Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Neuraxial Opioids
Pharm (Test 2)
| Question | Answer |
|---|---|
| Which opioid receptors are present in high cntns in the dorsal horn of the spinal cord? | mu, kappa, delta |
| Which receptors are present in the substantia gelatinosa? | mu |
| An epidural dose of an opioid is typically ______X the subarachnoid dose. | 5-10 |
| Neuraxial opioids are specific for _______ pain. | visceral (organ) |
| Neuraxial opioid administration (is or isn't?) associated with sympathetic denervation? | isn't |
| What is the mechanism of action of epidural opioids? | diffuse across dura to affect mu receptors on the spinal cord AND are absorbed to produce the same effects like IV opioids |
| The (higher or lower?) the lipid solubility of an opioid, the more systemic absorption. | higher |
| Lower lipid soluble morphine has a (faster or slower?) onset and a (longer or shorter?) duration. | slower onset, longer duration |
| What is epidural fentanyl's time of peak CSF concentration? | 20 min |
| What is epidural sufentanil's time of peak CSF concentration? | 6 min (most lipid soluble) |
| What is epidural morphine's time of peak CSF concentration? | 1-4 hrs (least lipid soluble) |
| Only _____% of epidural morphine dose enters CSF. | 3% |
| What is epidural fentanyl's time of peak blood concentration? | 5-10 min |
| What is epidural sufentail's time of peak blood concentration? | <5 min |
| What is epidural morphine's time of peak blood concentration? | 10-15 min |
| True or False: The systemic absorption of epidural opioids produces blood levels similar to those after IM injections. | True |
| What is one way to decrease systemic absorption of epidural opioids? | add epinephrine to the solution (constricts the vasculature) |
| What is one way to enhance the analgesia of subarachnoid opioids? | add epinephrine to the solution |
| Describe the affect of epinephrine to both epidural and subarachnoid opioids. | epidural=decreases systemic absorption; subarachnoid=enhances analgesia |
| What is an epidural dose of fentanyl? | 50-100mcg |
| What is the duration of epidural fentanyl? | 1-3 hrs |
| What is an epidural dose of morphine? | 2-5 mg |
| What is the duration of epidural morphine? | 4-24 hrs |
| What is a spinal dose of morphine? | 0.25-1mg |
| Which opioid is most likely to move cephalad? | morphine (least lipid soluble) |
| What factors can accelerate cephalad mvmt of opioids? | coughing, straining (NOT body position) |
| What are the 4 classic side effects of neuraxial opioids? | 1)pruritis, 2)N/V, 3)urinary retention, 4)ventilator depression |
| What can prevent N/V and pruritis? | Narcan 0.25mcg/kg/hr |
| What is the most common side effect of neuraxial opioids? | pruritis |
| What is the cause of neuraxial opioid-induced pruritis? | opioids in CSF moving up to interact w/ OR in the trigeminal nucleus |
| What patients are most at risk for neuraxial opioid-induced pruritis? | obstetric (d/t estrogen effect on OR) |
| How quickly does neuraxial opioid-induced pruritis occur? | within a few hrs (may occur prior to analgesia onset) |
| What are 2 treatments for pruritis? | Narcan 0.25mcg/kg/hr (most effective) or antihistamines (which cause sedation) |
| What side effect is most common among young males? | urinary retention |
| True or False: Urinary retention is more common with neuraxial opioids than IV or IM. | true |
| True or False: Urinary retention is worse with large doses and increased systemic absorption. | False (not related to dose size or systemic absorption) |
| What causes neuraxial opioid-induced urinary retention? | interaction of opioid with OR of the sacral spinal cord (inhibition of sacral parasympathetic outflow causing detrusor muscle relaxation and increased bladder capacity) |
| What is the onset and duration of neuraxial opioid-induced urinary retention? | onset=15min; duration=up to 16hrs |
| What is the treatment for neuraxial opioid-induced urinary retention? | narcan |
| What is the most serious side effect of neuraxial opioids? | ventilation depression |
| What is the incidence of neuraxial opioid-induced ventilator depression? | 1% |
| What is the onset of neuraxial opioid-induced ventilator depression? | unpredictable! may be within minutes, may be 6-12 hrs after administration |
| Which opioids are responsible for early onset ventilator depression (<2hrs)? | fentanyl, sufentanil (high lipid solubility --> dec. risk of cephalad mvmt) |
| Which opioid is responsible for delayed onset ventilator depression? | morphine (low lipid solubility --> inc. risk of cephalad mvmt to OR in ventral medulla) |
| What are some risk factors for ventilator depression? | large doses, geriatric, other opioids or sedatives, prolonged/extensive surgery, co-morbidities, thoracic surgery (?) |
| What are some risk factors for delayed onset ventilator depression?/ | other opioids or sedatives, coughing |
| Describe the risk of ventilator depression in obstetrics/ | decreased risk d/t increased ventilator stimulations from progesterone |
| What is the most reliable sign of ventilator depression? | decreased LOC (possibly caused by hypercarbia) |
| What is the treatment for ventilator depression? | narcan infusion may help; supplemental O2 |
| What opioid is most associated with sedation caused by neuraxial opiois? | sufentanil |
| How soon after admin. does the reactivation of herpes virus occur? | 2-5 days |
| What causes the reactivation of herpes virus? | cephalad movement of morphine and interaction of the trigeminal nucleus |
| Which opioid is associated with the reactivation of herpes? | morphine |
| Why is there a risk of water retention? | d/t release of vasopressin |
| What can cause spinal cord injuries? | toxic preservatives |
| Why is there a risk of dec. body temp? | inhibition of shivering |
Created by:
lindseymontgomery
Popular Nursing sets