AGONISTAS-ANTAGONISTAS OPIACEOS
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AGONISTAS-ANTAGONI Y
ANTAGONISTAS OPIACDR SERGIO ALEJANDRO ANDRADE LOZANO RES
1ER AÑO DE ANESTESIOLOGIA.
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COMPUESTOS ANTAGONISTAAGONISTAS.•
Nalorfna u l !r"# r an$a%on"&$a '( ")lan* + En 1 /0.• R r$2a $o*o& lo& ,$o& * la #orfna.
• O3$ n,"4n !or al5u"la,"4n * l n"$r4% no * la !"!+ la a*","4n * una ,a* na la$ ral * 6 ,ar3ono& 7
7 al"l 4 # $"l-al"l a la #orfna.
POTENTEANALGESIA
E8ECTOSPSICOTOMIMETIC
OS
USOANTAGONISTA EN
DOSIS 9AJAS
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COMPUESTOS ANTAGONISTAAGONISTAS.•
La 3u!r norfna & un a%on"&$a !ar,"al * l r , !$• Lo& o$ro& ,o#!u &$o& &on an$a%on"&$a& * l
a%on"&$a& !ar,"al & o ,o#!l $o& * l r , !$or =. TAM9IEN
DEPRESIONRESPIRATORI
A
E 8 E C T O
T E C > O
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PENTAZOCINA•
Anal% &"a !or &$"#ula,"4n * l r , !$or =.• ? a @ * la !o$ n,"a * la #orfna.• M nor !o$ n,"al * a3u&o 5u ,on la #orfna.• Pu * !r & n$ar ,$o& *"& or",o&; &o3r $
an,"ano& ,on *o&"& B #%. S !u * n r r$"rnalo ona.
E8ECTO TEC6 7
INOTROPIA
A U M E N T O
D E
L A T A
A U M E N T O
D E
L A 8 C
A U M E N T A
P R E S I O N D E
L A
A R T
. P U L M
.
A U M E N T A L A S
C A T E C O L A M I N
A
S S E R I C A S
.TRANSTO
INTESTINAL.
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PENTAZOCINA•
U&o l"#"$a*o !or au# n$o * PONF.• Pro anal% &"a l"#"$a*a.• An$a%on" a o$ro& o!"o"* &.• E ,$o& "n* & a3l &.• H#!ula& * 6 #% 1#l.• Do&"& anal% &",a * 1#% =% C :r& SC o IM o
C :r& IF. M "#o 6B #% *2a. En n" o& # "#o 1• In","o * a,,"4n IM 1K7/ #"n. IF /-6 #"n.• M $a3ol"&#o : ! $",o + ,r ,"4n r nal. T ? /-6:r&.
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9UTOR8ANOL•
A%on"&$a * r , !$or & =.• La a,,"4n &o3r lo& u & * an$a%on"&$a o !ar,"al • E& * K a < , & #a& !o$ n$ 5u la #orfna.• D &!u & * a*#"n"&$ra,"4n "n$ra#u&,ular l ,
r !"*a# n$ + & !",o n 1:r.• F"*a # *"a * / 7 6 :r&.• Nau& a&; &u*ora,"4n; &o#nol n,"a + &$"#ula,"4n• Ca#3"o& ,ar*"o a&,ular #2n"#o& n !a," n$ & &an• E ,$o& r r&"3l & ,on nalo ona.
E8E6
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9UTOR8ANOL•
En ,ar*"4!a$a&• M nor !o$ n,"al
* a3u&o 5u la#orfna o l8 n$an"l.
I N D I C E
C A R D I A C O
P R E S I O N D E
8 I N D E
D I A S T O L E D E L
F I
P R E S I O N D E
L A
A R T
. P U L M
.
