Notes in 17 Opioid

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Published	12/13/2023	Second-order neurons run from the {{c1::dorsal horn}} to the {{c1::thalamus}}.
Published	12/13/2023	Third-order neurons run from the {{c1::thalamus}} to the {{c1::cerebral cortex}}.
Published	12/13/2023	The descending inhibitory pain pathway begins in the {{c1::periaqueductal gray area}} and the {{c1::rostroventral medulla}}, and projects to the {{c2:…
Published	12/13/2023	What neurotransmitters are released by spinal neurons to inhibit pain (modulation)?{{c1::GABA}} and {{c1::glycine}}
Published	12/13/2023	What neurotransmitters are released by the descending pain pathway to inhibit pain?{{c1::Norepinephrine, 5-HT, endorphins}}
Published	12/13/2023	What processes augment the pain signal in the spinal cord?{{c1::Central sensitization}}{{c1::Wind up}}
Published	12/13/2023	Stimulation of the {{c1::μ-1}} opioid receptor subtype is responsible for bradycardia.
Published	12/13/2023	Which opioid receptors are responsible for urinary retention?{{c1::μ and δ }}
Published	12/13/2023	Which opioid receptors DO NOT cause sedation?{{c1::δ }}
Published	12/13/2023	Which opioid receptors are responsible for miosis?{{c1::μ and κ }}
Published	12/13/2023	Which opioid receptors produces GI effects (reduced peristalsis, N/V, increased biliary pressure)?{{c1::μ}}
Published	12/13/2023	Which opioid receptors cause pruritis?{{c1::μ and δ}}
Published	12/13/2023	Which μ receptor subtype produces supraspinal and spinal analgesia?{{c1::μ-1}}
Published	12/13/2023	What μ receptor subtype produces only spinal analgesia?{{c1::μ-2}}
Published	12/13/2023	What μ receptor subtype produces respiratory depression, constipation, and physical dependence?{{c1::μ-2}}
Published	12/13/2023	What μ receptor subtype produces immune suppression?{{c1::μ-3}}
Published	12/13/2023	Opioids {{c1::have no effect on::increase/decrease}} the baroreceptor reflex.
Published	12/13/2023	What evoked potentials are contraindicated with opioids?{{c1::None - opioids have minimal effects on SSEP}}
Published	12/13/2023	Opioids {{c1::decrease}} core body temperature by resetting the {{c2::hypothalamic temperature set point}}.
Published	12/13/2023	In {{c1::women::gender}}, morphine has a greater potency, slower onset, and longer duration of action.
Published	12/13/2023	What mechanisms are responsible for responsible for tolerance and physical dependence of opioids?{{c1::receptor desensitization}} and increased synthe…
Published	12/13/2023	What two opioid side effects are not affected by opioid tolerance?{{c1::Miosis}} or {{c1::constipation}}
Published	12/13/2023	The time course of opioid withdrawal is directly related to the individual agent's {{c1::half-life}}.
Published	12/13/2023	Remifentanil should be dosed with {{c1::lean}} body weight.
Published	12/13/2023	Normeperidine has {{c1::½}} the potency of meperidine.
Published	12/13/2023	{{c1::Alfentanil}} is the only opioid with a pKa (6.5) less than physiologic pH.
Published	12/13/2023	Alfentanil has an effect site equilibration time of around {{c1::1.4}} minutes.
Published	12/13/2023	Opioid-induced hyperalgesia can be prevented with {{c1::ketamine}} or {{c1::magnesium sulfate}}.
Published	12/13/2023	What opioid agonist is used for opioid maintenance therapy in opioid dependence?{{c1::Methadone}}
Published	12/13/2023	Methadone is a {{c1::μ}} opioid receptor agonist.
Published	12/13/2023	The {{c1::dextrorotatory}} isomer of methadone acts as a {{c2::NMDA}} receptor {{c2::antagonist}}.
Published	12/13/2023	Methadone inhibits reuptake of {{c1::monoamines}} in the synaptic cleft.
Published	12/13/2023	Oral methadone has a bioavailability of {{c1::80}}%.
Published	12/13/2023	Methadone has a duration of action of {{c1::3}} to {{c1::6}} hours.
Published	12/13/2023	Methadone is metabolized by the {{c1::liver (CYP450)}} to {{c2::inactive::active/inactive}} metabolites.
Published	12/13/2023	{{c2::Methadone::opioid}} can cause {{c1::QT interval prolongation}} by inhibiting the delayed rectifier potassium ion channel (IKr).
Published	12/13/2023	Opioid-induced skeletal muscle rigidity produces the most rigidity at the {{c1::larynx}}.
Published	12/13/2023	Opioid-induced skeletal muscle rigidity will {{c1::increase}} oxygen consumption.
Published	12/13/2023	Opioid-induced skeletal muscle rigidity will {{c1::decrease}} thoracic compliance, functional residual capacity, and minute ventilation.
Published	12/13/2023	Opioid-induced skeletal muscle rigidity will {{c1::increase}} the central venous pressure.
Published	12/13/2023	Opioid-induced skeletal muscle rigidity will {{c1::increase}} the pulmonary artery pressure and pulmonary vascular resistance.
Published	12/13/2023	Opioid-induced skeletal muscle rigidity will {{c1::increase}} intracranial pressure.
Published	12/13/2023	What partial agonist/agonist-antagonist has a similar analgesic effect to morphine?{{c1::Nalbuphine}}
Published	12/13/2023	What opioid partial agonist/agonist-antagonist can be administered via a transdermal route?{{c1::Buprenorphine}}
Published	12/13/2023	What opioid partial agonist/agonist-antagonist can be administered via a intranasal route?{{c1::Butorphanol}}
Published	12/13/2023	What opioid partial agonist/agonist-antagonist is preferred in patients with a history of heart disease?{{c1::Nalbuphine}}
Published	12/13/2023	What opioid partial agonist/agonist-antagonist can be used to treat shivering?{{c1::Butorphanol}}
Published	12/13/2023	Cardiac and pulmonary events from naloxone can be prevented by {{c1::slow titration}}.
Published	12/13/2023	Administration of naloxone to an opioid abusing mother can cross the placenta and precipitate {{c1::acute opioid withdrawal}} in the neonate.
Published	12/13/2023	{{c2::Nalmefene}} is an opioid antagonist with a similar profile to naloxone, with a duration of action of {{c1::10}} hours.
Published	12/13/2023	Extended release naltrexone is used to treat {{c1::alcohol withdrawal}}.
Published	12/13/2023	What opioid antagonist undergoes significant first pass metabolism?{{c1::Naloxone}}
Published	12/13/2023	Stimulation of the μ opioid receptor can cause {{c1::prolactin}} release.
Published	12/13/2023	Which opioid has the lowest pKa?{{c1::Alfentanil (6.5)}}
Published	12/13/2023	Which opioid has the highest pKa?{{c1::Meperidine (8.5)}}
Published	12/13/2023	Which opioid has the highest unionized fraction?{{c1::Alfentanil (89%)}}
Published	12/13/2023	Which opioid has the lowest unionized fraction?{{c1::Meperidine (7%)}}
Published	12/13/2023	Which opioid has the lowest protein binding fraction?{{c1::Morphine (35%)}}
Published	12/13/2023	Which opioid has the highest protein binding fraction?{{c1::Remifentanil & Sufentanil (93%)}}
Published	12/13/2023	Which opioid has the highest Vd?{{c1::Fentanyl (4 L/kg)}}
Published	12/13/2023	Which opioid has the lowest Vd?{{c1::Remifentanil (0.39 L/kg)}}
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