Term
|
Definition
| Receptor that causes antidiuresis and decreased electrolyte excretion |
|
|
Term
|
Definition
| Receptor that causes diuresis and little change in electrolyte excretion. |
|
|
Term
| Fentanyl, Sufentanil, Alfentanil and probably Remifentanil |
|
Definition
| Most likely preserve or minimally alter renal function in humans (4 drugs). |
|
|
Term
|
Definition
| T/F A patient is considered to be a "full stomach" if NPO for 10 hours but has been on a Fentanyl gtt. |
|
|
Term
|
Definition
| To reverse opioid-induced gastric delays, you can give _______ but _______ is preferred pre-operatively. |
|
|
Term
|
Definition
| To reverse opioid-induced biliary duct pressure and sphincter of Oddi tone, you can give _____ but ______ is preferred. |
|
|
Term
|
Definition
| T/F Intraoperative opioids has no effect on post-op N/V |
|
|
Term
| Chemoreceptor trigger zone, area postrema, medulla, delta |
|
Definition
| N/V from opioids occurse from stimulation in the _________ in the _________ of the ________. (Mu/kappa/delta) receptors are the most likely culprits. |
|
|
Term
|
Definition
| A patient has a H/O increased post-op N/V, which of the following fentanyls might be the best choice intra-op: Alfentanil, Fentanil, Sufentanil |
|
|
Term
| Morphine, Meperidine, Fentanyl |
|
Definition
| Adverse neonatal effects can occur after either ______ or _______ administration to mothers. _________ has minimal effect on the neonate. |
|
|
Term
|
Definition
| Opioids (increase/decrease) the immune response? |
|
|
Term
| Alfentanil, Naloxone, Nalbuphine |
|
Definition
| In a wheal study compared with saline, which 3 drugs showed no flare? |
|
|
Term
|
Definition
| This drug has varying degrees of pain relief and might not always be effective for severe pain. |
|
|
Term
Fentanyl: 1-3 mcg/kg
Alfentanil: 10-20 mcg/kg
Sufentanil: 0.1-0.3 mcg/kg |
|
Definition
Analgesic dose:
Fentanyl
Alfentanil
Sufentanil |
|
|
Term
|
Definition
| If using an opioid as a single agent anesthetic, you expect to see a (more/less) decrease in BP. |
|
|
Term
|
Definition
| One of the safest and most effective ways of titrating to a patient's pain immediately post-op. |
|
|
Term
| Give another dose of opioid |
|
Definition
| In the OR, you notice the pt's HR starts to increase, what class of drug would you give? |
|
|
Term
|
Definition
| In the OR under general anesthesia, you notice your pt's BP is creeping up, which drug would you consider increasing? |
|
|
Term
|
Definition
| Remifentanil (will/will not) produce residual post op anesthesia with minimal side effects. |
|
|
Term
| Alfentanil and Remifentanil |
|
Definition
| Synthetic opioids used in drips to titrate quickly. |
|
|
Term
|
Definition
| Has greater decrease in HR and BP than Fentanyl |
|
|
Term
|
Definition
| Opioid that produces some of the most stable VS if adequately hydrated. |
|
|
Term
|
Definition
| Opioid that frequently requires reversal of respiratory depression at the end of a case. |
|
|
Term
|
Definition
| Maximum respiratory effort but quickest offset of analgesia. |
|
|
Term
Hypotension--Histamine release
Tachycardia--Resembles atropine
Urticaria--Histamine release |
|
Definition
| Meperidine causes hypotension, tachycardia and urticaria. Why? |
|
|
Term
|
Definition
| Packaged concentration of Fentanyl |
|
|
Term
|
Definition
| Induction dose of Fentanyl |
|
|
Term
|
Definition
| Delay of onset for Fentanyl |
|
|
Term
|
Definition
| Delay of onset for Alfentanil and Remifentanil |
|
|
Term
| Titrate the opioid in anticipation of pain (give before the pain stimulus) throughout the surgery. |
|
Definition
| Doing this will often result in a stable hemodynamic course, lead to rapid awakening and adequately control pain for the patient. |
|
|
Term
|
Definition
| Repeated large doses or high infusion rates of Fentanyl will be (most/least) likely to result in depression of spontaneous ventilation. |
|
|
Term
|
Definition
| Low dose Fentanyl for the entire case |
