Aba asa opioids

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Aba asa opioids

  1. 1. What ASA/ABA wants you to know about Opioids
  2. 2. 1) mechanism of action • Receptors: mu, kappa, delta, sigma • Pre/post synaptic • Calcium • Peri-aq. Grey and dorsal horn
  3. 3. 2) pharmacokinetics and pharmacodynamics • Lipid solubility • Vd = dose/[drug] • Fentanyl, Morphine, Hydromorphine, Methadone, Remifentanyl • Context sensitive half-life
  4. 4. 3) metabolism and excretion • Liver Metabolism/Renal Excretion • Morphine • Meperidine • Hydromorphone • Methadone • Fentanyl
  5. 5. 4) effect on circulation • Meperidine heart rate and contractility • MAP decrease: brady (vagus), venodilation, decreased SNS tone, histamine release
  6. 6. 5) effect on respiration • Apneic Threshold • Morphine and Meperidine Bronchospasm • Chest wall rigidity • Block bronchoconstriction to intubation
  7. 7. 6) effect on other organs • Brain – reduce CRMO2, CBF, ICP • Minimal EEG change, no reliable amnesia • EEG activation with meperidine • N/V – medullary chemoreceptor trigger zone
  8. 8. 7) side effects and toxicity • Meperidine and MAOI • GI – reduce peristalsis, biliary spasm • Endocrine – block release of catecholamines, ADH, cortisol better than VA. • Immune suppression, REM disturbance, hypogonadism, hyperalgesia, addiction/overdose.
  9. 9. 8) indications and contraindications • Cancer pain • Perioperative period • Chronic pain? • OHS, pregnancy, meperidine, combinations,
  10. 10. 8) indications and contraindications • Cancer pain • Perioperative period • Chronic pain? • OHS, pregnancy, meperidine, combinations,

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