Opioids

Front 1

How much does an opioid agonist-antagonist decrease MAC?

Back 1

8-20%

Front 2

Dose of Nalmefene (Revex)?

Agonist/Antagonist...?

Back 2

0.25mcg/kg IV q 2 to 5 min

Antagonist

Front 3

How is Nalmefene (Revex) metabolized?

Back 3

Conjugation

Front 4

Which has a longer duration of action Naloxone or Nalmefene?

Back 4

Nalmafene

Front 5

This antagonist has a sustained antagonism for as long as 24 hours when taken PO and is thus a good treatment option for addicts.

Back 5

Naltrexone

Front 6

Name opioids that are antagonists and what receptor they act on.

Back 6

Naloxone, Naltrexone and Nalmafene are all mu antagonists

Front 7

Dose and Duration of action of Naloxone (Narcan)?

Back 7

IV 1-5 mcg/kg
Infusion 5mcg/kg/h
Duration: 30-45 minutes
T 1/2: 60-90 minutes

Front 8

Nausea, vomiting, increased SNS activity, reversal of analgesia, pulmonary edema and cardiac dysrhythmias are all side effects of what opioid antagonist?

Back 8

Naloxone (Narcan)

Front 9

Opioid agonist-antagonists, what receptors do they act on.

Back 9

Bind to Mu receptors as partial agonists or competitive antagonist. Partial agonist effects on kappa and delta receptors

Front 10

Name opioid agonist-antagonists.

Back 10

Pentazocine (Talwin), Butorphanol (Stadol), Nalbuphine (Nubain), Buprenorphine (Buprenex), Nalorphine, Dezocine (Dalgon)

Front 11

Which opioid agonist-antagonist has a high affinity for Mu1 receptors and moderate affinity for delta receptors with a ceiling effect?

Back 11

Dezocine (Dalgon)

Front 12

Which opioid agonist-antagonist has a high incidence of dysphoria?

Back 12

Nalorphine

Front 13

Which opioid agonist-antagonist has a s.e. of prolonged resp. depression and is resistant to naloxone?

Back 13

Buprenorphine (Buprenex)

Front 14

Which opioid agonist-antagonist can be placed epidurally & is highly lipid soluble which can lead to delayed resp. depression?

Back 14

Buprenorphine (Buprenex)

Front 15

What is the most common s.e. for Nalbuphine (Nubain)?

Back 15

Sedation

Front 16

Which opioid agonist-antagonist does not increase HR, BP or PAP?

Back 16

Nalbuphine (Nubain)

Front 17

Which opioid agonist-antagonist has a low affinity for Mu receptors and a moderate affinity for kappa receptors?

Back 17

Butorphanol (Stadol)

Front 18

Which opioid agonist-antagonist is a derivative of benzomorphan?

Back 18

Pentazocine (Talwin)

Front 19

Pentazocine has agonist effects on what receptor(s)?

Back 19

Delta and Kappa

Front 20

Which opioid agonist-antagonist has high risk of dependence?

Back 20

Pentazocine (Talwin)

Front 21

Which opioid agonist-antagonist has s.e. of sedation, N/V, dysphoria, diaphoresis, dizziness and an increase in plasma catecholamines?

Back 21

Pentazocine (Talwin)

Front 22

Synthetic opioid by the acetylation of morphine.

Back 22

Heroin

Front 23

This opioid does not posess antipyretic, antiinflammatory, or antitussive properties.

Back 23

Propoxyphene

Front 24

This synthetic opioid would be appropriate only for addicts.

Back 24

Methadone (Dolophine)

Front 25

This opioid is 10x more potent than morphine (Chris has never seen it used)?

Back 25

Oxymorphone (Numorphan)

Front 26

What is the onset, peak and duration of Hydromorphone (Dilaudid)?

Back 26

Onset 15-30 min
Peak 30-90 min
Duration 4-5 hours

Front 27

This opioid has more sedation, less eurphoria and is 5x more potent than morphine?

Back 27

Hydromorphone

Front 28

This opioid is demethylated in the liver and excreted by the kidneys?

Back 28

Codeine (methylmorphine)

Front 29

This opioid is an antitussive at 15mg and an analgesic at 60mg PO?

Back 29

Codeine (methylmorphine)

Front 30

Side effects of this opioid include N/V, minimal sedation, constipation, physical dependence?

Back 30

Codeine (methylmorphine)

Front 31

Codeine (Methylmorphine) is created by substitution of what?

Back 31

Substitution of a methyl group for the hydroxyl group on C 3 of morphine

Front 32

What is the onset, peak and duration of IV Remifentanil (Ultiva)?