|
|
Term
|
Definition
| Moderate dose of Fentanyl for an entire case |
|
|
Term
|
Definition
| High dose of Fentanyl for the entire case. You expect these pts to to to ICU vented. |
|
|
Term
|
Definition
| Drug of choice to provide IMMEDIATE pain relief |
|
|
Term
|
Definition
| Packaged concentration of Alfentanil. |
|
|
Term
|
Definition
| Induction dose of Alfentanil |
|
|
Term
| No, the induction dose of Alfentanil is usually sufficient to blunt the hemodynamic response to laryngoscopy and intubation. |
|
Definition
| If you give an induction dose of Alfentanil, would you need to supplement it with another opioid to blunt the hemodynamic response to laryngoscopy and intubation? |
|
|
Term
|
Definition
| Your pt is on an Alfentanil gtt in the OR, you should (turn it off/decrease) the gtt how soon before the end of the case? |
|
|
Term
|
Definition
| Induction dose of Sufentanil |
|
|
Term
|
Definition
| While Sufentanil produces "railroad track VS", it has the ability to produce (more/less) vasodilation than some of the other fentanyls. |
|
|
Term
| You must reconstitute and dilute it. |
|
Definition
| What is one of the drawbacks to choosing to use a vial of Remifentanil? |
|
|
Term
| 1 mg/kg slowly over 60-90 seconds |
|
Definition
| Induction dose of Remifentanil. |
|
|
Term
| Remifentanil, ester linkage |
|
Definition
| Allows the most predictable and rapid trouble-free emergence from anesthesia due to its _________. |
|
|
Term
|
Definition
| Offset time or DOA of Remifentanil. |
|
|
Term
|
Definition
| You (do/do not) want to use Remifentanil in a high-pain surgery like a CABG? |
|
|
Term
| Droperidol and opioid, Cannot |
|
Definition
| Neuroleptanalgesia-Anesthesia drugs involved. They (can/cannot) be combined with patients taking MAOIs? |
|
|
Term
| Sedative-hypnotic, muscle relaxant, opioid |
|
Definition
| TIVA consists of what 3 classes of drugs? |
|
|
Term
| Patient condition and surgical stimuli |
|
Definition
| Maintenance infusions of TIVA vary according to _________ and _________. |
|
|
Term
| Alfentanil, Propofol, Midazolam (has muscle relaxant properties) |
|
Definition
| _________ + __________ + __________ have profound synergism for TIVA. |
|
|
Term
|
Definition
| Propofol should be (decreased/terminated) _________ before the case ends. |
|
|
Term
| High incidence of recall (because opioids do not make patients unconscious--they are still processing thoughts) |
|
Definition
| What is the main problem with using opioids as a sole anesthetic? |
|
|
Term
| Added drug costs, decreased, lack |
|
Definition
| Other disadvantages to using opioids as a sole anesthetic include __________, ________ ability to "fast track", and a _________ of evidence in favor for such a technique. |
|
|
Term
| Premature infants for PDA surgery. |
|
Definition
| However, this specific population frequently uses Fentanyl as the sole anesthetic for surgery. |
|
|
Term
|
Definition
| Drug of choice for adult heart surgery. |
|
|
Term
| Muscle rigidity and upper airway closure |
|
Definition
| Two of the downsides to using high dose opioids such as Sufentanil in surgery is ____________ and __________. |
|
|
Term
|
Definition
| You've just given an induction dose of an opioid and are now unable to bag the patient, what is your next step? |
|
|
Term
|
Definition
| When do you give a Fentanyl lollipop to a child before surgery? |
|
|
Term
|
Definition
| Gold standard for shivering |
|
|
Term
| Tramadol (opioid), Droperidol |
|
Definition
| Besides Meperidine, what other two drugs can be used for shivering? |
|
|
Term
|
Definition
| What is the active metabolite of morphine? |
|
|
Term
| Pentazocine, Butorphanol, Buprenorphine, Nalbuphine |
|
Definition
| Name 3 opioid agonist-antagonists |
|
|
Term
|
Definition
| Common side effects of Pentazocine |
|
|
Term
|
Definition
| Pentazocine agonizes ______ receptor, and has a _______ effect to both analgesia and respiratory depression. |
|
|
Term
|
Definition
