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Pharmacology Unit5&6
Pharm Notes
Question | Answer |
---|---|
Types of Opioid Receptors?(4) | Mu:Analgesia(primary), Euphoria, Respiratory Depression, and Sedation. Kappa:Analgesia(primary) and Sedation. Delta: Analgesia(limited research. Sigma: Unwanted effects(dysphoria, hallucinations and confusion). |
Opioids? | alters the perception and emotional responses of pain due to receptors being in the CNS |
Classification of Opioid drugs?(3) | 1.Agonist(mimics/produce maximum effect). 2.Antagonist(block/reverse). 3.Agonist-Antagonist(mixing effects). |
Agonist Opioids? Prototype?(2) | Produce maximum effects of Mu and Kappa receptors. Prototypes:Morphine and Codeine. |
Morphine's Indication?(5) Route(6) Pharmacokinetics?(3) | Indication:severe pain, depress cough, pulmonary edema, MI(doesn't alter HR or BP) and antidiarrheal effects. Routes:PO, IM, IV SQ, epidural, and rectal. Kinetics:liver, kidneys, wide distribution. |
Morphine common SE?(4) ADR?(4) | SE:vertigo, faintness, light-headedness in ambulatory and puritus. ADR: Respiratory Depression, seizures, Tachycardia and confusion. |
Other types of Agonist Opioids?(10) | Codeine, Hydrocodone, Hydromorphone, Levorphanol, Oxycodone, Oxymorphone, Fentanyl, Methadone, Propoxyphene, Meperidine. |
Codeine? (1) Hydrocodone? Hydromorphone?(1) | Codeine: analgesic, antitussive, antidiarrheal effects, PO with milk. Hydrocodone: analgesic and antitussive. Hydromorphone: analgesic and antitussive. Faster onset of action and short duration. |
Levorphanol?(2) Oxycodone?(1) Oxymorphone?(1), SE?(4) Administration?(1) | Levorphanol: longer duration and smaller dose. Oxycodone: smaller doses than Codeine. Oxymorphone: antitussive. SE: N,V,less constipation, euphoria. Admin: PO with food or milk. |
Fentanyl Types?(3) Warning?(1) | Types:Sublimaze and Innovar (given with Anesthesia) and Duragesic(available as patch that last for 72hrs). Warning: when given IV too fast and in large doses can cause muscle rigidity of chest wall. |
Methadone?(3) Propoxyphene?(3) | Methadone: extended half-life, detoxification approved, give PO liquid. Propoxyphene:for mild-moderate pain, give with caution to those with excessive alcohol use, suicidal thoughts or prone to addiction. |
Meperidine? Route?(1) Administration?(1) Adverse Reaction?(1)Contraindicated?(3) Monitor?(3) | Helpful in those with acute asthma and GI/Biliary complications. Route: IM(rotate sites). Admin:large frequent doses. ADR: can lead to neurotoxicity. Contrain:liver dysfunction, COPD, chronic pain. Monitor:tachycardia, hypotension, behavior change. |
Agonist-Antagonists?(3) Types(5?) Pharmacokinetics?(3) | less potent analgesic, lower dependency potential and no severe withdrawal symptoms. Types:Butorphanol Tartrate, Dexocine, Pentazocine, Nalbuphine, Buprenorphine. Kinetics: liver, excreted, wide distribution. |
Dezocine? Nalbuphine? | Dezocine: IM, IV, added to CNS depressants. Nalbuphine: used for preop and OB. |
Butorphanol Tartrate? Avoid giving to those who are?(3) Can be used with those who have?(1) Routes?(3) | for moderate to severe pain. Avoid: MI, Narcotic dependent, or head injuries. Helpful: Gallbladder disease. Routes: IM, IV, nasal spary |
Pentazocine? Avoid giving to those with?(4) | combine with PO Narcan to prevent high incidence of abuse. Avoid: terminally ill, anxious, fearful, MI |
Buprenorphine? Helpful Respiratory Stimulant?(1) | dissociates slowly form Mu Receptors to block the effects of opioid agonist. Doxapram, not Narcan, can reverse respiratory depression from Buprenorphine. |
Opioid Antagonists? Treatments?(5) Receptors?(3) SE?(4) | reverse effects of agonist. Treats: opioid overdose, constipation, reverse respiratory depression, CNS depression or disease progression. Receptors: Mu, Kappa, and Delta. mainly Mu. SE:Hypertension, Tachycardia, HA and Hallucinations |
Opioid Types?(3) | Nalmefene, Naloxone, Naltrexone |
