Barry Basics Opiod Slides
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| OPIOIDS | show 🗑
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| TYPES OF OPIOIDS | show 🗑
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| show | Morphine and Papaverine: Derived from opium, an extract of the poppy plant.
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| SEMI SYNTHETIC OPIOIDS | show 🗑
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| show | Demerol, Methadone, Fentanyl, Butorphanol, Pentazocine: Manufactured by synthesis rather than chemical modification of morphine.
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| CLASSIFICATIONS OF OPIOIDS | show 🗑
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| show | Capable of eliciting full agonist (morphine-like) effects
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| AGONIST-ANTAGONISTS | show 🗑
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| show | Competitive: binds to receptor but can be knocked off if a higher concentration of the agonist is present.Non-competitive: Very strong affinity for receptor. NOT DISPLACED by high concentrations of the agonist.
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| MOA | show 🗑
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| show | The actions of endogenous ligands (endorphins, enkephalins and dynorphins) by binding to the opioid receptor which activates pain modulating systems.
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| show | By activating postsynaptic opioid receptors in the midbrain and medulla (results in inhibition of pain pathways.
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| HOW DO OPIOIDS CAUSE SPINAL ANALGESIA? | show 🗑
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| HOW DO OPIOIDS CAUSE PERIPHERAL ANALGESIA? | show 🗑
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| OPIOID RECEPTORS | show 🗑
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| show | Primarily supraspinal analgesiaSome spinal analgesiaEuphoriaMiosisUrinary retention
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| MU-2 RECEPTORS | show 🗑
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| show | Spinal and supraspinal analgesiaSedationDysphoria (psychosis)
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| show | Mostly spinal analgesiaSome supraspinal analgesiaSome respiratory depressionPhysical dependence
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| show | Dose-dependent ventilatory depression (decreased RR with compensatory increased TV)Not reliable at producing LOC: some sedation,but main effect is analgesia.May stimulate chemoreceptor trigger zone.Cause spasm of biliary smooth muscle.
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| HOW IS BILIARY SMOOTH MUSCLE SPASM TREATED? | show 🗑
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| show | The Prototype: E 1/2 time is 1.5-3hrs.Doseages: Intra-op- 0.1-1 mg/kg IV Post-op- .05-0.2mg/kg IV .03-0.15 mg/kg IV
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| WHAT IS THE MAJOR FEATURE OF MORPHINE? | show 🗑
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| WHAT ARE THE ACTIVE METABOLITES OF MORPHINE? | show 🗑
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| HOW IS MORPHINE METABOLIZED? | show 🗑
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| show | Pharmacokinetic profile similar to morphine.8-10X more potent than morphine.Similar SE profile (less n/v, itching, and dysphoria).No active metabolite.
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| MEPERIDINE | show 🗑
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| WHICH OPIOID IS GIVEN IN PACU FOR SHIVERING? | show 🗑
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| WHAT IS THE METABOLITE OF MEPERIDINE? | show 🗑
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| show | Meperidine:Causes a severe excitatory state: signs and symptoms include: Increase in HR, BP and Temp. Delerium, seizures and possible death.
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| show | Structurally related to meperidine.100x more potent than morphine.E 1/2 time: 3-6 hours.Doseages: Intra-op- 2-10 mcg/kg. CT surgery- 30-50 mcg/kg. Post-op-0.5-1.5 mcg/kg.Minimal CV depression: may decrease HR.1cc = 50 mcg.
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| WHICH OPIOID CAUSES CHEST WALL RIGIDITY? | show 🗑
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| show | 7-10x more potent than fentanyl.Intra-op dose: 0.2-0.8 mcg/kgCT surgery: 10-30 mcg/kgE 1/2 time: 2.5-3.5 hours
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| show | 1/5-1/10 As potent as fentanyl.Intra-op dose: 10-100 mcg/kgE 1/2 time: 1.5 hrs.More rapid onset and shorter duration of action then fentanyl and sufentanyl.
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| show | Similar potency as fentanyl.Extremely rapid onset, clearance and recovery.E 1/2 time: 15-30 min.Dose: 1 mcg/kg IV over 60-90sec then 0.25-1mcg/kg or 0.05mcg/kg/min.
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| HOW IS REMIFENTANYL METABOLIZED? | show 🗑
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| WHAT ARE THE OPIOID ANTAGONISTS? | show 🗑
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| show | Also known as Narcan.Most frequently used.Great affinity for Mu receptors and is a competitive antagonist.Used to reverse unconciousness from narcotic overdose.Reverses respiratory depression: give in 20-40mcg increments.
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| HOW LONG DOES NARCAN LAST? | show 🗑
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| show | Mix 1 amp (0.4mg) in 9cc of NS. Give one cc at at a time (20 mcg).
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| WHAT HAPPENS WITH ABRUPT REVERSAL OF OPIOIDS? | show 🗑
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| show | Also known as Trexan.Longer acting anatagonist given in PO form for addicts.May last up to 24 hoursPatients who take this may have a temporary resistance to narcotics.
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| show | Butorphanol (Stadol)Nalbuphine (Nubain)
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| BUTORPHANOL | show 🗑
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| NALBUPHINE | show 🗑
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| show | Nubain (nalbuphine)
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| WHAT IS FLUMAZENIL? | show 🗑
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