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MU Pharmacology
Exam 2 Flashcards
| Term | Definition |
|---|---|
| Caffeine: Vivarin, NoDoz, caffeine citrate (Cafcit) class/indications | CNS stimulant that decreases drowsiness, fatigue (drug names) |
| dextroamphetamine (Adderall) and methylpenidate (Ritalin)- class, action | CNS stimulants that increase catecholamine activity in frontal cortex and RAS. Treatment of ADHD and narcolepsy |
| SE of amphetamines | Increased metabolism, weight loss, BP increases (HTN) |
| modafinal (Provigil) indications/action | Narcolepsy, sleep apnea, and shift-work sleep disorder drug. Maintains wakefulness |
| General action of antidepressants | Increase/potentiate concentrations of norepinephrine, serotonin, dopamine in CNS |
| Types of antidepressants | Tricyclics, MAOIs, SSRIs, Heterocyclics |
| SNRI Indications | ADHD; adjuvant for opiods |
| SNRI drug name/action | atomoxetine (Strattera): 1st nonstimulant, blocks reuptake of NE. Better alternative bc no abuse potential, doesn't affect growth or cause insomnia. Watch suicide ideation in teens |
| MAOI drug name/action/considerations | phenelzine (Nardil): blocks MAO enzyme from degrading serotonin, NE, and dopamine in synapse; cannot combine with tyramine (in either foods or drugs) --> hypertensive crisis. Last resort drug. |
| Tricyclic Antidepressants drug/action/considerations | amitriptyline (Elavil) and imipramine (Tofranil): block reuptake of NE and serotonin. Anticholinergic side effects -> watch cardiac pts. Takes 4-8 wks to work |
| SSRIs drug/action/considerations | fluoxetine (Prozac): 1st choice, d/t no heart effects. Blocks reuptake of serotonin. Decreases libido, weight gain (as with all antidepressants), takes 4 wks. |
| Heterocyclic drug/action/considerations | mirtazapine (Remeron), buproprion (Wellbutrin): often used if others don't work. Has varying effects on NE, serotonin, dopamine. May potentiate seizures in pt with hx. Wellbutrin also used to help quit smoking |
| Antimanic drug/action/considerations | Lithium salts (Lithane, Eskalith): inhibits NE and serotonin (in excess during manic episodes). Watch for hyponatremia-- low Na leads to lithium toxicity- eat salty foods. Safe therapeutic range = .5-1.2 mEq. Is a Class X, contraindicated for pregnancy |
| Psychotropics include: (name classes) | Antidepressants, SSRIs/SNRIs, CNS stimulants, antimanics, anxiolytics, antipsychotics. Any drug that acts on mental processes |
| General anesthetics action | Blocks autonomic and muscle reflexes. Produces amnesia and analgesia (although not all); Produces unconsciousness- given in 3 steps |
| 3 steps of general anesthesia | Induction, Maintenance (when surgery occurs), Recovery |
| Inhalation anesthetics: drug, action, cautions | isoflurane (Forane) (P): produces amnesia, muscle relaxant, hypnosis, not NOT analgesia- give narc. May cause vomiting, hypotension, and shivering post procedure.Watch for genetic malignant hyperthermia- tachycardia, fever,rigid muscles, acid/base dx |
| IV anesthetics: drug/action/cautions | propofol (Diprivan) (P): avoid in soy and egg allergy; titrated slowly to produce hypnosis, amnesia, sedation for procedures. Irritating to veins |
| Local anesthetics: drug/action/cautions | lidocaine (Xylocaine) (P), bupivicaine (Marcaine- for epidural): not to be given systemically. Numbs structures by blocking Na channels. |
| Local anesthetics routes | Topical, infiltration- directly into site to be treated; field block- entire area procedure will occur (dentistry); nerve block- epidurals and intrathecal= spinal anesthesia- higher risk |
