5.6
Opioids
Opioid Receptor
- G‐coupled protein receptor
- All opioids bind to the opioid receptor
- Receptor Subtypes
- μ Receptor
- Analgesia
- Euphoria/addiction
- Nausea
- Respiratory depression
- Constipation
- 𝛿 Receptor
- Analgesia
- Κ Receptor
- Dysphoria
- Miosis
- μ Receptor
Equianalgesic
| Parenteral (mg) | Oral (mg) | |
|---|---|---|
| Morphine | 10 | 30 |
| Hydromorphone | 1.5 | 7.5 |
| Fentanyl | 0.1 | N/A |
| Codeine Alfentanil Sufentanil |
100 1 0.01 |
200 N/A N/A |
Morphine
- Clinical Indications
- Analgesia
- Adult: 2.5–5 mg IV
- Peds: 0.05–0.2 mg/kg IV
- Myocardial ischemia
- Analgesia
- Cerebral
- ↓ CBF
- ↓ CMRO2
- Nausea
- Cardiovascular
- Minimal
- Pulmonary
- ↓ RR
- ↓ TV
- Renal
- Minimal
- Hepatic
- Primary site of metabolism
- Contraindications
- Asthma [34]
- Controversial
- ↓ Renal activity
- Asthma [34]
- Board Facts
- ↑ Risk of PONV
- Pruritus, more common with neuraxial opioids, can be treated with propofol, diphenhydramine, hydroxyzine, nalbuphine, or naloxone [35]
- Active metabolites can accumulate in decreased renal function
Fentanyl
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