from metabolites than from morphine |
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What prolongs E t 1/2 of morphine and its metabolites
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renal failure
liver failure elderly |
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What will we use demerol for
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shivering
12.5 mg IV dont forget to fix the problem |
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max dose of demerol
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1000 mg/day
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Demerol works on what receptors
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Kappa and Delta, Mu agonist
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only opiod that causes midriasis
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demerol
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Onset and duration of demerol
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onset 5-15 min
duration 3-4 hrs |
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Active metabolite of demerol
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Normeperidine
has toxic properties CNS excitation: apprehnesion, restlessness, tremors, myoclonus, comma, death |
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who is demerol contraindicated in
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people taking MAOI or on serotonin uptake inhibitors- would allow for accumulation fo meperidines substrates leading to serotonergic overactivity
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S/S of serotonergic overactivity
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delirium
hyperthermia headache hypertension hypotension rigidity convulsions coma death |
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peak and onset of fentanyl
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onset seconds
peak 5-6 minutes |
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What enables us to use fentanyl patch
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low molecular weight
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does fentanyl have active metabolites
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no
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Concentration and pain dose of fentanyl
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50 mcg/ml
25-100 mcg |
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Duration of transdermal fentanyl
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last 36-48 hrs so leave it on
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Transmucosal fentanyl
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45 min onset (makes good for post op pain of short cases)
kids 10-20 mcg/kg large kids 400-800 mcg |
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fentanyl sedation dose
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1-2 mcg/kg
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Induction dose fo fentanyl
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1-5 mcg/kg
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infusion doses of fentanyl
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3-6 mcg/kg/hr
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What receptor does sufentanil work on
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highly selective Mu agonist- potent analgesia
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Is sufentanil good for infusions
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yes
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onset and peak of sufenta
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onset seconds
peak 4-5 min |
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Supply and doses of sufenta
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supply- 50 mcg/kg
induction- 0.5-1 mcg/kg maintenance- 0.5-1 mcg/kg/hr |
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when will sufenta infusion wear off
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less 2 hrs- 30 min
greater than 2 hrs -45 min |
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Alfentanil= what
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apnea
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onset, supply and doses of alfenta
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onset - 1 min
supply- 500 mcg/ml induction- 15-40 mcg/kg infusion- 0.5-15 mcg/kg/min |
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what is special about remifentail
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only ultra short acting opiod
E t 1/2- 9.5 min |
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Onset and peak of remi
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onset seconds
peak 1-3 min |
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how does remi metabolize
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by plasma esterases- wakes due to metabolizing not redistribution
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loading dose of remi
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dont need one
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supply of remi
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1,2,5 ml vials
50 mcg/ml |
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doses of remi
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1 mcg/kg over 1 min- reduce dose in elderly
maintenance- 0.125-0.375 mcg/kg/min |
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can you give remi intrathecally
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no due to glycine formulation that is toxic to the nerves
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What types of cases is remi good for
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neuro
carotids endoscopies |