| Urinary analgesic drug/action/cautions | phenazopyridine hydrochloride (Pyrimidine, AZO): passes thru and has analgesic effect on urinary tract to relieve pain, swelling, burning. Does not tx the UTI. Causes urine to be orange/red. Too much= yellow skin. Give with food, incr fluid intake |
| Benzodiazapine class/indications | Anxiolytic and hypnotic. Used to decrease anxiety, ETOH withdrawal, muscle spasm, sleep aid, pre-op sedation, agitation by enhancing GABA receptors (decr. nerve excitability) |
| Benzo SE | Anticholingeric: dry mouth, urinary retention, constipation, blurred vision; drowsiness, BP changes, anemia, phebitis, incr. liver enzymes |
| Benzos Cautions | Always taper off- seizures (for withdrawal, antidote=flumazenil (Romazicon); decrease narc doses to prevent too much RR depression; give PO if possible; pt safety, psychosis in elderly, smaller dose in blacks |
| temazepam (Restoril) | Sleep aid, situationally used |
| diazepam (Valium) | anxiety, acute ETOH withdrawal, muscle spasm, seizures |
| lorazepam (Ativan) | Pre-op, anxiety, procedural amnesia, rapid onset |
| midazolam (Versed) | Produces amnesia for unpleasant procedures (colonoscopy, etc), induction of general anesthesia |
| chlordiazepoxide (Librium) | Can be used before an anticipated ETOH withdrawal- do not give with grapefruit juice. |
| alprazolam (Xanax) | anxiety, panic attacks |
| Non-benzos: chloral hydrate (Aqua Chloral) | For children, prior to procedures, fairly safe |
| eszopiclone (Lunesta) | Only drug approved for long-term sleep aid |
| zaleplon (Sonata) | Short-term sleep aid |
| zolpidem (Ambien) | Sleep aid; watch dose in elderly, similar to benzos |
| ramelteon (Rozerem) | Melatonin receptor agonist drug- sleep aid; do not give with melatonin. No abuse potential |
| disulfiram (Antabuse) | Maintains sobriety by producing severe nausea when ETOH is consumed. Opiate antagonists also help to decrease cravings |
| Narcotic antagonist action | Block opiod receptors, reverse effects of respiratory depression and sedation. Reverses analgesia, increases HR and BP. May cause withdrawal. Short effect time. naloxone (Narcan) |
| Opiod agonist-antagonists (contain some Narcan) | pentazocine (Talwin) (P) and nalbuphine (Nubain), Stadol. Analgesics with less abuse potential. May induce withdrawal in pts with narc addiction-dont give.for moderate-severe pain, anesthesia aid, childbirth |
| Opiod agonist-antagonist cautions | Cardiac pts, narc abusers, labor. Increases BP and produces hallucinations. Watch- will interact with other CNS depressants |
| Adjuvant meds for pain control include | TCA (amitryptiline/Elavil and imipramine/Tofranil), SNRIs (duloxetine/Cymbalta & velafaxine/Effexor), Anticonvulsants (pregabalin/Lyrica and gabapentin/Neurontin, and local anesthetics (lidocaine patch) |
| TCAs action/cautions as an adjuvant | Increase NE & serotonin. Anticholinergic SE. Treats nerve pain/fibromyalgia. 2-3 wks to work. Sedating, take HS. Causes ortho.hypotnsn- watch cardiac pts |
| SNRIs as an adjuvant | Blocks NE reuptake; No anticholinergic SE. Nerve pain/fibro. May change sleep habits, dizziness, sweating, tachycardia, HTN (d/t NE action) |
| Opiod agonists uses | Severe acute or chronic pain, aid anesthesia, relieves perception of pain during diagnostic exams, nonbacterial abdominal cramps and diarrhea, pulmonary edema, severe unproductive cough, SOB/dyspnea |
| How do opiods treat pulmonary edema? | It causes vasodilation in the periphery, causing blood to sit in extremities, decreasing preload to the heart and lungs. Decreases sensation of "suffocating" thru sedation too. |
| How do opioids treat a severe, unproductive cough? | Decreases cough reflex by decreasing the brain's perceived need to cough |