Nalmefene?(2) Naloxone?(4) Naltrexone?(2) | Nalmefene: IV onset 2-5mins, IM/SQ onset 5-15mins. Naloxone: Inactivated by PO, given Parenterally. IV onset 21-2mins, IM/SQ onset 2-5mins. Naltrexone: indicated for detoxifiedand opioid dependent clients, only one given PO. |
Opioids Withdrawal Symptoms?(10) | chills, hot flashes, Piloerection(goose bumps), Rhinorrhea, Mydrasis, lacrimation, anxiety, sweating, craving for drug, muscular twitching. |
Nonopioid centrally acting analgesics? | relieve moderate to severe pain without using opioid receptors. |
Nonopioid types(1)? Route?(1) SE?(5) | Type:Tramadol. Route: PO. SE:sedation, dry mouth, constipation, HA, minimal Respiratory Depression. |
Nonopioid Contraindicated? | Contra: seizures, MAOI, Intoxication to alcohol, sedatives, opioids, psychotropic drugs, sensitivity to opioids, hx of substance dependency. |
Cyclooxygenase?(1) Cyclooxygenase Inhibitors Types?(1) Effects?(3) Mechanism?(1) ADR?(3) | Enzyme: that produces prostaglandins(promote inflammation and pain). Type:aspirin. Effects: suppress inflammation, relieve pain, and reduce fever. Mech: Inhibition of Cyclooxygenase ADR: Gastric Ulceration, Bleeding, Acute Renal Failure. |
Cyclooxygenase forms?(2) | Cox-1:(good) found in all tissues and helps to regulate processes. Cox-2:(bad) found in tissues that are injured to produce inflammation and perception of pain. Also present in the brain to mediate fever and perception of pain. |
Results from inhibiting Cox-1? Cox-2? | Cox-1: gastric erosion/ulceration, bleeding tendencies, acute renal failure, and lack of protection against MI. Cox-2:suppression of inflammation, alleviate pain and reduce fever. |
Cyclooxygenase Inhibitors categories?(2) | 1.reduce inflammation:(NSAIDS)Aspirin, Ibuprofen, Naproxen and Celecoxib. 2.cannot reduce inflammation: Acetaminophen. |
First Generation NSAID? Prototype?(1) Use?(3) Pharmacokinetics?(3) | NSAID: inhibit both Cox-1/2. Prototype: Aspirin. Purpose: suppress inflammation(larger doses), relieve pain, reduce fever, dysmenorrhea, colorectal cancer, antiplatelt. Kinetics: sm.intestine, protein bound(allowing other durgs to work better),kidneys. |
Aspirin ADR GI?(3) Bleeding?(1) Renal?(4) Salicylism?(4) | GI:most common, gastric distress, heartburn, and nausea. Bleeding:supressing platelet aggregation. Renal:inhibits kidney function, blood flow, filtration and ischemia. Salicylism:tinnitus,sweating, HA, resp alkalosis. |
Aspirin ADR: Reye's Syndrome?(1) Pregnancy?(1) Hypersensitivitiy?(4) | Reye:do not give to children suspected of having influenza or chickenpox. Pregnancy: D-benefits out weight the harm. Hyper:asthama, hay fever, chronic urticaria, nasal polyps. |
Aspirin Contraindicaiton?(1) Interations?(2) Lethal Dose(2) Routes?(2) | Contra:bleeding disorders, allergy to ASA. Interaction: intensifies with warfarin. Dose:20-25gm adults, 4gm children. Routes: PO(different types of tablets) and PR(suppository). |
Nonaspirin NSAID? Prototype?(1) Differ from ASA?(3) Indication?(1) | NSAIDS with fewer ADR. Type: Ibuprofen. Differ:expensive, less GI bleeding and tinnitus, cause less inhibition of platelet aggregation. Indication:inflammatory disorders. |
Second-Generation NSAID? Type?(1) Pharmacokinetics? (2) Indicated?(2) | Selectivity for COX-2, suppress inflammation and pain with minimal risk for ADR. Type: Celecoxib. Kinetics: liver and kidneys. Indicate: OA and RA only. |
Celecoxib contraindication?(2) SE?(6) | contra: 3rd trimester pregnancy, allergic to sulfa. SE:Dyspepsia(impaired digestion), abdominal pain, renal toxicity, edema, Warfarin, cardio effects. |
Drugs w/o anti-inflammatory properties?(1) Action?(1) Indicated?(2) Pharmacokinetics?(4) ADR?(1) | Type: Acetaminophen. Action: inhibits prostaglandin formation in the CNS. Indicat: mild pain and fever. Kinetic: easily absorbed, easily distributed, liver and kidneys. ADR: rare at therapeutic dose |
