Back to the Basics
These two opioids inhibit the NMDA receptors
Tramadol, Methadone
This opioid has the longest half-life
Dosing a remifentanil infusion by this method will lead to dramatically higher concentration in obese patients
Total Body Weight
Reduction of this lead to constipation from opioids
peristalsis
The partial agonists will exert this mechanism when administered with a full agonist such as morphine or fentanyl
competitive antagonism
Originating from injured nerve terminals, this pain mediator activates nociceptors
The ester structure of this opioid allows it to be metabolized by hydrolysis from nonspecific esterases
Remifentanil
In kidney failure, this metabolic byproduct can accumulate and lead to life-threatening respiratory depression due to its analgesic potency rivaling its parent compound
Morphine 6-Glucuronide
Heart Rate
Better not give this opioid to your depressed patient with a vancomycin-resistant staph aureus infection
Tramadol
neuraxial opioids relieve pain by activating mu receptors in this area of the spinal cord
Substantia gelatinosa
This synthetic is a great choice for infusion when significant intraoperative stimulation and post-operative pain are expected
sufentanil
Giving this opioid to your ESRD patients can lead to excitatory CNS effects including anxiety, tremulousness, myoclonus, and frank seizures
Meperidine
Opioids reduce minute ventilation by reducing this
Least likely to increase biliary sphincter tone, this agonist-antagonist is great for biliary colic and labor analgesia
Butorphanol
Mu agonists are best at treating "second pain" sensations that are carried by this slow conducting, unmyelinated fiber
C-fibers
Along with the liver, this organ helps with biotransformation of fentanyl through carboxylesterases
Lung
This metabolite of hydromorphone has no analgesic properties, and can accumulate in ESRD leading to potential neurotoxicity, myoclonus, and restlessness
Hydromorphone-3-glucoronide
High dose opioid anesthesia was traditionally used for cardiac surgery but abandoned due to this major complication
intraoperative awareness
Unlike naloxone, this agonist-antagonist can reverse opioid-induced ventilatory depression while maintaining some analgesia
nalbuphine
Miosis from opioids is produced by activation of this nucleus in this cranial nerve
Edinger-Westphal nucleus in CNIII
Bolusing these three opioids will lead to decreased SVR via release of this compound
morphine, meperidine, hydromorphone
histamine
liver failure usually does not have a major impact on opioid pharmacokinetics with the exception of this phase during liver transplantation
Anhepatic phase
nausea and vomiting from opioids are triggered by activation of this brain region near this ventricle
chemoreceptor trigger zone in the 4th ventricle
Naltrexone utilizes this mechanism to treat OUD and this substance use disorder
competitive antagonist and AUD