Difference between revisions of "Opioids"
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(Created page with "* Don’t combine benzodiazepines and opioids. If you need to reverse, use flumazenil. =Short-Acting= * Oxycodone, Hydromorphone, Morphine =Long-Acting= * Oxycodone ER = OxyC...") Tags: Mobile web edit Mobile edit |
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| − | * Don’t combine benzodiazepines and opioids. If you need to reverse, use flumazenil. | + | {| class="wikitable" |
| + | |+ Commonly Used Opioids | ||
| + | |- | ||
| + | ! Opioid !! Dose !! Onset !! Duration !! Elimination !! Unique effects/indications | ||
| + | |- | ||
| + | | Fentanyl || 1-20 ug/kg || 4-6 min || 30-45 min || Hepatic || Not used as infusion | ||
| + | |- | ||
| + | | Sufentanyl || 0.3-1 ug/kg || 1-2 min || 20-40 min || Hepatic || ... | ||
| + | |- | ||
| + | | Remifentanyl || 0.3-1 ug/kg || 1-1.5 min || 5-10 min || Plasma esterases, context sensitive half-life || Profound hypotension/bradycardia, "MAC sparing" reduces need for other anesthetics by 75% | ||
| + | |- | ||
| + | | Alfentanyl || 5-50 ug/kg || 1-2 min || 20 min || Hepatic || ... | ||
| + | |- | ||
| + | | Morphine sulfate || 25-75 mg || 10-30 min || 2-5 hrs || Hepatic || Can cause histamine release | ||
| + | |- | ||
| + | | Meperidine || Example || 10-30 min || 2-5 hrs || Hepatic || Used for post-op shivering, can't give to patients taking MAOIs | ||
| + | |} | ||
| + | |||
| + | * Don’t combine [[benzodiazepines]] and opioids. If you need to reverse, use [[flumazenil]]. | ||
| + | * Central loci of opioid action (descending inhibitory pain pathways) | ||
| + | ** PAG | ||
| + | ** Nucleus Raphe magnus | ||
| + | ** Rostral ventromedial medulla | ||
=Short-Acting= | =Short-Acting= | ||
* Oxycodone, Hydromorphone, Morphine | * Oxycodone, Hydromorphone, Morphine | ||
| + | * Morphine can cause rash/pruritis | ||
=Long-Acting= | =Long-Acting= | ||
| − | * Oxycodone ER = OxyContin | + | * Oxycodone ER = OxyContin |
| − | * | + | * Methadone |
* Fentanyl is really only used intra-op or in palliative care. | * Fentanyl is really only used intra-op or in palliative care. | ||
Latest revision as of 20:58, 31 January 2023
| Opioid | Dose | Onset | Duration | Elimination | Unique effects/indications |
|---|---|---|---|---|---|
| Fentanyl | 1-20 ug/kg | 4-6 min | 30-45 min | Hepatic | Not used as infusion |
| Sufentanyl | 0.3-1 ug/kg | 1-2 min | 20-40 min | Hepatic | ... |
| Remifentanyl | 0.3-1 ug/kg | 1-1.5 min | 5-10 min | Plasma esterases, context sensitive half-life | Profound hypotension/bradycardia, "MAC sparing" reduces need for other anesthetics by 75% |
| Alfentanyl | 5-50 ug/kg | 1-2 min | 20 min | Hepatic | ... |
| Morphine sulfate | 25-75 mg | 10-30 min | 2-5 hrs | Hepatic | Can cause histamine release |
| Meperidine | Example | 10-30 min | 2-5 hrs | Hepatic | Used for post-op shivering, can't give to patients taking MAOIs |
- Don’t combine benzodiazepines and opioids. If you need to reverse, use flumazenil.
- Central loci of opioid action (descending inhibitory pain pathways)
- PAG
- Nucleus Raphe magnus
- Rostral ventromedial medulla
Short-Acting
- Oxycodone, Hydromorphone, Morphine
- Morphine can cause rash/pruritis
Long-Acting
- Oxycodone ER = OxyContin
- Methadone
- Fentanyl is really only used intra-op or in palliative care.