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Pharm 28-34
| Question | Answer |
|---|---|
| drugs that relieve pain without causing loss of consciousness | Analgesics |
| most effective analgesics available | opiods |
| three major classes of opioid receptors, | mu, kappa, and delta. |
| • Morphine and other pure opioid agonists relieve pain by ....—primarily at ... receptors and partly at ...receptors. | mimicking the actions of endogenous opioid peptides. primarily mu. partly kappa. |
| this is the most serious adverse effect of the opioids. | respiratory depression |
| other side effects of opioids are | constipation, urinary retention, orthostatic hypotension, emesis, and elevation of intracranial pressure (ICP). |
| why must oral doses of morphine must be larger than parenteral doses to produce equivalent analgesic effects | first pass effect |
| • To minimize symptoms of abstinence, opioids should be withdrawn | gradually |
| • Patients taking opioids should avoid alcohol and other CNS depressants because these drugs can | intensify opioid-induced sedation and respiratory depression. |
| • Patients taking opioids should avoid anticholinergic drugs (eg, antihistamines, tricyclic antidepressants, atropine-like drugs) because these drugs can exacerbate | opioid-induced constipation and urinary retention |
| • Opioid overdose produces a classic triad of signs: | coma, respiratory depression, and pinpoint pupils |
| • Use of meperidine [Demerol] should not exceed 48 hours so as to avoid accumulation of | normeperidine, a toxic metabolite |
| • The combination of codeine with a ....produces greater pain relief than can be achieved with either agent alone. | nonopioid analgesic (eg, aspirin, acetaminophen) |
| • Most agonist-antagonist opioids act as agonists at ...receptors and antagonists at ...receptors | kappa receptors, mu receptors |
| • If given to a patient who is physically dependent on pure opioid agonists, an agonist-antagonist will precipitate what? | withdrawal |
| • Pure opioid antagonists act as antagonists at ... receptors and at ...receptors | mu and kappa |
| opioids should be administered on a ...schedule as opposed to ... | fixed schedule (with supplemental doses for breakthrough pain) rather than PRN. |
| • Use of parenteral opioids during delivery can suppress ...in mother and cause what in the neonate? | suppress uterine contractions ,respiratory depression in the neonate |
| this drug and other pure opioid antagonists can reverse respiratory depression, coma, analgesia, and most other effects of pure opioid agonists | Naloxone |
| this drug is used for opioid-induced constipation. | methylnaltrexone |
| any natural or synthetic drug that has actions similar to morphine | opioid |
| Endogenous Opioid Peptides: Three families: | enkephalins, endorphins, and dynorphins |
| this opioid receptor Causes analgesia, respiratory depression, euphoria, and sedation, decreased GI motility, Related to physical dependence | mu receptor |
| Causes analgesia and sedation, decreased GI motility | kappa receptor |
| Pure-opioid Agonist: Activates ... and ... receptors; “Strong Opioid Agonists (Morphine)” and “Moderate to Strong (Codeine)” | Mu and Kappa receptors |
| Agonist-Antagonist Opioids: this drug is prototype | Pentazocine |
| pure opioid antagonist | narcan |
| strong agonist | morphine/fentanyl |
| this drug Mimick the actions of endogenous opioid peptides, primarily at Mu receptors. | morphine/fentanyl |
| side effects of Morphine/Fentanyl | anxiety reduction, sense of well-being, respiratory depression, orthostatic hypotension, urinary retention, constipation; biliary colic, Miosis, neurotoxicity, increased ICP; tolerance and physical dependence with prolonged use |
| Codiene/Oxycodone/Hydrocodone | administered PO,relief of mild to moderate pain, very effective cough suppressant |
| If administered to a pt who is physically dependent on a pure opioid agonist, pentazocine can precipitate .... | withdrawal |
| drug use that is inconsistent with medical or social norms | abuse |
| __________________ is a general term defined as any drug, natural or synthetic, that has actions similar to those of morphine. ________ has been used to mean an analgesic, CNS depressant, and any drug capable of causing physical dependence. | 1. opioid 2. narcotic |
| Responses to the activation of _____________ include analgesia, respiratory depression, euphoria, sedation, and the development of physical dependence | mu receptors |
