Apex midterm questions and answers

Apex midterm questions and answers
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Opioid receptors & their ligands?
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Where do opioids work? - ANSWERMu --> endorphins
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delta --> enk mj mj mj


kappa --> Dyn mj mj mj




PNS & CNS (brain, spinal cord)
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what drugs work on each step of pain nociception? - ANSWERtransduction -
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NSAIDs, LA, opioids, antihistamines, steroids
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transmission - LA mj mj


modulation - nmda, ssri, snri, nxl opioids, alpha 2 agonists, ache inhibitors
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perception: alpha 2 agonists, GA, opioids mj mj mj mj mj




explain 1st, 2nd, 3rd order neurons in transmission. What spinal tract is
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transmission in? - ANSWER1st: site --> dorsal horn
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2nd: DH --> thalamus (cell body in DH)
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3rd: thalamus --> cortex (cell body in thalamus)
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Spinothalamic

Where is the most important site of modulation? - ANSWERSubstantia gelatinosa in
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DH rex lam 2 & 3
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Which 2 effects of opioids are NOT impacted by tolerance? - ANSWERMiosis &
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constipation
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MoA of opioids? - ANSWER-bind to g protein
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-↓adenylate cyclase --> ↓camp mj mj mj


-↓ca+ presynaptically, ↑k+ postsynaptically
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Mu receptors effects
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Delta effects mj


kappa effects - ANSWERmu: bradycardia, miosis, n/v, sphincter of oddi contraction
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(↑biliary pressure), euphoria, prolactin rlz, hypothermia, resp depression, pruritis,
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analgesia
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delta: analgesia, urinary retention, resp depression, NO CNS, NO MIOSIS
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kappa: antishivering, diuresis, resp depression?, dysphoria, hallucinations, delirium,
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sedation, NO PRURITIS
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opioid OD - s/s, narcan dose - ANSWER↑ICP, TV, PaCo2
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↓pH, RR mj

,Apex midterm questions and answers
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narcan: 1-4mcg/kg (20-40mcg) mj mj


**slowly, sudden ↑SNS --> tachy, pulm edema, arrythmia, death
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*can also cause n/v
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*can do infusion
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which drugs release histamine? - ANSWERopioids: morphine, meperidine, codeine
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NMB: succs, atra, miva, (NOT PANC)
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barbs: thiopental (reflex tachy)
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which opioid increase sphincter of oddi pressure the least? - ANSWERmeperidine
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which opioids have metabolites? How are opioid metabolites excreted? -
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ANSWERmorphine, meperidine, TRAMADOL & maybe hydromorphone
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(CODEINE??)
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morphine - m6g, m3g mj mj mj


*CI in renal pt, elderly
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mep - normep mj mj mj


*can cause myoclonus, seizures
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renally

how are all opioids metabolized? - ANSWERliver
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which opioid contraindicated for nxl use? - ANSWERremi
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*has glycine in constitution, causes skeletal muscle weakness
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which opioids are likely to cause chest wall rigidity?
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tx?
does chest wall rigidity increase icp? FRC? - ANSWERmore potent ones (suf, alf,
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remi, fent)
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paralyze & intubate mj mj mj


↑ICP, ↓FRC mj




how do opioids affect immune function?
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how do they affect SSEPs?
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BP? - ANSWER↓killer t cell, cause inflammation, ↓immunologic fxns
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do not affect sseps
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do no affect BP, if drop in BP its from histamine.
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*do not affect contractility.
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what opioid has anticholinergic side effects & inhibits n. conduction?
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which opioid should you not admin with a pt on MAOI - ANSWERMEP &
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FENTANYL
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Mep: stimulate mu & kappa
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,Apex midterm questions and answers
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causes tachy, mydriasis, dry mouth (xerostomia)
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mep & fentanyl: has mild MAOI properties
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which opioid has the fastest onset? why? - ANSWERalfentanil
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*all opioids are weak bases, alfentanil PKA is 6.8
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**↑unionized fxn at phys pH mj mj mj mj mj


**↓Vd
*all other opioids pka > 7.2
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which opioid is the most ionized/least unionized at phys pH? - ANSWERmep
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list opioids by potency - ANSWERmeperidine 100mg
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morphine 10mg mj mj


hydromorphone 1.4mg (7x as strong) mj mj mj mj


alfentanil 1000mcg mj


fentanyl 100mcg mj


remi 100mcg mj


sufentanil 10mcg mj




draw context sensitive half time graph of opioids - ANSWER
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list opioid antagonists - ANSWERNaloxone
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Naltrexone - can also use for alcohol abuse, long acting
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Nalmefene - longer acting narcan mj mj mj mj


Methylnaltrexone - doesnt cross cns, good for bowel obs mj mj mj mj mj mj mj mj




list partial agonists
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drawbacks - ANSWERBuprenorphine - analgesia stronger than morphine
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butorphanol - analgesia stronger than morphine mj mj mj mj mj


nalbuphine - good for heart disease mj mj mj mj mj




a local anesthetic with a pka (further, closer) to physiological pH will have a faster
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onset. - ANSWERcloser to.
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3 components of local anesthetic molecule and what they determine? - ANSWER1.
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benzene ring
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*lipophilicity mj


2. intermediate chain
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*metabolism, allergy mj


*COC or NH-C mj mj


3. tertiary amine
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*hydrophilicity; accepts proton mj mj


*weak base mj

, Apex midterm questions and answers
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metabolism of esters vs amides mj mj mj mj mj


allergy potential esters vs amides - ANSWEResters: pseudocholin
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amides: liver cyp450 mj mj




esters: PABA preservative allergy
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*cross sensitivitymj mj


amides: methylparaben mj




local anesthetics are weak ____ that are typically more ____ at phys pH
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what part of the LA exerts the anesthetic action? - ANSWERbases; ionized
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the charged, ionized component
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**except w/ benzocaine mj mj




Order pkas locals - ANSWERamides have lower pka
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*bupi, levobupi, ropi: 8.1
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*lido, prilo: 7.9
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*mepi: 7.6 mj




esters higher mj mj


*procaine 8.9 mj


*chloro 8.7 mj


*tetra 8.5 mj




what is the highest pka of the amides?
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what is the highest pka of the esters? - ANSWER8.1
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8.9

max doses amides
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levobupi, bupi, bupi + epi, ropi, lido, mepi etc - ANSWERlevobupi 150mg (2mg/kg)
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bupi 175 (2.5)
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bupi + epi 200 (3)
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ropi 200 (3)
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lido 300 (4.5)
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mepi 400 (7)
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lido + epi 500 (7)
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prilo <70kg: 500/>70kg: 600 (8)
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max doses esters - ANSWERprocaine 350-600mg (7mg/kg)
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chloroprocaine 800 (11) mj mj


chloroprocaine + epi 1000 (14) mj mj mj mj




Max dose of Exparel (liposomal bupi)
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