Acetaminophen Overdose? Overdose amount? Early Symptoms?(6) Early Symptoms Time? Late Symptoms?(3) Late Symptoms Time? | causes severe liver damage. Amt: 4gms/day Early:sweating, anorexia, N/V/D, discomfort E-Time: 6-14hrs after ingestion. Late: swelling, tender, pain in abd area. L-Time: 2-4 days after ingestion. |
Acetaminophen Overdose Treatment Steps?(4) | (1) admin 17 doses of Acetycysteine(mucomyst). (2) admin gastric lavage or emesis. (3) serum levels (>150ug/ml)=hepatotoxicity. (4) perform Liver, Renal and Cardiac function test. |
Osteoarthritis? Risk?(6) How many HCP visits a year? Nonpharmacological Therapy?(4) | OA: slowly progressive MS disorder that deteriorates the articular cartilage and underlying bone. Risk: age, female, obese, family hx, sports injury, previous joint damage. HCP: 4x year Nonpharm: education, joint supports, PT, diet/ lifestyle changes. |
OA Pharmacological Therapy?(6) | Capsaicin, Aspirin, Acetaminophen, Corticosteroids, Experimental, and alternatives |
Capsaicin? Administration?(3) Contraindications?(1) ADR?(2). | topical analgesic for RA/OA, prevents/depletes Substance P(pain impulses) production. Admin:3-4x day, wear gloves, avoid eyes/broken skin. Contra: allergy to hot peppers. ADR: cough, burning(increased with heat, warm water, humidity and clothing) |
In OA, Aspirin? Acetaminophen? | ASA: Initial choice for OA in large doses. Acetaminophen: has weak anti-inflammatory action so beneficial in OA. |
Corticosteroids? Caution? Administration?(2) | benefits in OA by helping with flare up with less toxicity. Caution: repeated use can increase the acceleration of the disease. Admin: Oral route is non beneficial in OA. Intraarticular injections helps with OA. |
Experimental(1) and Alternative(3) Pharmacological use for OA? | Experi: helps to modify the disease process. Alter: fish oil, nettle leaf, ginger, willow bark. |
Hyaluronate Injections? Does it help with OA? Administration?(1) | acts as a lubricant and shock absorber. OA: NO. Admin: injected into the knee to offer pain relief for several months. |
Gout? Hyperuricemia cause?(2) Gout drugs either?(2) | recurrent Inflammatory disease caused by hyperuricemia. Hyper: (1) excessive uric production, (2) impaired renal excretion. Drugs: either relieve inflammation or reduce uric acid. |
Types of anti-inflammatory drugs for Gout?(2) The first Type? Use?(3) ADR?(4) The Second Type? SE?(2) | Colchicine: only for gout, inhibits leukocyte infiltration. Use:1.treat attacks(within hrs), 2.reduce recurrent attacks(taken qd), 3.abort impending attacks(taken q2hrs). ADR? N/V/D, abd discomfort. Indomethacin:suppress inflammation. SE: HA, GI ulcer |
Types of anti-Hyperuricemia drugs for Gout?(3) First Type?(1) Use?(3) ADR?(2) SE?(3) Administration?(1) | Allopurinol/Probenecid/Sulfinpyrazone Allo: inhibits uric acid. Use:Tophaceous Gout, imbalanced blood, cancer therapy. ADR:hypersensitivity, may cause attacks in the 1st few mths. SE: GI, Neuro, and Cataracts. Admin: with 2,000ml fluid/day. |
The last two type of anti-Hyperuricemia drugs for Gout?(2) Use?(1) SE?(3) Drug Interactions?(2) | Probenecid/Sulfinpyrazone. Use: increase excretion of uric acid. SE: Mild N/V and anorexia, take with food. ADR: exacerbate/induce attacks, hypersensitivity, renal injury Interact: dont take with ASA, reduce indocin dosage if taken with probenecid. |
AED/Anticonvulsants?(2) Goal for TX?(1) Picking type of drug?(1) Why monitor plasma blood levels?(4) Types?(2) | AED: suppress neurons during a seizure, suppress propagation of seizure activity. Goal: reduce to live normal/near normal life. Drug: trial period Plasma levels: dosage levels, cause of lost control, pt adherence and toxicity. Type: traditional/new |
Traditional AED? Types?(6) | Trad: effective, intolerable SE, long list of drug interaction, less safe in pregnancy and cheap. Types:Phenytoin, Barbiturates, Valproic acid, Carbamazapines, Ethosuximide, Primidone, Benzodiazepines. |
