Nagelhout Pharm 1 Exam 3
Which stimuli requires the highest dose narcotics to achieve no response: skin incision, skin closure, intubation? - ANSWER-Intubation
T or F. Opiates have anti-emetic properties. - ANSWER-True.They inhibit vomiting center especially with repeated doses.
What receptors are responsible for the ventilatory depressing and analgesic effects of opiods? - ANSWER-Mu
T or F. Naloxone is an antagonist at ALL opioid receptors? - ANSWER-True.
A patient who's taking Monoamine oxidase inhibitor and has been given meperidine may suffer from? - ANSWER-SEIZURES
Serotoninergic crisis: clonus, agitation, hyperreflexia and hyperthermia
Rank these drugs from least potent to most potent- Meperidine, Fentanil, Codeine, Alfentanil, Sufentanil, Morphine, Remifentanil? - ANSWER-1. Codeine 0.04
- Meperidine 0.1
- Morphine 1
- Alfentanil 10
- Fentanil 100
- Remifentanil 100
7.Sufentanil 1,000
T or F. It's ok to give fentanyl to someone with morphine allergy. - ANSWER-True.Fentanyl is a piperidine derivative. Morphine is phenantrene alkaloid. Cross allergy occurs to drugs in the same classes
T or F. Morphine's metabolite has no significant analgesic activity? - ANSWER-False.They have significant analgesic activity. Accumulation may occur with repetitive dosing in renal patient.
Which class of opioids are best to give to asthmatics? - ANSWER-phenylpiperadines (i.e fentanil) (no histamine release)
Which opioid has a metabolite that is CNS toxic? - ANSWER-Meperidine.metabolite (normeperidine) causes seizure. caution in patient with renal disease or the elderly or when used repeatedly. 1 / 2
What is the least potent opiate? - ANSWER-Codeine.Relative potency of 0.04 relative to morphine.
T or F. High dose opioids like sufentanil provide all of the requirement of general anesthesia? - ANSWER-False.Supplemental drugs may be need to achieve amnesia/unconsciousness, relaxation and sympathetic control.
What is the most potent opioid? - ANSWER-Sufentanil 500-1000 as potent as morphine sulfate
Which opioid is metabolized by non esterase dependent enzymes? - ANSWER- Remifentanil This happens via hydrolysis of ester bonds in the blood plasma
What is the elimination half life of remifentanil? - ANSWER-5-10 minutes
T or F. Remifentanil has anti shivering property? - ANSWER-False.Only Meperidine has anti shivering property.
What is the precursor molecule for beta-endorphin? - ANSWER-Pro-ipiomelanocortin or POMC.
What is the precursor molecule for Enkephalins? - ANSWER-Proenkaphalin A
What is the precursor molecule for Dynorphins? - ANSWER-Prodynorphin
On what body systems to narcotics act? - ANSWER-1. CNS
- GI system
What is the ultimate goal of multimodal therapy in the relief of pain? - ANSWER-Lower the dose of any single agent to improve anti-nociception and
Decrease side effects (especially of opioids: sedation, respiratory depression,
constipation, pruritus, and PONV.)
Stadol (Butorphanol), a partial agonist is also considered an opioid antagonist, why? - ANSWER-When given after a full agonist such as morphine, can replace morphine (compete with morphine for the opioid receptor) and produce a lower level of analgesia
How does Buprenex, a partial opioid agonist, relieve pruritis from morphine? - ANSWER-It acts as an antagonist of morphine, competes with morphine at the receptor.
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