• M $a3ol"&#o : ! $",o a :"*ro " + nor 3u$or anol; ,r ,"4n ,al '1K
ur"nar"a '< 0.• S u&a 2a "n$rana&al !ara la #"%ra a + l *olor !o&$o! ra$or"o.• F"al * 1#% #l + /#% #l; &!ra+ na&al * 1 #% #l.• IM; 1 a #% ,a*a :ora& IF; .K a / #% '1 a #,% =%0 ,a*a :
!"*ural * 1 a / #% '/ - #,% =%0. In$rana&al 1#% a /#% ,a*a 6 a• En AG9 "n*u,,"4n /#%; M$o .K-1#%. Ma 1/.K#%.
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9UPRENOR8INA•
D r" a*o * la $ 3a2na. A%on"&$a * 3"l * l r , !$o• A%on"&$a !ar,"al * l r , !$or u; 66 , & #a& !o$ n
#orfna.• E& #u,:o #a& a 2n 5u l 8 n$an"l al r , !$or u.• El "n","o * a,,"4n IF o,urr a lo& K-1K#"n•
A,,"4n !",o a la& 6 :ora& ,$o !rolo%a*o 'Q1 :r&0.• Co#o an$a%on"&$a * l 8 n$an"l o * l &ul n$an"l $"
a,,"4n a lo& 1K #"n.• El "n","o * a,,"4n 2a IM & a lo& 1K #"nu$o& ,on !"
*ura,"4n * B :r&
E8 TEC>LOS
#
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9UPRENOR8INA•
S !u * r r$"r ,on nalo ona.• S un n B a !ro$ 2na&. El FD & * /.<L =%; l Cl/ #l =% #"n. La "*a # *"a & $r" &",a; *"&$r"3u,"4n #"n; r *"&$r"3u,"4n * < #"n + l"#"na,"4n * /-6:r&.
• M $a3ol"&#o : ! $",o "n$ &$"nal a Nor3u!r norfna. S n : , & n un '&"n # $a3ol" ar0 + n or"na ,o#o
# $a3ol"$o&.
TRA9AJ
O
CADIAC
O
PRESIO
N
ARTERIA
L8REC.
CARDIA
C
A
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9UPRENOR8INA•
Anal% &",o 6 - #,% IF , B:r&.• AG9 -1/.K#,% =% IF. N" o& /-B#,% =% IF.• Dolor !o&$o! ra$or"o 6 #,% IM. • Dolor ,r4n",o 6K-K/.K- #,% :r TD.• Oral ./- . #% $a3 FO. Su3l"n%ual .K-/#%.•
Anal% &"a E!"*ural -<#,% =% 4 1K#,% :r.• Su3*ural / #,% *o&"& n",a.• Su3,u$ n a 6 #,% :r.• La a*#"n"&$ra,"4n IF * 3 r r al" ar& n no # no& *
#"nu$o&.
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9UPRENOR8INA•
D ! n* n,"a.• E&!a&#o 3"l"ar.• El a la PIC.• R a,,"on & al r%",a&.•
Con u&"o + * l"r"o.• E&!a&#o * 2a& ur"nar"a&.• Prur"$o + ra&:.
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NAL9U8INA•
A%on"&$a 7 An$a%on"&$a.• R la,"ona*o a la o "#or ona + la nalo ona.• Un"4n a u;= + *.• An$a%on"&$a u + a%on"&$a =.• Anal% &"a; * !r &"4n r &!"ra$or"a + & *a,"4n l"#"$a*o&•
In","o * a,,"4n n K-1 #"n. IF.• 6-B :r& * *ura,"4n. F"*a # *"a * K :r&.• S !u * u&ar !ara & *a,"4n ,on&," n$ + AG9.• Ta#3" n !ara *olor !o&$o! ra$or"o + ,r4n",o.• A$ nua,"4n !o3r * la r &!u &$a a la "n$u3a,"4n.