Newer AED? Types(8) | New: effective, tolerable, SE, limited drug interaction, safer in pregnancy, and expensive. Types:Oxcarbazepine, Lamotrigine, Gabapentin, Pregabalin, Levetiracetam, Topiramate, Tiagabine, Zonisamide. |
Phenytoin?(3) Routes?(4) Therapeutic Range? Drug Interaction?(3) | Traditional AED, inhibits Na Routes:PO(with food), IM(not recommended), IV(not >50mg/ml), SubQ(never). Range:10-20mcg. Inter: BC, Warfarin, and ETOH. |
Phenytonin Drug Interaction?(3) teaching(1) | inter:decreases warfarin effects, increase OC in women, ETOH increase metabolism. Teach: cautious in liver disease, |
Barbiturates? Therapeutic Range? SE?(1) Route?(2)Contraindications?(1) | Traditional AED that is a downer,long last, GABA. Range:15-45mcg. SE:drowsiness. Route: PO, IV(no> 60mg/ml). Con:child/pregnancy |
Valproic Acid? Treat?(3) Therapeutic Range? Contraindicated?(1) | Taditional AED, blocks Na/Ca and increases GABA. Tx:ABSENCE. Range:40-100mcg. Contra: pregnancy. |
Carbamazapines? Therapeutic Range? Assessments(1) Nursing Interventions?(2) | Traditional AED, #1 for Partial, pain and hard to control seizures. Range:4-12mcg. Assess: Skin for S-J syndrome. NI: blood counts, hematologic toxicity. |
Ethosuximide? Therapeutic Range? Administration?(1) SE?(5) Use?(1) Nursing Intervention?(1) | Traditional AED. Range:40-100mcg. Admin:PO take with meals. SE: N/V, drowsy, anemia, discolored urine. Use: Perfect drug for ABSCENCE seizures in CHILDREN and adults. NI:CBC |
Primidone? Therapeutic Range? Drug Interaction?(1) | Traditional AED, nearly identical to Barbiturates, so never take them together. This is a adjunct drug with other AEDS. Range:5-15mcg. Inter:CNS depressants. |
Benzodiazepines? Types?(3) | Traditional AED that must be used as adjunct, not a sole drug. (1) Diazepam: acute tx only. (2)Clonazepam: used for long-term. (3)Lorazepam: for anxiety,assess Vs baseline. |
Oxcarbazepine? Administration?(1) Drug Interaction?(3) Contraindicated?(3) | New AED block Na channels. Administration: can be taken mono or with adjunct with other AEDS. Inter:OC and ETOH. Contra:pregnancy and breast feeding, using lasix drug. |
Lamotrigine? Indication?(4) | New AED, blocks Na and Ca channels to decrease glutamate. Indicate: in adjunction tx for partial, generalized, tonic/clonic seizures and bipolar disorders. |
Gabapentin? Indication?(2) ADR?(3) Caution?(1) | New AED with unknown action. Indicat: partial seizures.neurological pain ADR:Somnolence, nystagmus, peripheral edema. Caution: driving or hazardous activity. |
Pregabalin? Indication?(3) Adverse Effects?(4) Caution?(1) Drug Interaction?(1) | New AED.Inter: . Inidcate: adjunction for partial seizures, neuropathic pain and fibromyalgia. Adverse:somnolence, blurred vision, edema, reproduction effects. Caution: risk for physical dependence. Drug:CNS depressants. |
Levetiracetam? Indication?(4) Drug Interaction?(1) | New AED with unique unknown action. Indicate:seizures, migraines, bipolar disorder and Peds epilepsy. Drug:none! good for patients with polypharmacy. |
Topiramate? Indication?(3) Caution?(1) Adverse Effects?(3) | New AED, USES ALL 4 MECHINISIMS. Indicate:partial and tonic/clonic and migraines. Caution: may cause seizures in those who take as mono treatment. ADR:somnolence, wt loss and closed angel glaucoma. |
Tiagabine? Indication?(1) Adverse Effects?(1) | New AED that blocks the reuptake of GABA. Adjunct. Inidcate:partial. ADR: may cause seizures in people w/o seizures on mono treatment. |
Zonisamide? Indication?(1) Adverse Effects?(2) Contraindicated?(3) | New AED that blocks Na and Ca channels. Adjunct. Indicate:partial. ADR: depression, suicide. Contra: allergy to sulfonamide, pregnancy or breast feeding. |
Overall Teaching(6) | 1.take med as ordered. 2.Keep seizure chart. 3.avoid driving/hazardous activites. 4.never discontinue w/o permission. 5.carry extra med. 6.no ETOH or CNS depressants. |