| Opioid agonist cautions | Allergy, pregnancy/lactation labor (crosses placenta), acute abdomen (do not give narcs-masks real problem), head injury (can depress function even further), respiratory depression, liver/kid. dx, prostatic hypertrophy- exacerbates urinary retention |
| Opiods AE | Resp. depression, orthostatic hypotension (d/t vasodilation), decreased GI motility (N/V/C/biliary spasm), lightheadedness, dizzy, hallucinations, pupil constriction (pinpoint), slowed mentation, pruritus (not an allergy), urinary ret., sweating, dry mout |
| Nursing implications for Opioid agonists | Hold med if RR <10, have emergency O2 and suction ready, tx pain without delay, give before therapy, smallest effective dose, monitor sedation, pt safety, monitor voiding/stool (also bowel program), teach pulm. hygiene- deep breathing. Nonnarc interventio |
| Cancer pts on opiods | Treat breakthrough pain. Make sure you wake them up at night to give meds to keep therapeutic dose. Stay on schedule |
| Critically ill on opiods | Small doses, watch RR. |
| tramadol (Ultram) | A weaker narc for chronic pain. Can accumulate however |
| methadone (Dolophin) | Used to substitute addictive substance during withdrawal |
| oxycodone (Roxicodone) | Highly abused; immediate release, is a codeine derivative. oxycontin = ER, ppl tend to crush, snort this |
| hydrocodone (Vicodin, Lortab) | Similar to codeine; CII drug |
| hydrocodone XL (Zohydro) | An ER hydrocodone, given at 50 mg instead of usual 5 mg. Newer drug for chronic pain, pt is under contract to not abuse/overdose |
| hydromorphone (Dilaudid) | Semi-synthetic morphine, very strong. Usually given by IV drip for cancer pts. Like morphine but much more potent |
| codeine | Antitussive. Weaker than morphine, but often given with APAP. Usually PO in cough syrups |
| fentanyl (Sublimaze, Duragesic) | Aids anesthesia, post-op, chronic pain. Given transmucosally (lollipop) or transdermally thru patch- 24 hr onset, lasts 3 days (dispose of in needle container) Heat sensitive |
| meperidine hydrochloride (Demerol) | Shorter duration than morphine, less resp. depression in newborn (good for childbirth), less smooth muscle spasm (renal/biliary colic- pts w stones), little to no effect if PO.Contraindicated in renal failure.Has toxic limit |
| morphine (Roxanol) (P) | Severe acute or chronic pain, a nonceiling drug. PO doses must be higher d/t first pass effect. IM, IV, Subcut, R, epidural, intrathecal all possible routes. May produce renal, biliary colic |
| Priorities during overdose | Airway (Fowler's position, O2 mask on), Breathing, Circulation. Give opioid antagonist- nalaxone/Narcan. Taper doses, substitute methadone in place of addictive substance, then slowly withdraw. |
| S/S of withdrawal syndrome | Pupil dilation, A/N/V/D, increased temp, HR, BP, diaphoresis, restlessness, anxiety, rhinorrhea. Peak = 36-72 hrs after last dose, declines over 10 days. In infants- inconsolable cry, have a high mortality rate |
| Ladder of Analgesia | 1= nonopioids, give for cancer and chronic pain at first, 2= opioids for mild to mod pain, 3= opioids for mod to severe pain, start acute pain here. 4= nerve blocks, PCA, etc for surgical procedures, then move down. |
| Types of nociceptive pain | Visceral- response to inflammation, ischemia, or stretch- often poorly localized- referred pain. Somatic- superficial or deep, more receptors- more localized |
| Examples of neuropathic pain | Deafferentation: loss of sensory input d/t peripheral nerve injury(ex. phantom limb), central pain: lesion in CNS- irritated nerve tracts; sympathetically maintained: dysregulated ANS circuit; Peripheral neuropathy-nerve dam. (diabetes) |
| Mechanisms of pain perception | Transduction, Transmission, Perception, Modulation |