E8E
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NAL9U8INA•
S ,r $a n or"na + $a#3" n n #a$ r"a ,al. # $a3ol" a n l :2%a*o.• Do&"& & *a,"4n anal% &"a IF IM SC; K-1
#% =%0.• In*u,,"4n IF; .6-6 #% =%. M$o ./K- .K#% =•
Anal% &"a "n$ra no&a ,on$rola*a !or l !a," n* 1 a K #% ' . /- .1 #% =%0 "n u&"4n; 1-< #.1K #% =% :0.
• Do&"& # "#a / #% a!l",a,"4n; 1B #% *2a.• La& *o&"& * an$a%on"&#o &on u&ual# n$ la
r 5u r"*a& !ara anal% &"a. T: E&& n, o Anal% &"a an* Anal% &",& (a$="n&-P"$,: or*; J. M",:a l.;Ja:r; Jona$:an S.;S"na$ra; Ra+#on
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NAL9U8INA•
:"! r$ n&"4n :"!o$ n&"4n ar$ r"al &"&$ #",a&• 3ra*",ar*"a; $a5u",ar*"a.• D !r &"4n r &!"ra$or"a.• D"&n a + a&#a;•
Eu or"a; *"& or"a; ,on u&"4n; & *a,"4n.• C4l",o&; *"&! !&"a.• M"o&"&; !rur"$o; ur$",ar"a.• D"&lal"a; *"&o!&"a; ru3",un* + ur% n,"a ur"na
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DEZOCINA•
L"% ra# n$ #a& !o$ n$ + a,$ a #a& r !"*o 5u la #orfna; ,o*ura,"4n &"#"lar.• A%on"&$a !ar,"al * r , !$or & u.• An$a%on"&$a =.• E ,$o& a* r&o& &"#"lar & a lo& * la #orfna.• Do&"& "%ual a la #orfna. .1 #% =%.•
In","o * a,,"4n IF 1K #"n; IM 6 #"n.• S a&o,"a ,on #a& PONF 5u l 8 n$an"l.• S" ,$o& *"& or",o&.• No *"&!on"3l n USA.• M $a3ol"&#o : ! $",o !or %lu,orono ,on)u%a,"4n. El"#"na,"4n r
E8 TEC
.
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COMPUESTOS ANTAGONISTA•
U&a*o& !ara r &$aurar la n$"la,"4n.• R r&an
• La !o$ n,"a * la Nalo ona a la nal3ufna & *
PRURITO NAUSEAS FOMITO RETENCIURINARI
RIGIDEZ ESPASMO9ILIAR
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COMPUESTOS ANTAGONISTA•
E "&$ n r !or$ & * anal% &"a # )ora*a !or la# *"a*a !or o!"o"* & n*4% no&. VE ,$o !ara• En 1 K & "n$ro*u) ron la nalorfna + l l alor
$ n2an ,$o& & ,un*ar"o& "na, !$a3l & + un* r r&"4n "n,o#!l $a !or lo ,ual & a3an*ono
•
La nalo ona & "n$ro*u)o n 1 B .
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NALOXONA• S u&a !ara r r$"r l ,$o * !r &or r &!"ra$or"o * l
#or 2n",o&.• Ta#3" n ,o#o !rofl ,$",o * + $ra$a#" n$o * lo& ,$o&
,ola$ ral & * lo& o!" , o&.• U&o *"&,u$"*o n l ,:o5u & !$",o.
•
E& un Nal"l * r" a*o * la o "#or ona; * 1 a / , & #5u la nalorfna.• An$a%on"&$a !uro * lo& r , !$or & u; *; =. In:"3"*or ,o#!• la$ n,"a IF; 1-/ #"n IM SC; /-K #"n. E ,$o # "#o IF
#"n. Dura,"4n IF IM SC; 1- :r.
OPIOIDESENDOGENOS
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NALOXONA• E ,$o& a* r&o& r la,"ona*o& ,on la ra!"* * a*#
+ la *o&"&
• El * #a !ul#onar &$a # *"a*o !or l"3 ra,"4n n*4%,a$ ,ola#"na& & ,un*ar"o a au# n$o n la !r &"4n :"*ro,a!"lar !ul#onar + ! r# a3"l"*a* * lo& #"&#o&.