| Agonizes kappa receptors and is either antagonistic or partially agonistic to Mu receptors. |
|
|
Term
|
Definition
| A good opioid to use during conscious sedation due to its limited respiratory depressant effects. |
|
|
Term
|
Definition
| Antagonizes mu receptors, agonizes kappa and delta receptors. |
|
|
Term
|
Definition
|
|
Term
| Mu mostly, some kappa, some delta |
|
Definition
| Narcan works on the following receptors: |
|
|
Term
| Opioid induced N/V, Pruritis, urinary retention, skeletal muscle rigidity and biliary spasm |
|
Definition
| Narcan reverses these 5 side effects associated with opioids. |
|
|
Term
Half life: 1-2 mins
DOA: 30-60 mins |
|
Definition
Narcan half-life:
Narcan DOA: |
|
|
Term
| 0.4-0.8 mg IV or IM; dilute and give in divided doses |
|
Definition
|
|
Term
| Increase, increase, longer, pulmonary edema |
|
Definition
| Giving Narcan can have several side effects. (increase/decrease) HR, (increase/decrease) BP, "renarcotization" with (longer/shorter) acting opioids, and probably the most severe side effect ___________. |
|
|
Term
| If need to give more morphine after reversal with Narcan, pt may need about half as much morphine to have better analgesia, secondary to increased release of endogenous opioids and opioid receptor upregulation. |
|
Definition
| What is the "paradoxical reaction" you may get with Narcan? |
|
|
Term
| Chemical in nature--precipitation of an acid and a base (Sux + Thiopental) |
|
Definition
| A pharmaceutical interaction. |
|
|
Term
Where one agent alters another's kinetics.
Sufentanil with INH agent prolongs Sufentanil DOA.
Propofol and morphine metabolized by CYP 450, so increases morphine levels. |
|
Definition
| Give an example of a pharmacokinetic drug interaction. |
|
|
Term
| Synergy with drugs. Opioids decrease the MAC of INH agents to a certain point. |
|
Definition
| Give an example of a pharmacodynamic drug interaction. |
|
|
Term
|
Definition
| BZDs _______ the effects of opioids and _______ requirements for opioids for loss of consciousness. |
|
|
Term
|
Definition
| T/F BZDs help to potentiate the antinociceptive effects of morphine. |
|
|
Term
| True, together they will significantly drop BP |
|
Definition
| T/F BZDs + opioids will have a pharmacodynamic synergism with blood pressure |
|
|
Term
| Thiopental because opioids blunt the tachycardic response...it's still intact, but the HR won't be as high as normal with Thiopental and so BP will be compromised. |
|
Definition
| When giving Thiopental and Fentanyl, you might want to decrease the dose of which drug to maintain adequate hemodynamics? |
|
|
Term
|
Definition
| CV stability with Etomidate and opioids |
|
|
Term
| Stable, will balance each other out (stimulation vs. depression) |
|
Definition
| CV stability with Ketamine and opioids |
|
|
Term
| CV preserved. N2O has mild sympathomimetic effects |
|
Definition
| N2O + opioids effect on CV |
|
|
Term
|
Definition
| For hemodynamic stability, low dose volitile agents and opioids may reduce the MAC by ______ to ______. This combination also ensures adequate amnesia and promotes immobility. |
|
|
Term
|
Definition
| Pancuronium is molecularly related to this drug. |
|
|
Term
| MAOIs inhibit hepatic microsomal enzymes and allow meperidine metabolites to build up. |
|
Definition
| Giving Meperidine to a pt on an MAOI can cause a fatal interaction because___________ |
|
|
Term
|
Definition
| Opioid + Mivacurium causes _________ in BP probably due to __________ release. |
|
|
Term
| Can potentiate the opioid and also slow HR because opioids inhibit calcium channels. |
|
Definition
|
|
Term
| Significant antinociceptive effects, prolonging opioid, decreasing dose of opioid. Mag is an NMDA antagonist. |
|
Definition
|
|
Term
| Can counteract the respiratory effects of Alfentanil. |
|
Definition
|
|
Term
|
Definition
| An H1 antagonist that modestly stimulates ventilation when used alone. Also has sedative, antipyretic and antiemetic effects. |
|
|