| ________________ is the prototype of the strong opioid analgesic and remains the standard by which newer opioids are measured | morphine |
| The most serious adverse effect of the opioids is _________. They can also cause ______________________ by blunting the baroreceptor reflex and dilating peripheral arterioles and veins | respiratory depression, orthostatic hypotension |
| The adverse effect on the gastrointestinal system related to opioid use includes ____________________, _________________ and ________________. | constipation, biliary colic, emesis |
| With continuous use, morphine can cause _________________ and _____________. | tolerance, physical dependence |
| ___________________ is a strong opioid analgesic with a potency 100 times that of morphine | Fentanyl |
| Clinical manifestations of opioid overdose include ___________, ___________, and __________________. | coma, respiratory depression, pinpoint pupils |
| _______________ is administered orally and is indicated for relief of mild to moderate pain | codeine |
| ______________ is the most widely prescribed drug in the United States | hydrocodone |
| this pain, which results from injury to tissues | nociceptive |
| this pain, which results from injury to peripheral nerves. | neuropathic |
| Three groups of analgesics are used for cancer pain: | nonopioid analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs] and acetaminophen), opioid analgesics, and adjuvant analgesics. |
| Because nonopioids and opioids relieve pain by different mechanisms, combining an opioid with a nonopioid can | be more effective than either drug alone |
| Most NSAIDs inhibit both (enzymes) | COX1 COX2 |
| Principal adverse effects of the NSAIDs are | gastrointestinal (GI) injury, acute renal failure, and bleeding |
| The COX-2 inhibitors cause less GI injury than the nonselective NSAIDs, but ... | they pose a greater risk of thrombotic events. |
| By inhibiting platelet aggregation, NSAIDs increase the risk of | bruising and bleeding in patients with thrombocytopenia, a common side effect of cancer chemotherapy |
| this drug relieves pain but, unlike the NSAIDs, does not suppress inflammation, inhibit platelet aggregation, or promote gastric ulceration or renal failure | Acetaminophen |
| Opioids are especially effective against nociceptive pain; they have limited efficacy against | neuropathic pain |
| Respiratory depression is increased by other drugs with CNS-depressant actions like | alcohol, barbiturates, benzodiazepine |
| 10. Drug sensitivity occurs in the neonate for two reasons: ________________________ and __________________________. | 10. the blood-brain barrier is incompletely formed, the kidneys and liver are poorly developed |
| 9. Bisphosphonates, such as ________________ and _____________________, can reduce cancer-related bone pain. | 9. etidronate (Didronel), pamidronate (Aredia) |
| this is a first-line drug for abortive therapy of severe migraine | Ergotamine |
| Overdose with ergotamine can cause | ergotism, a serious condition characterized by severe tissue ischemia secondary to generalized constriction of peripheral arteries |
| • these are first-line drugs for abortive therapy of moderate to severe migraine | Triptans (eg, sumatriptan) |
| why are Triptans contraindicated for patients with ischemic heart disease, prior myocardial infarction (MI), or uncontrolled hypertension? | Triptans can cause coronary vasospasm, |
| these are preferred drugs for migraine prophylaxis | Propranolol, divalproex, and amitriptyline |
| preventative drug therapies | Beta-Blockers; Propanolol, Timolol, Metroprolol, and nadolol Tricyclic Antidepressants: Amitryptilline/Elevil Antiepileptic Drugs: Depakote, Topamax Estrogens: for menstrual migraines |
| The drug of choice for stopping an ongoing migraine attack is _______________. | ergotamine |
| A prominent effect of use of parenteral dihydroergotamine is ________________. | diarrhea |
| The drugs of choice for preventing migraine headaches are the ______________. | beta blockers |
| The ______________________ are the first-line drugs for terminating a migraine attack | serotonin receptor agonists |
| __________________________________ can prevent migraine and tension-type headaches in some patients | Tricyclic antidepressants |
| • First-generation antipsychotics are thought to relieve symptoms of schizophrenia by blocking | D2 receptors |
| • First-generation antipsychotic drugs produce three types of early extrapyramidal symptoms (EPS): | acute dystonia, parkinsonism, and akathisia. |
| Acute dystonia and parkinsonism respond to what kinds of drugs | anticholinergic drugs (eg, benztropine). |