• E ,$o an$a%4n",o n r , !$or & u * la # *ula &u!ra
TA UICARDIA >IPERTENSIONATERIAL
EDEMAPULMONAR
ARRITMIASCARDIACAS
NALOXONE-INDUCED PULMONARY EDEMA San* ! 9an&al; MD Ra+#on* [:an; DO Pa$r","a A. T" $) n/ 16/' \M $"n%A3&$ra,$&0 B /.
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NALOXONA DOSIS.DEPRESIÓN RESP. POR SOBREDOSIS:• Adultos: . - #% IF IM SC r ! $"r 5/-6#"n PRN no
1 #% ' . 1 #% =%0. '#"&#a *o&"& !o&$an &$ &"a0• Niños: ]/ =% o QK a o& .1 #% =% *o&"& IF IM SC
n , &ar"o; r ! $"r 5/-6#"n PRN no , * r / #% *o&"&. ^K a o& / #% IF IM SC ET &" & n , &ar"o; r ! $"r 5
POST ANESTESIA:• Neonatos: . 1 #% =% IF n na u#3"l",al *ar una *o&"
&u3& ,u n$ * .1 #% =% &" & n , &ar"o.• Niños: . 1 #% =% IF 1 & !u * r ! $"r una *o&"& *
:$$! r r n, .# *&,a! .,o# *ru% nar,an-nalo on - "o-6 6 1_
IN8USIONMCG ML
DE
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NALOXONA DOSIS.•
In u&"4n K-1K #,% =% :r 'n" o& 1 -1K #,%& % n *o&"&-r &!u &$a.• Co#o al$ rna$" a & !u * n u&ar / 6 * la *o&"
,$" a "n","al n una 3a& :orar"a ' ./K-B./K#%a*#"n"&$rar ? * la *o&"& 3olo "n","al 1K #"nu$o* &!u & * "n","ar la "n u&"4n !ara !r n"r *
n lo& n" l & * nalo ona.• S !u * u&ar 2a n*o$ra5u al / 7 /.K , & la
' .<-1#%0.• C:o5u & !$",o IF; 6 #,% =% "n u&"4n; 6 -
#,% =% :r '!or 1 a 1B :ora&0.:$$! r r n, .# *&,a! .,o# *ru% nar,an-nalo on - "o-6 6 1_ --- :$$! an &$ &"a.,o#.# *ru
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NALOXONA•
En l ,a&o * la * !r &"4n r &!"ra$or"a !or 3u!r& * 3 r u&ar una "n u&"4n !rolon%a*a.• M $a3ol"&#o : ! $",o ,on a,"*o %lu,oron",o. E ,r
!r *o#"nan$ # n$ n or"na.
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NALTREXONA•
An$a%on"&$a * r , !$or & u; *; =.• Ma+or *ura,"4n * a,,"4n 5u la nalo ona T1 / * 1/ :r&.
• E& a,$" a !or 2a oral.• M $a3ol"&#o : ! $",o a B-nal$r ol.• Do&"& * /K #% FO "n","al; lu %o K #% *2a FO
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NALME8ENO•
T" n #a+or afn"*a* !or r , !$or & u.• E& 5u"!o$ n$ a la nalo ona.• Do&"& oral * .K-6#% =%.• Do&"& !ar n$ ral * ./-/#% =%.• Con, n$ra,"4n !",o 1-/:r&.• F"*a # *"a * <.K:r&.• Ma& ,aro 5u la nalo ona.• U&o n r r&"4n o!" , a * u$"l"*a* ,on a%on
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METILNALTREXONA•
S"n u$"l"*a* !ra,$",a a,$ual n an &$ &"a.• No ,ru a la 3arr ra : #a$o n, al",a.• U&o n ,on&$"!a,"4n "n*u,"*a !or o!"o"* &.
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