Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++Table Graphic Jump Location|Download (.pdf)|PrintOpioidsMedicationPharmacologyClinical pearlsMorphineClassPhenanthreneIV/IM dosing equipotentIV dosing may produce less nausea/vomitingActive metabolite (morphine 6-glucuronide) accumulates with renal insufficiency/failureIntrathecal/epidural use: hydrophilic nature allows for single dose to have prolonged effect at the mu receptors within the substantia gelatinosa (12–24 h). Migration to brain stem can produce delayed respiratory depressionDose1–3 mgRelative potency1Onset/peak5/20 minMetabolismHepaticSide effectsCauses common opioid side effects1 as well as histamine releaseHydromorphone (Dilaudid)ClassPhenanthreneGood alternative to morphine in renal insufficiencyPurported to have less emetogenic effect compared with morphineDose0.1–0.4 mgRelative potency7.5Onset/peak5/20 minMetabolismHepaticSide effectsCommon opioid side effects1Meperidine (Demerol)ClassPhenylpiperidineMost effective opioid at decreasing postoperative shiveringUse in renal insufficiency can lead to accumulation of the metabolite, normeperidine, which can cause seizuresAtropine-like structure can increase HR; does not cause miosisDose12.5–100 mgRelative potency0.1Onset/peak5/20 minMetabolismHepaticSide effectsInteraction with MAOIs can cause fatal hypermetabolic reactionFentanyl (Sublimaze)ClassPhenylpiperidineUse as analgesic component of TIVA at 0.2–1.5 μg/kg/hContext-sensitive half-time (CSHT) leads to prolonged elimination with infusions greater than 2 hTerminate infusion 30 min prior to expected emergence to allow drug accumulated in other compartments to be eliminatedDose25–50 μgRelative potency100Onset/peak1/5 minMetabolismHepaticSide effectsCommon opioid side effects1 and chest wall rigiditySufentanil (Sufenta)ClassPhenylpiperidineAs component of TIVA has more favorable CSHT but will accumulate with longer infusionsVery rapid onsetDose5–10 μgRelative potency1,000Onset/peak30 s/1 minMetabolismHepaticSide effectsCommon opioid side effects1Alfentanil (Alfenta)ClassPhenylpiperidineGood alternative to remifentanil as bolus agent for brief periods of more intense stimulationGood choice of analgesic component of TIVA (0.5–3 μg/ (kg min)) when duration anticipated to be longer than 8 h (although remifentanil still superior in terms of recovery)Dose100–300 μgRelative potency15Onset/peak30 s/1 minMetabolismHepaticSide effectsCommon opioid side effects1Chest wall rigidity at high doses or with rapid administrationRemifentanil (Ultiva)ClassPhenylpiperidineWith a flat CSHT with infusion of any duration, excellent TIVA componentRapid onset and offset makes it good for blunting sympathetic effects of brief periods of increased stimulationVery-low-dose infusions can be used for sedation; however, works synergistically with propofol to cause respiratory depression and apneaDose5–50 μg IVRelative potency100Onset/peak30 s/1 minMetabolismTissue esterasesSide effectsCommon opioid side effects.1Acute opioid desensitization, hyperalgesia1Common opioid side effects include nausea/vomiting, respiratory depression, urinary retention, pruritus, constipation, sedation, and miosis. Doses given are typical one-time bolus doses, not total doses for a given procedure. ++Figure 58-1. Context-Sensitive Half-Time of OpioidsGraphic Jump LocationView Full Size||Download Slide (.ppt)Curves are based on simulated pharmacokinetic models. Solid ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth