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86 Cards in this Set
- Front
- Back
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What is the Brand name of Sufentanil?
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Sufenta
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How is Sufentanil typically supplied (concentration)?
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50mcg/ml
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The usual dose of Sufentanil is?
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Infusion 0.005 - 0.05 mcg/kg/min Start with a 0.25 - 1 mcg/kg bolus Intraop dose 0.25-30mcg/kg
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What is the time to onset of Sufentanil?
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1-3min
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What is the time to peak of Sufentanil?
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3-5 minutes
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What is the duration of Sufentanil?
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25-45min
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How is Sufentanil metabolized?
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hepatic
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What receptors does Sufentanil act on?
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Mu
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What drug class is Sufentanil in?
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opioid
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What is the mechanism of action of Sufentanil?
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doses up to 8mcg/kg produces analgesia; doses >8mcg/kg produce hypnosis and anesthesia; doses of 25mcg/kg attenuate the sympathetic nervous system response to surgical stress; doses 25-30mcg/kg attenuate catecholamine response
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What patients would you not give Sufentanil to?
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known hypersensitivity; avoid using high doses when using nitrous oxide or vice versa (cardiovascular depression); pts on CCB and BB may experience more bradycardia and hypotension; head injuries-may obscure clinical course; use with caution in pulmonary disease; use with caution in kidney/liver dysfunction
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What is the Brand name of Hydromorphone?
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Dilaudid
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How is Hydromorphone typically supplied (concentration)?
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1 mg/ml, 2mg/ml
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The usual dose of Hydromorphone is?
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Analgesic dosing 0.4 - 2mg IV
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What is the time to onset of Hydromorphone?
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15 - 30 minutes
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What is the time to peak of Hydromorphone?
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30 - 90 minutes
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What is the duration of Hydromorphone?
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2 - 4 hours (IV), 4- 6 hours (IM, PO, subQ)
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How is Hydromorphone metabolized?
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Liver, urine and bile excretion
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What receptors does Hydromorphone act on?
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Mu receptor agonist
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What drug class is Hydromorphone in?
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Semisynthetic Opioids/Opiates, Morphine derivative
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What is the mechanism of action of Hydromorphone?
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Binds to opiate receptors in the CNS
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What patients would you not give Hydromorphone to?
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Lack of known active metabolites, recommended for patients with renal failure.
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What is the potency of Hydromorphone compared to Morphine?
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5x (2mg Dilaudid = 10mg Morphine
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What is the Brand name of Fentanyl?
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Sublimaze
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How is Fentanyl typically supplied (concentration)?
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50 mcg/ml
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The usual dose of Fentanyl is?
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Sedation: 1-2 mcg/kg IV General: 5-15+mcg/kg IV Cardiac Surgery: 50-150 mcg/kg IV
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What is the time to onset of Fentanyl?
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Immediate onset
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What is the time to peak of Fentanyl?
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3-5 minutes
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What is the duration of Fentanyl?
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0.5-2 hours
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How is Fentanyl metabolized?
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Liver (CYP 3A4)
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What receptors does Fentanyl act on?
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Mu opioid receptor
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What drug class is Fentanyl in?
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Opioid agonist (narcotic analgesic)
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What is the mechanism of action of Fentanyl?
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Agonist reaction with mu receptors in brain, spinal cord, and other tissues. Highly lipophilic, crosses BBB
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What patients would you not give Fentanyl to?
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Pts with known sensitivity, head injury (increased (ICP), caution in elderly, liver impairment, renal impairment, resp impairment, seizure disorder
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How potent is Fentanyl compared to Morphine?
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75 to 125x more potent than morphine as an analgesic
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How does Fentanyl effect midazolam and propofol?
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Analgesic concentrations greatly potentiate the effects of midazolam and decrease the dose requirements of propofol
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Does Fentanyl cause a release of histamine?
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No histamine release
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Does Fentanyl have cardiac effects?
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Minimal cardiac depressant effects
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What benefits does IV administration have over other routes?
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Intravenous administration permits increased concentrations in highly perfused tissues such as the kidneys, lungs, spleen, heart, and brain.
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What is the Brand name of Meperidine?
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Demerol
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How is Meperidine typically supplied (concentration)?
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10 mg/ml
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The usual dose of Meperidine is?
