Apex midterm UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS
Opioid receptors & their ligands? Mu --> endorphins
Where do opioids work? delta --> enk
kappa --> Dyn
PNS & CNS (brain, spinal cord)
what drugs work on each step of pain nociception? transduction - NSAIDs, LA, opioids, antihistamines, steroids
transmission - LA
modulation - nmda, ssri, snri, nxl opioids, alpha 2 agonists, ache inhibitors
perception: alpha 2 agonists, GA, opioids
explain 1st, 2nd, 3rd order neurons in transmission. What 1st: site --> dorsal horn
spinal tract is transmission in? 2nd: DH --> thalamus (cell body in DH)
3rd: thalamus --> cortex (cell body in thalamus)
Spinothalamic
Where is the most important site of modulation? Substantia gelatinosa in DH rex lam 2 & 3
Which 2 effects of opioids are NOT impacted by Miosis & constipation
tolerance?
MoA of opioids? -bind to g protein
-↓adenylate cyclase --> ↓camp
-↓ca+ presynaptically, ↑k+ postsynaptically
Mu receptors effects mu: bradycardia, miosis, n/v, sphincter of oddi contraction (↑biliary pressure),
euphoria, prolactin rlz, hypothermia, resp depression, pruritis, analgesia
Delta effects
kappa effects delta: analgesia, urinary retention, resp depression, NO CNS, NO MIOSIS
kappa: antishivering, diuresis, resp depression?, dysphoria, hallucinations, delirium,
sedation, NO PRURITIS
opioid OD - s/s, narcan dose ↑ICP, TV, PaCo2
↓pH, RR
narcan: 1-4mcg/kg (20-40mcg)
**slowly, sudden ↑SNS --> tachy, pulm edema, arrythmia, death
*can also cause n/v
*can do infusion
which drugs release histamine? opioids: morphine, meperidine, codeine
NMB: succs, atra, miva, (NOT PANC)
barbs: thiopental (reflex tachy)
, which opioid increase sphincter of oddi pressure the meperidine
least?
which opioids have metabolites? How are opioid morphine, meperidine, TRAMADOL & maybe hydromorphone (CODEINE??)
metabolites excreted?
morphine - m6g, m3g
*CI in renal pt, elderly
mep - normep
*can cause myoclonus, seizures
renally
how are all opioids metabolized? liver
which opioid contraindicated for nxl use? remi
*has glycine in constitution, causes skeletal muscle weakness
which opioids are likely to cause chest wall rigidity? more potent ones (suf, alf, remi, fent)
tx? paralyze & intubate
does chest wall rigidity increase icp? FRC? ↑ICP, ↓FRC
how do opioids affect immune function? ↓killer t cell, cause inflammation, ↓immunologic fxns
how do they affect SSEPs? do not affect sseps
BP? do no affect BP, if drop in BP its from histamine.
*do not affect contractility.
what opioid has anticholinergic side effects & inhibits n. MEP & FENTANYL
conduction? Mep: stimulate mu & kappa
which opioid should you not admin with a pt on MAOI causes tachy, mydriasis, dry mouth (xerostomia)
mep & fentanyl: has mild MAOI properties
which opioid has the fastest onset? why? alfentanil
*all opioids are weak bases, alfentanil PKA is 6.8
**↑unionized fxn at phys pH
**↓Vd
*all other opioids pka > 7.2
which opioid is the most ionized/least unionized at phys mep
pH?
list opioids by potency meperidine 100mg
morphine 10mg
hydromorphone 1.4mg (7x as strong)
alfentanil 1000mcg
fentanyl 100mcg
remi 100mcg
sufentanil 10mcg
Opioid receptors & their ligands? Mu --> endorphins
Where do opioids work? delta --> enk
kappa --> Dyn
PNS & CNS (brain, spinal cord)
what drugs work on each step of pain nociception? transduction - NSAIDs, LA, opioids, antihistamines, steroids
transmission - LA
modulation - nmda, ssri, snri, nxl opioids, alpha 2 agonists, ache inhibitors
perception: alpha 2 agonists, GA, opioids
explain 1st, 2nd, 3rd order neurons in transmission. What 1st: site --> dorsal horn
spinal tract is transmission in? 2nd: DH --> thalamus (cell body in DH)
3rd: thalamus --> cortex (cell body in thalamus)
Spinothalamic
Where is the most important site of modulation? Substantia gelatinosa in DH rex lam 2 & 3
Which 2 effects of opioids are NOT impacted by Miosis & constipation
tolerance?
MoA of opioids? -bind to g protein
-↓adenylate cyclase --> ↓camp
-↓ca+ presynaptically, ↑k+ postsynaptically
Mu receptors effects mu: bradycardia, miosis, n/v, sphincter of oddi contraction (↑biliary pressure),
euphoria, prolactin rlz, hypothermia, resp depression, pruritis, analgesia
Delta effects
kappa effects delta: analgesia, urinary retention, resp depression, NO CNS, NO MIOSIS
kappa: antishivering, diuresis, resp depression?, dysphoria, hallucinations, delirium,
sedation, NO PRURITIS
opioid OD - s/s, narcan dose ↑ICP, TV, PaCo2
↓pH, RR
narcan: 1-4mcg/kg (20-40mcg)
**slowly, sudden ↑SNS --> tachy, pulm edema, arrythmia, death
*can also cause n/v
*can do infusion
which drugs release histamine? opioids: morphine, meperidine, codeine
NMB: succs, atra, miva, (NOT PANC)
barbs: thiopental (reflex tachy)
, which opioid increase sphincter of oddi pressure the meperidine
least?
which opioids have metabolites? How are opioid morphine, meperidine, TRAMADOL & maybe hydromorphone (CODEINE??)
metabolites excreted?
morphine - m6g, m3g
*CI in renal pt, elderly
mep - normep
*can cause myoclonus, seizures
renally
how are all opioids metabolized? liver
which opioid contraindicated for nxl use? remi
*has glycine in constitution, causes skeletal muscle weakness
which opioids are likely to cause chest wall rigidity? more potent ones (suf, alf, remi, fent)
tx? paralyze & intubate
does chest wall rigidity increase icp? FRC? ↑ICP, ↓FRC
how do opioids affect immune function? ↓killer t cell, cause inflammation, ↓immunologic fxns
how do they affect SSEPs? do not affect sseps
BP? do no affect BP, if drop in BP its from histamine.
*do not affect contractility.
what opioid has anticholinergic side effects & inhibits n. MEP & FENTANYL
conduction? Mep: stimulate mu & kappa
which opioid should you not admin with a pt on MAOI causes tachy, mydriasis, dry mouth (xerostomia)
mep & fentanyl: has mild MAOI properties
which opioid has the fastest onset? why? alfentanil
*all opioids are weak bases, alfentanil PKA is 6.8
**↑unionized fxn at phys pH
**↓Vd
*all other opioids pka > 7.2
which opioid is the most ionized/least unionized at phys mep
pH?
list opioids by potency meperidine 100mg
morphine 10mg
hydromorphone 1.4mg (7x as strong)
alfentanil 1000mcg
fentanyl 100mcg
remi 100mcg
sufentanil 10mcg
