Question | Answer |
Acetylsalicylate use | alleviate mild, non-visceral pain |
Acetylsalicylate class | NSAID |
Acetylsalicylate MOA | irreversible COX inhibitor |
Acetylsalicylate probs | binds albumin, when saturated can enter CNS |
NSAID MOA | inhibit COX, decrease PG synth |
NSAID site of action | PNS |
Acetominophen site of action | CNS |
Ibuprofen class | NSAID |
Ibuprofen MOA | reversible COX inhibitor |
NSAID uses | anti-inflammatory, anti-pyretic |
Sulindac MOA | metabolized to sulfide- NSAID |
Sulindac class | NSAID |
Ketorolac class | NSAID |
NSAID probs | GI, renal, CHF, bleeding |
COX II inhibitors | more selective for COXII, otherwise not many benefits |
How does toxicity vary in NSAIDs | toxicity parallels half-life with chronic use |
Acetominophen class | non-opioid analgesic |
Acetominophen toxicity | due to glutathione depletion |
3 opioid branches | POMC, proenkephalin, prodynorphin |
Enkephalins | endogenous opiods, reguate pain perception |
Enkephalins | endogenous opioid, regulates pain pereception |
B-endorphin | endogenous opiod, regulates stress |
Dynorphin | endogenous opioid, regulates pain perception |
B-endorphin source | POMC |
Enkephalins source | unmyelinated C-fibers |
Which opioid receptors are targeted by drugs? | mu and kappa |
Opioid MOA | inhibit adenylate cyclase, decrease cAMP |
Opioid cellular effects | hyperpolarization, NT release inhibition, disinhibition |
Morphine effectiveness | better for C-fiber pain than A-delta |
Morphine side effect | respiratory depression |
Why is morphine not anticonvulsant? | Excreted by glucuronidation- buildup causes seizures |
Why not give morphine with asthma? | high association with histamine release |
When does mydriasis occur with morphine OD? | Once asphyxia occurs |
Why does morphine cause resp depression? | medullary respiratory center becomes less sensitive to CO2 |
What morphine effects induce tolerance? | resp. depression, euphoria, analgesia |
CV morphine side effect | orthostatic hypertension, less sensitive baroreceptor reflex |
What morphine effects do not induce tolerance? | GI effects- constipation, reflux |
Acute opioid toxicity | pinpoint pupils, resp depression, coma |
When is a low dose of naloxone needed to reverse opioid OD? | in a chronic abuser |
acute withdrawal rxn (opioids) | copious release of body fluids |
Why choose oral opioid admin? | prolonged analgesia, less toxicity, tighter control, increased mobility |
Why is codeine not always effective | polymorphism- some don't have P450 req to convert |
Hydromorphone | Dilaudid |
Meperidine | Demerol |
Hydromorphone class | opioid receptor agonist |
Naloxone | opioid receptor antagonist |
Meperidine class | opioid receptor agonist |
Fentanyl street name | China white |
Fentanyl class | opiod receptor agonist |
Fentanyl use | pre- post- and during surgery |
Hydromorphone plus | very potent, no metabolites |
Meperidine minus | euphoric- pts request it |
Meperidine plus | fewer GI effects, used in OB |
diphenoxylate, loperamide | Lomotil, Imodium- GI affecting opioids |
Fentanyl plus | quick onset, no histamine release, no hemodynamic instability |
Methadone use | oral analgesic |
Methadone plus | less sedation than morphine |
Methadone class | opioid receptor agonist |
Why hydrocodone over codeine? | more effective, less GI prob, no polymorphism concern |
Propoxyphene | Darvon |
Propoxyphene use | weak analgesic, antitussive |
Propoxyphene class | opioid receptor agonist |
Pentazocine | Talwin |
Pentazocine class | mixed opioid agonist/antagonist |
mixed opioid ag/antag probs | resp depression, dysphoria, induce withdrawal |
Naltrexone class | opioid receptor antagonist |
Hydromorphone is chosen over which drug? | meperidine |
norepinephrine class | sympathomimetic |
epinephrine class | sympathomimetic |
dopamine class | sympathomimetic |
isoproterenol class | sympathomimetic |
dobutamine class | sympathomimetic |
phenylephrine class | sympathomimetic |
methoxamine class | sympathomimetic |
clonidine class | sympathomimetic |
dexmedetomidine class | sympathomimetic |
terbutaline class | sympathomimetic |
albuterol class | sympathomimetic |