Back 32

Onset 1 min
Peak 1 min
Duration 5-10 min

Front 33

Place in order from highest to lowest Context Sensitive 1/2 times Alfentanil/Fentanil/Remifentanil/Sufentanil.

Back 33

Fentanil > Alfentanil > Sufentanil > Remifentanil

Front 34

This opioid agonist has an ester linkage making it susceptible to hydrolysis?

Back 34

Remifentanil (Ultiva)

Front 35

This opioid agonist is specific to Mu receptors, has a small Vd and its clearance is not affected by renal or hepatic failure?

Back 35

Remifentanil (Ultiva)

Front 36

This might be a good opioid agonist for a 'wake up test'?

Back 36

Remifentanil (Ultiva)

Front 37

What are the recommended doses for Remifentanil (Ultiva)?

Back 37

IV: 1mcg/kg IV over 60 sec Infusion: 0.5-1mcg/kg IV over 10 min

Front 38

Which opioid agonist should be avoided in untreated Parkinson's patients, why?

Back 38

Alfentanil (Alfenta)
It decreases the central dopamine transmission

Front 39

This opioid agonist (and dose) blunts BP and HR response to intubation? (and dose) blunts catecholamine response?

Back 39

Alfentanil 15mcg/kg
Alfentanil 30mcg/kg

Front 40

This opioid agonist is metabolized by N-dealkylation of Piperidine and Amide independently?

Back 40

Alfentanil (Alfenta)

Front 41

This opioid agonist is 96%cleared hepatically within 60 minutes.

Back 41

Alfentanil (Alfenta)

Front 42

Alfentanil's effects are prolonged with_________, because of alterations in P-450 activity?

Back 42

Erythromycin

Front 43

With initial dose, which opioid agonist has first-pass pulmonary uptake of:
10%/60%/75%

Back 43

Alfentanil (Alfenta) 10%
Sufentanil (Sufenta) 60%
Fentanyl 75%

Front 44

What is the onset, peak and duration of Alfentanil?

Back 44

Onset immediate
Peak immediate
Duration (fast?)

Front 45

What % of Alfentanil exists in the non ionized form and does it have a low or high pKa?

Back 45

90%
low pKa

Front 46

Which opioid agonist is useful when you want to avoid coughing and bucking on emergence?

Back 46

Sufentanil (Sufenta)

Front 47

This opioid agonist is metabolized by N dealkylation and O demethylation?

Back 47

Sufentanil (Sufenta)

Front 48

Protein binding by opioid agonist, place in order from highest to lowest: Fentanyl/ Sufentanil/ Alfentanil/ Remifentanil/ Morphine/ Meperidine

Back 48

Sufentanil 93%
Alfentanil 92%
Fentanyl 84%
Remifentanil 80%
Meperidine 70%
Morphine 35%

Front 49

This opioid agonist is 5-10x more potent than Fentanyl?

Back 49

Sufentanil (Sufenta)

Front 50

What are the clinical doses for low dose analgesia/ med. dose (surgical anesthesia)/ high dose (alone for surgical anesthesia) of Fentanyl?

Back 50

Low dose 1-2mcg/kg IV
Med dose 2-20mcg/kg IV
High dose 50-100mcg/kg IV

Front 51

This opioid agonist is metabolized by N-demethylation?

Back 51

Fentanyl (Sublimaze)

Front 52

What is the onset, peak and duration of Fentanyl?

Back 52

Onset 2-5 min
Peak 20-30 min
Duration 0.5-1 hour

Front 53

This opioid agonist is 75-125x more potent than morphine? Why?

Back 53

Fentanyl b/c of its high lipid solubility

Front 54

Describe Serotonin Syndrome and which drugs are associated with this fatal interaction?

Back 54

HTN, tachycardia, hyperpyrexia, convulsions
Meperidine and MAOIs or SSRIs

Front 55

Side effects of this opioid agonist include: respiratory depression, orthostatic hypotension, increased HR, and mydriasis.

Back 55

Meperidine (Demerol)

Front 56

What opioid agonist and agonist-antagonist suppress post op shivering? How?

Back 56

Meperidine and Butorphanol Stimulate Kappa receptors

Front 57

What happens with high doses of Meperidine?

Back 57

Negative cardiac inotropic effects and histamine release

Front 58

What is the onset, peak and duration of Meperidine?

Back 58

Onset 5 min
Peak 30-60 min
Duration 2-4hours

Front 59

What opioid agonists are derived from phenylpieridine?

Back 59

Meperidine, Fentanyl, Sufentanil, Alfentanil, Remifentanil

Front 60

Which opioid agonist acts on mu and kappa receptors?

Back 60

Meperidine (Demerol)

Front 61

What is the onset, peak and duration of Morphine?

Back 61

Onset 20 min
Peak 30-60 min
Duration 4-6 hours