Impairs metabolism

Interferes with formation of glucuronide conjugates 

M3G

M6G- 100x more potent than morphine

Onset: 20 mins

Peak: 30-60 mins

Duration of Action 4-6 hour 

Spasm of biliary smooth muscle- sphincter of Oddi

Constipation, biliary colic, delayed gastric emptying 

Make sure it is not from histamine release

Cutaneous Vessels Dilate

Bronchoconstriction 

May look shocky 

Can go to fetus and depress neonate

No real barrier from mother to fetus 

Onset: 5 min

Peak: 30-60 min

Duration: 2-4 hours 

Principal elimination

pH dependent

Renal impairment can cause accumulation 

Metabolite of Meperidine

Can cause CNS excitation, delirium, Sx

Atropine like- myodriasis and increased HR

Can cause serotonin syndrome

Crosses placenta 

Great for shivering 

Less GI effects because it is more like atropine 

Onset: 2-5 min

Peak: 20-30 mins

Duration: 30 mins- 1 hr

Oralet 

ACTIQ 

Great for peds and chronic pain

25 mcg/hr per 10cm2 of patch 

24 hrs for blood to stablize

17 hr 1/2 once d/c 

(3 hr actual half life)

8-100 mcgs/kg

Infusion: 0.5-3 mcg/kg/min

Onset: Immediate

Peak: Immediate

Parkinson Disease- decrease central dopamine transmission

Erythromycin- CYP450 impaired, prolongs sedation and respiratory depression 

0.05-0.3 mcg/kg/min

Loading dose: 1mcg/kg 

Onset: 1 min

Peak: 1 min

Duration: 5-10 mins

Onset: 15-30 min

Peak: 30-90 min

Duration of Action: 4-5 Hours 

Bind to Mu receptors where they produce a limited response or no affect

Exert partial effect on kappa and delta receptors

May cause dysphoria

Provide analgesia with limited respiratory depression

Low potential for dependence

Have ceiling effect 

10-30 mg IV

50 mg PO

20-40 mcg IVP

5 mcg/kg/hr Infusion 

0.25 mcg/kg IV q 2 to 5 mins

Do not exceed 1 mg