ephedrine class | sympathomimetic |
cocaine class | indirect sympathomimetic |
imipramine class | indirect sympathomimetic |
amphetamine class | indirect sympathomimetic |
tyramine class | indirect sympathomimetic |
prazosin class | a-adrenergic blocker |
terazosin class | a-adrenergic blocker |
doxazosin class | a-adrenergic blocker |
phenoxybenzamine class | a-adrenergic blocker |
phentolamine class | a-adrenergic blocker |
tamsulosin class | a-adrenergic blocker |
yohimbine class | a-adrenergic blocker |
Rauwolscine class | a-adrenergic blocker |
atipamezole class | a-adrenergic blocker |
propranolol class | B-adrenergic blocker |
metoprolol class | B-adrenergic blocker |
atenolol class | B-adrenergic blocker |
butoxamine class | B-adrenergic blocker |
Reserpine class | adrenergic blocker |
guanethedine class | adrenergic neuron blocker |
sympathomimetic effect | inc. HR, inc. BP, bronchodilation |
phenylephrine use | nasal decongestant |
apraclonidine, brimonidine use | tx. glaucoma |
methylphenidate use | (Ritalin) ADD |
dextroamphetamine use | tx. narcolepsy |
phentiramine/fenfluramine use | weight loss (phen/fen) |
TCA MOA | serotonin/norepi reuptake inhibitors |
desipramine class | TCA |
amitriptyline class | TCA |
sertraline class | TCA |
TCA side effects | heart, dry mouth, constipation, urinary retention |
MAOI MOA | inhibit dopamine breakdown by MAO |
phenylzine class | MAO-A inhibitor |
phenylzine use | tx. depression |
selegiline class | MAO-B inhibitor |
selegiline use | tx. Parkinson's Disease |
MAOI side effects | acture hypertension, chronic hypotension |
Botox | clostridium botulinum |
Botox MOA | blocks Ca2+ mediate ACh release |
hemicholinium MOA | blocks choline reuptake |
Tubocurarine, pancuronium class | neuromuscular blockers |
tubocurarine, pancuronium MOA | competitive nicotinic receptor antagonists |
tubocurarine, pancuronium effect | flaccid paralysis |
decamethonium, succinylcholine class | neuromuscular blockers |
decamethonium, succinylcholine MOA | nicotinic receptor agonists, AChE resistant |
decamethonium, succinylcholine effect | muscle paralysis |
why does deamethonium last longer than succ? | not hydrolyzed by AChE |
Botox class | Ganglionic blocker |
hemicholinium class | Ganglionic blocker |
edrophonium (Tensilon) class | short acting AChE inhibitor |
Neostigmine class | medium acting AChE inhibitor |
Neostigmine use | tx. Myasthenia Gravis |
Edrophonium (Tensilon) use | diagnosis of Myasthenia Gravis |
Pyridostigmine class | medium acting AChE inhibitor |
Pyridostigmine use | reversal of competitive neuromuscular blockade |
Physostigmine class | medium acting AChE inhibitor |
Physostigmine use | tx. anticholinergic OD, glaucoma |
Organophosphates, war chemicals | irreversible, toxic AChE inhibitors |
AChE I side effects | parasympathetic activation |
Bethanechol class | cholinomimetic (muscarinic receptor agonist) |
Bethanechol use | tx. post-op, post-partum urinary retention |
pilocarpine class | cholinomimetic (muscarinic receptor agonist) |
pilocarpine use | tx. glaucoma |
atropine class | anticholinergic (muscarinic receptor antag) |
atropine use | pupillary dilation |
scopolamine class | anticholinergic (muscarinic receptor antagonist) |
scopolamine use | motion sickness, post-op nausea |
ipratropium class | anticholinergic (muscarinic receptor antagonist) |
ipratropium use | tx. bronchospasm |
tolterodine class | anticholinergic (muscarinic antagonist) |
tolterodine use | tx. overactive bladder |
PCP, ketamine | NMDA antagonists- anesthetics |
gabapentin use | tx. neuropathic pain |
pregabalin class | Ca channel blocker |
pregabalin use | tx. neuropathic pain |
cocaine MOA | inhibits catecholamine reuptake |
benzodiazepine MOA | GABAa agonist |
ambien (zolpidem) MOA | GABAa agonist |
Baclofen MOA | GABAb agonist |
Selegiline class | MAO-B inhibitor |
Bromocriptine | direct dopamine receptor agonist |
Amantadine | blocks reuptake and enhances release of dopamine |
trihexyphenidyl and benztropine | anti-cholinergics for PD |
anticholinergic toxicity signs | tachycardia, urinary retention |
Sinemet | Carbidopa/Levodopa |