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Okay today we are going to talk about hydromorphone trade name dilaudid it is a semi-synthetic opioid strong agonist and a hydrogenated ketone of morphine that acts primarily on new opioid receptors and to a lesser degree delta receptors dilaudid is highly hydrophilic and has a faster onset and a shorter duration of action when compared to morphine mechanism of action

In this schematic representation the presynaptic action has been demonstrated by discharge of a large number of neurotransmitters including glutamate the principal excitatory amino acid related to the most deceptive nerve terminals as well as acetylcholine norepinephrine serotonin and substance p mu receptors which are gi-protein receptors function to inhibit the

Conversion of adenosine diphosphate to cyclic a.m. p dilaudid has both a presynaptic and postsynaptic effects on the afferent nerve fiber once again dilaudid is an agonist of the new opioid receptor and to a lesser degree degree the delta receptor the receptors are physically coupled to g-protein and through this mechanism it affects ion channel gates it modulates

Intracellular calcium disposition and alters protein phosphorylation in the presynaptic terminal calcium voltage-gated channels are closed and with inhibition of calcium there is a subsequent inhibition of vesicular release which contain neurotransmitters such as glutamate and other neuro peptides the presynaptic terminal also shares a common pathway as in the

Post synaptic terminal in the post synaptic terminal the potassium voltage-gated channels are open and causes an e flux of potassium which creates hyper-polarization of the cell and blocks transmission of pain impulses we dosing pio dosing you can have a 1 to 4 milligram queue for hours or with extended release 8 to 64 milligrams every 24 hours i am injection

1 to 4 milligrams queue for hours subcu injection 1 to 4 milligrams queue for hours or iv at point 2 to 4 milligrams every 4 hours you can also choose a suppository 3 milligrams per 1 suppository every 4 to 8 hours the pca gives you a demand dose at 0.05 to 0.04 milligrams every 5 to 10 minutes the epidural gives you a point 8 to 1 point 5 milligram bolus with

An infusion concentration of 0.05 to 0.075 with the rate of 0.04 to point 4 milligrams per hour the demand dose of 0.15 milligrams with a 30 minute lockout spinal dosing is 5 to 10 times less than the epidural dosing and the provider needs to ensure that it is preservative free onset peak and duration the onset of action with dilaudid is rapid usually within 8 to

30 minutes for im or 30 to 60 minutes pío and the duration of analgesia depending upon the amount used and the route of administration may be up to 2 to 5 hours the t 1/2 alpha is 0.5 to 1 hour i am or oral and the t 1/2 beta is 2 to 3 hours metabolism dilaudid is extensively metabolized in the liver with 62% of the world dos being metabolized in the first past

And the remaining metabolized via glucuronidation dilaudid as metabolite 3gu kurenai which is completely devoid of analgesia however it can evoke excitatory neurological responses such as seizures it is excreted in urine as the metabolite with only a small percent being unchanged in drug for anesthetic indications dilaudid is prescribed for moderate to severe pain

However it is increasingly being used in the spinal because it lasts longer than fentanyl but lacks the histamine release of morphine anesthetic contraindications concern dilaudid should be used with caution with patients with compromised renal and hepatic function additionally vigilance should be used when administering to patients who have a hypersensitivity to

The minute medication it is postulated the dilaudid can cause histamine release so caution should be used in asthmatic patients references for this are the anesthetic pharmacology by eavers basic and clinical pharmacology by qasim goodman and gilman’s the pharmacological basis of therapeutics by brunton mww drugs calm w ncbi unl mu nih gov and wfd egg of

Transcribed from video
Dilaudid By Michael Bentley