| Migraine drug categories | Ergotamine derivatives, Triptans (selective serotonin 5-HT receptor agonists) |
| Migraine pathogenesis | Trigger- lights, caffeine, weather, foods, hormonal changes, stress, noise, fatigue, sleep deprivation, hunger, ETOH. -> neuronal hypersensitivity releases vasoactive enzymes-> dilation/plasma proteins-> inflam-> migraine |
| Types of HA/migraine | Cluster- behind eye; sinus- cheekbones, above eyes; TMJ- temples, in front of ears; tension- band around head; neck- back of head, neck; migraine- all over, throbbing, N, vision changes, sensitivity to stimuli |
| Triptans (selective serotonin 5-HT receptor agonists) | zolmitriptan (Zomig), sumatriptan (Imitrex (P)); ABORTIVE AGENT. Binds serotonin receptors- produces vasoconstriction for acute tx.Is not selective for which vessels-> caution in HTN, CAD, PVD, and pregnancy! watch circulation. Do not combine with ergots! |
| Daily preventative meds for migraine | topiramate (Topamax), valproic acid, gabapentin (Neurontin) |
| Ergot derivatives | ergotamine tartrate (Ergomar) (P): abortive agent, take at first sign. SL or inhalation; caution in PVD, CAD, HTN, pregnancy. (produces vasoconstriction), not for prolonged use, watch circulation in extremities. may contain caffeine |
| Ergotism S/S | Produced by overdose- N/V, thirst, chest pain, BP increases drastically. |
| OTC Migraine meds | Often contain ASA/APAP/caffeine (potentiates drug), like Excedrin HA |
| Anti-gout drug categories | Urocosuric agent, Xanthine Oxidase Inhibitors/urocosuric agent, Antigout agent/alkaloid |
| Urocosuric agent | Probenecid (only name); increases excretion of uric acid via kidneys. Is contraindicated in renal/liver dx. Teach to alkalinize urine to throw out more acid, No ETOH or ASA, increase fluid intake |
| Urocosuric agent AE/Cautions | Caution: Sulpha allergy, contraindicated in renal or liver dx. AE= n/v, liver necrosis, hyperglycemia (watch diabetics). No ETOH or ASA |
| Xanthine Oxidase Inhibitor/Urocosuric Agent | allopurinol (Zyloprim) (P): decreases serum uric acid as a byproduct. Often used to prevent gout in cancer pts (increased # of dying cells release uric acid); effective in chronic gout w/ tophi and decr. renal fxn. Mobilizes -> acute gout attack |
| Xanth. Oxidase inhibitor considerations | Watch UO. Acute gout attack may occur as tophi are mobilized, could cause stones. drink adequate fluids to support renal fxn. May suppress BM. Monitor UA and CBC |
| Antigout agent/alkaloid | colchicine (Colcrys) (P)- for ACUTE GOUT. Decreases WBC diapedesis into cells with crystals- reduces inflammation, pain, swelling. |
| Antigout agent/alkaloid precautions | Doesn't tx gout, just inflammation. Reduce elderly dose, renal, liver dz. Do not take with grapefruit juice, ETOH- affects liver enzyme pathways. AR= N/V/BM suppression, neuropathy from decreased B12 absorption |
| 4 stages of gout | 1. asymptomatic hyperuricemia, 2. acute flares, 3 inter critical gout, 4. advanced gout. May be d/t decreased metabolism/excretion of UA, kidney probe, diet, dehydration |
| Nonnarcotic Analgesic Antipyretic | acetaminophen (Tylenol) (APAP) (P): ASA substitute as does not cause GI distress or bleeding; Choice for children d/t ASA causing Reyes. |
| APAP Cautions | May produce liver necrosis esp with ETOH, cigs, antiseizure drugs. Overdose= N/V/A/sweating/elevated LFTs/jaundice/delirium/nephrotoxicity as kidneys try to flush out. Rx= gastric lavage w/ activated charcoal. Antidote= Mucomyst (acetylcysteine) |
| APAP laws | FDA says tabs can contain no more than 325 mg with mixed drugs). Safe dose = 4g, 2g in liver dz. Tylenol advises <3g/day. Watch for APAP in other meds to avoid overdose |