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25-100mg (0.5-2 mg/kg)
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What is the time to onset of Meperidine?
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<1 minute
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What is the time to peak of Meperidine?
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5-20 minutes
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What is the duration of Meperidine?
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2-4 hours
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How is Meperidine metabolized?
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In the liver by hydrolysis to meperidinic acid followed by partial conjugation with glucuronic acid; urinary excretion
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What receptors does Meperidine act on?
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Kappa receptors (opiate receptors)
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What drug class is Meperidine in?
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Synthetic opioid agonist
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What is the mechanism of action of Meperidine?
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Activation of kappa receptors inhibits presynaptic release and postsynaptic response to excitatory neurotransmitters (ACh, Substance P) from nociceptive neurons.
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What patients would you not give Meperidine to?
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MAOI use w/in 14 days
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How potent is Meperidine compared to morphine
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1/10th potency of morphine
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Does Meperidine cross the placenta?
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Yes, Meperidine crosses the placenta and appears in breast milk
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What is the Brand name of Morphine?
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Morphine, MS Contin, Duramorph etc
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How is Morphine typically supplied (concentration)?
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1-2-4-10 mg/ml IV
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The usual dose of Morphine is?
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Typical dose is 2-10mg bolus.
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What is the time to onset of Morphine?
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Typically 15-30 minutes due to Morphine's relatively low lipid solubility
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What is the time to peak of Morphine?
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30-45 minutes IV
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What is the duration of Morphine?
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2-4 hours depending on dose IV
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How is Morphine metabolized?
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Hepatic via glucuronidation by phase II metabolism enzyme UDP-glucuronosyl transferase-2B7
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What receptors does Morphine act on?
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The mu receptors - appears most important in terms of analgesia and respiratory depression and opioid effects.
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What drug class is Morphine in?
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Opiod
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What is the mechanism of action of Morphine?
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Morphine's main effect is binding to and activating the μ-opioid receptors in the central nervous system.
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What patients would you not give Morphine to?
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Hypovolemic, Opiod naive, acute resp depression, increased ICP, renal failure
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What is the Brand name of Ketorolac?
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Toradol
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How is Ketorolac typically supplied (concentration)?
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15 mg/ml or 30 mg/ ml
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The usual dose of Ketorolac is?
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IM/IV: 30-60mg followed by 15-30mg q6-8h; PO: 10mg q4-6h
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What is the time to onset of Ketorolac?
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30 mins
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What is the time to peak of Ketorolac?
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60-120 minutes
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What is the duration of Ketorolac?
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4 - 6 hours
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How is Ketorolac metabolized?
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<50% hepatic, renal metabolism; 91% renal elimination
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What receptors does Ketorolac act on?
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COX receptor inhibition
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What drug class is Ketorolac in?
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NSAID
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What is the mechanism of action of Ketorolac?
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limits prostaglandin synthesis by COX inhibition
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What patients would you not give Ketorolac to?
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Adverse effects are similar to other NSAIDs: peptic ulceration, bleeding decreased renal blood flow, do not exceed 5d, caution with hypovolemia/impaired renal function; consider reactive airway disease in patients with perennial vasomotor rhinitis and nasal polyps
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What is the Brand name of Alfentanil?
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Alfental
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How is Alfentanil typically supplied (concentration)?
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500 mcg/ml
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The usual dose of Alfentanil is?
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50-300 mcg/kg
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What is the time to onset of Alfentanil?
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1-2 mins
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What is the time to peak of Alfentanil?
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1-2 mins
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What is the duration of Alfentanil?
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10-15 mins
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How is Alfentanil metabolized?
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Hepatic metabolize; Renal elimination
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What receptors does Alfentanil act on?
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Mu opioid receptor
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What drug class is Alfentanil in?
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Opioid agonist (narcotic analgesic)
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What is the mechanism of action of Alfentanil?
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Agonist reaction with mu receptors in brain, spinal cord, and other tissues. Highly lipophilic, crosses BBB
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What patients would you not give Alfentanil to?
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Pts with known sensitivity, Caution in head injury (increased (ICP), caution in elderly, liver impairment, renal impairment, resp impairment, seizure disorder
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How potent is Alfentanil compared to Morphine?
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10x more potent than morphine
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