Opioids 1

Axial Anguish

100

This specific location in the spinal cord is where all 3 opioid receptors are present in high concentrations

Dorsal horn

200

Cephalad movement of opioids in the CSF can be facilitated by what two normal actions

Coughing and straining

300

Due to thickness of the dura, epidural doses are likely to be this much greater than spinal doses

5-10 times the dose

400

The addition of this neurotransmitter allows for decreased absorption of opioids, enhancing length of analgesia specifically for morphine

Epinephrine

500

How much of the epidural dose of morphine actually enters the CSF?

3%

Versed by Versed

100

This medication is most commonly administered as premedication or IV sedation

Midazolam

200

This unique aspect of midazolam reduces pain on injection

Water-soluble at low pH

300

The inhibition of the reuptake of this molecule by midazolam results in a cardioprotective effect

Adenosine

400

This population experiences up to double the elimination half time of midazolam

Elderly

500

Differentiate between GABA and glycine the effects of benzodiazepines:

Sedative, anxiolysis, muscle relaxation, anti-convulsant

GABA: anti-convulsant, sedative

Glycine: anxiolysis, muscle relaxation

Back That Thang Up

100

While not a true reversal agent, this medication stimulated hypoxic drive via activation of chemoreceptors in the carotid bodies

Doxapram

200

This is the maximum dose of flumazenil

1 mg

300

This receptor type is more antagonized than its counterparts by Narcan

Mu receptors

400

This side effect of narcan administration can be cause by increase in pressure and permeability of pulmonary capillaries

Acute (flash) pulmonary edema

500

Caution should be taken when administering flumazenil for consistent benzodiazepine users due to this reversal side effect

Withdrawal seizures

Ross and Rachel

100

This receptor is associated with psychomimetic effects including dysphoria, confusion, lack of euphoria, and depression

Kappa

200

This medication is backed by evidence that it can aid in reversing opioid-induced hyperalgesia

Suboxone

300

This agonist-antagonist is the best suited for CV patients due it's lack of cardiovascular effects

Nalbuphine (Nubain)

400

Patients taking suboxone chronically before surgery may require this adjustment by the anesthesia provider

Higher dose of opioid needed to achieve adequate pain control

500

This agonist-antagonist is unique in its lack of antagonism by morphine

Buprenorphine (Buprenex)

Order of the Fortix

100

This novel benzodiazepine has the quickest onset and fastest recovery

Remimazolam

200

Rank these 3 meds in amnestic potency

1. Lorazepam

2. Midazolam

3. Diazepam

300

Rank the hepatic clearance rates for Midazolam, Diazepam, and Lorazepam 

Bonus points for how much difference is

Midazolam > Lorazepam > Diazepam

Midazolam is 5x faster than lorazepam and 10x faster than diazepam

400

Differentiate these medications and their analgesic potency in respect to morphine:

Butorphanol (Stadol)

Buprenorphine (Buprenex)

Nalbuphine (Nubain)

Butorphanol more potent

Buprenorphine more potent

Nalbuphine equipotent

500

Rank these opioids in speed of diffusion into the CSF

Sufentanil, Morphine, Fentanyl

Bonus points for stating how long it takes to get to peak concentration in CSF

1. Sufentanil - 6 mins

2. Fentanyl - 20 mins

3. Morphine - 1 to 4 hours