| Tardive dyskinesia (TD), a late EPS, has | no reliable treatment |
| The risk of early EPS is much greater with | high potency FGAs |
| Neuroleptic malignant syndrome, which can be fatal, is characterized by | muscular rigidity, high fever, and autonomic instability |
| Neuroleptic Malignant syndrome can be treated with | Dantrolene and bromocriptine |
| Low-potency FGAs produce more ...than high potency | sedation, orthostatic hypotension, and anticholinergic effects |
| Antipsychotic drugs increase levels of circulating prolactin by blocking | the inhibitory action of dopamine on prolactin release. |
| Levodopa can counteract the beneficial effects of FGA drugs because | levodopa activates dopamine receptors, whereas FGAs block dopamine receptors. |
| this is the prototype of the low-potency FGAs | Chlorpromazine [Thorazine] |
| this is the prototype of the high-potency FGAs | Haloperidol [Haldol] |
| SGAs differ from FGAs in three important ways: | (1) block receptors for serotonin and to receptors for dopamine; (2) they cause few or no EPS, including TD; and (3) they carry a higher risk of—weight gain, diabetes, and dyslipidemia—which can lead to adverse cardio events and death. |
| • Among the SGAs, the risk of metabolic effects is greatest with | clozapine and olanzapine. |
| this was the first SGA and is the most effective antipsychotic drug available | Clozapine, |
| why are regular blood tests required on Clozapine | Clozapine can cause potentially fatal agranulocytosis |
| All of the conventional antipsychotic drugs can cause serious movement disorders called ______________________. | Extrapyramidal symptoms |
| Typically the patient with acute dystonia develops _______________________, ____________________, and ___________________. Initial treatment consists of __________________ medication administration | severe spasm of the muscles of the tongue, face, neck, or back; oculogyric crisis; opisthotonos; anticholinergic |
| _____________________ is characterized by involuntary choreoathetoid movements of the tongue and face. | Tardive dyskinesia |
| ________________ is characterized by pacing and squirming brought on by an uncontrollable need to be in motion. The three drugs used to suppress symptoms include _____________, __________, and _______________. | Akathisia; beta blockers, benzodiazepines, anticholinergics |
| • Therapeutic responses to antidepressants develop slowly. Initial responses develop in ... Maximal responses develop in ... | 1 to 3 weeks; 1 to 2 months |
| • The most common adverse effects of TCAs are | sedation, orthostatic hypotension, and anticholinergic effects (eg, dry mouth, constipation |
| • The most serious adverse effect of TCAs is | cardiotoxicity, which can be lethal if an overdose is taken |
| TCAs combined with MAOIs can cause | hypertensive crisis |
| SSRIs have two major advantages over TCAs: | they cause fewer side effects and are safer when taken in overdose |
| Like TCAs (and unlike SSRIs), MAOIs cause . | orthostatic hypotension |
| Patients taking MAOIs must not eat what and why? | tyramine-rich foods because hypertensive crisis can result. |
| __________________ are the most widely prescribed antidepressants | SSRIs |
| One tricyclic that can be given intramuscularly is _____________. | imipramine |
| What is the mechanism of action of fluoxetine? | It produces selective inhibition of serotonin reuptake, intensifying transmission at serotonergic synapses, thereby promoting CNS excitation rather than sedation. |
| The function of monoamine oxidase in neurons is to | convert monoamine neurotransmitters (ie, NE, serotonin, and dopamine) into inactive products |
| The most serious adverse effect of bupropion therapy is | seizures |
| Bipolar disorder is treated with three kinds of drugs: | mood stabilizers, antipsychotic drugs, and antidepressants |
| these are the preferred mood stabilizers for BPD | Lithium and valproic acid |
| Lithium trough levels 12 hrs p admin should be | should be less than 1.5 mEq/L. |
| Common side effects that occur at therapeutic lithium levels include | tremor, goiter, and polyuria |
| Lithium levels can be increased by | diuretics (especially thiazides) and by several nonsteroidal anti-inflammatory drugs |
| The principal mood stabilizers for bipolar disorder are ______________, __________________, and ______________________. | lithium, valproic acid, carbamazepine |
| Maintenance level of Lithium should be between | 0.4, 1 mEq/L |
Created by:
sarahdenali88