| indomethacin (Indocin) (P) | Acetic acid derivative, stronger than ibuprofen but higher risk of geriatric SE like CVA/MI. give less. Treats arthritis and gout- stronger anti-inflammatory effects. Also txs ductus arteriosus in neonates. |
| ketorolac (Toradol) | acetic acid deriv. For pain control, comparable to morphine. Strong analgesic and antiinflamm; may produce hematoma and wound bleeding, decr. healing if parenteral dose > 5 days. Used after ortho surg. Watch GI- risk for perforation |
| ibuprofen (Motrin) (P) | propionic acid deriv. Txs inflamm., fever, pain, arthritis, gout. Potentially nephrotoxic and hepatotoxic. Allergy more common in pts w/ hx of rhinitis and asthma. (NSAIDs cause bronchoconstriction). Includes naproxen (Aleve) and Advil |
| AE of ibuprofen | |
| Cautions for all NSAIDS | Do not give to asthmatics (bronchoconstriction); cause gastric irritation and renal impairment- watch BUN and creatinine. Stop NSAIDs 1 wk preop d/t anti-PLT effect. |
| Salicylates | aspirin/acetylsalicyclic acid (P) txs mod to severe pain, fever, prevents MI/CVA at low dose daily therapy. do not take for 2 wks preop. Take with food and adequate fluids to support renal. Avoid ASA w/ tartrazine. No caffeine |
| Salicylism SE | N/V/fever/TINNITUS/drowsiness, hyperventilation, respiratory alkalosis, metabolic acidosis, hemorrhage, seizures |
| Tx of salicylism | Mild: stop/reduce dose; Severe: activated charcoal, IV sodium bicarbonate to increase renal elimination, hemodialysis. |
| Interactions of ASA/NSAIDs | Increased effect with ETOH, narcs, anticoagulants. |
| AE of ASA/NSAIDs | Ulcers, A/N/V/bleeding-misoprostol (Cytosec); melena, bruising, hematuria; HA/dizziness, confusion. Hypersensitivity- asthmatics-> bronchospasm. Tinnitus and hearing loss, nephrotoxic: decr. UO, increased BUN, creatinine, hyperkalem, fluid retent, edema |
| ASA/NSAIDs contraindications | Impaired renal fxn, asthma, allergy, peptic ulcer dz, GI bleeding, children with viral infxn-> Reye's syndrome-- encephalopathy, blindness, LOC change, confusion. Use tylenol instead. |
| ASA and NSAID effect on PLTs | Both inhibit PLT aggregation (anticoags only affect clotting factors), ASA- immediate and permanent effect on PLTs (whole life span); NSAIDs- limited effect only while drug is in system. Just enough to keep clots from forming, blood moving around |
| Antiprostaglandins | Includes ASA (salicylates), NSAIDs and APAP, although APAP is not antiinflammatory. ASA = (P). Classes= Non-selective COX inhibitors and Selective COX-2 inhibitors |
| Non-selective COX inhibitors | Block both COX 1 and 2 (cyclooxygenase, precursor to prostas)- inhibit both physiological and pathological actions of prostas- includes NSAIDs and ASA |
| Selective COX-2 inhibitors | Inhibits pathologic effects of prostaglandins- inflammation, pain, vasodilation, swelling (increased capillary permeability), leukocytosis and inflamm. cytokines |
| Physiologic effects of prostas (blocked by Non-selective COX inhibitors) | GI protection- increased mucus production, decreased acid production, GI mucosal perfusion; Renal protection- perfusion, fxn; relaxes smooth muscle tone- bronchodilation, vasodilation; regulates PLT aggregation |
| Effects of Non-selective COX inhibitors blocking physiological pathway | GI ulcers, bleeding, impaired renal fxn, bronchoconstriction, decreased PLT aggregation |
| Selective COX-2 Inhibitor drug and indications | celecoxib (Celebrex) (P)- only for pts for which non-selective don't work, kidney dz, GI ulcers; only approved for short term use (couple months) d/t increased risk for CVA, MI, visual changes. Rx only. |
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