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Pharm exam 2

1st line antidepressants SSRIs, SNRIs bupropion, or mirtazapine
TU of antidepressants anziety disorder, phobic disorder, OCD, bullimia, tourettes, bipolar, adhd, neuropathic pain, migraine prophylaxis
SSRIs Fluoxetine (prozac), Paroxetine (paxil), sertaline (zoloft), fluvoxamine (luvox), citalopram (celexa), escitalopram (lexapro)
ADRs of SSRIs Serotnin syndrome (increased risk when combined iwth other antidepressants)
SNRIs -Duloxetine (cymbalta) -Venlafaxine (effexor) -Desvenlafaxine (prostiq)
ADRs of SNRIs seretonin syndrome, insomnia, agitation, anxiety, headache, dry mouth, constipation, nausea, loss of appetite, urinary retention, sweating, HTN ,sexual dysfunction, physical dependance
miscellaneous antidepressants Buproprion (wellburin zyban) Mirtaxepine (remeron) Trazadone
Buproprion (wellburtin, zyban) inhibits reuptake of ne and dopamine, FDA approved for smoking, simila ADRs to SNRIs + weight loss and seizure, NO sexual dysfunction
Mirtazepine (remeron) miscellaneous antidepressant that causes weight gain and sedation, HTN and parathesias.
Trazadone Serotonin reuptake inhibitor and seotonin antagonist, ADRs are sedation AND EPSE
First line TCAs -Ddeipramine -Nortiptyline -Protriptyline Other- Amitripyline (elavil)
TCA MOA inhibit reuptake of NE dopamine and serotonin narrow TW
TCA ADRs weight gain seizures, anticholinergic SEs,sedation, orthostatic hyportension (INCREASED FALLS) sexual dysfunction, serotonin syndrom, physical dpendence, cardiovascular, overdoses more likely bc narrow TW
Serotonin Syndrome Caused by antidepressants symptoms are hypotension/hypertension, agitation, muscle twitching, hyperthermia, shivering, tachycardia, seizure coma death
What antidepressants cause more sedation than others TCAs Trazodone Mirtazapine
Antidepressants that cause cardiovascular ADRs TCAs SNRIs Bupropion
Antidepressants with highest rates of anticholinergic ADRs TCAs
TU for Welbutrin (Bupropion) depression, smoking
Drugs for anxiety busiprone(buspar) and Bensodiazepins (pams and lams)
Busiprone (Buspar) effects serotonin, slow OOA, used to reat anxiety ONLY and is Not Sedating
Benzos enhance actions and binding of GABA and CNS binding sites, reduces ACUTE anxiery on PRN basis, treats insomnia, treats alcohol withdrawal and muscle spasm
ADRs of Benzos CNS depression, drowsiness, confusion, respiratory depression,anterograde amnesia, physical dependence
Drugs that treat muscle spasm Diazepam and Clonazepam
Treatment for chronic anxiety Daily does of antidepressant+busiprone
Acute anxiety Benzo PRN (long acting benzos can cause falls in older adults)
phys of schizophrenia involve dopamine and serotonin, present in late adolescence, cause hallucinations, delusions, agitation, tension, paranoia, hostility, illogical thoughts, lack of motivation, poor self care,
drugs to treat schizophrenia -2nd gen antipsychotics: -Aripiprazole (abilify) -Olanzepine (zyprexa) -Quetlapine (seroquel) -Risperidone (Risperdal) -Ziprasidone (geodon)
2nd Gen Antipsycotics MOA block serotonin and dopamine, also block a1 histamine and muscarinic receptors
2nd Gen Antissycotics ADRs sedation, sexual dysfunction, weight gain, glucose dysregulation, antichollinergic side effects, hyperprolactenimia and EPSE(RISPERIDONE), ortho hypotension, QT prolongation
Black box warning elderly patients with dementia should not take 2nd gen antipsychotics they could cause death
1st Gen antipsychotics -haloperidon(Haldol) -blocks dopamine and is less commonly used due to -higher rates of EPSE, antichollergic and -hyperprolactinemia
TU of antipsychotics schizo, bipolar, treatment resistant depression, , agitation irritability, aggression in autism(RISPERidONE)
Risperidone 2nd gen antipsychotic greatest risk for EPSE
EPSE caused by dopamine blocking include acute dystonia, akathisia, parkinsonism, tardive dyskinesia
Acute Dystonia happens after 1st few days of therapy, sever spasms of muscles in the face neck or back Medical emergency! Treated with anti slud drugs
akathisia -occurs iwthin first few months of therapy -includes pacing squirming and need for constant motion -may be treated with anti slud drugs
Parkinsonism- like movement disorders first few months of therapy -bradykinesia, drooling, tremor, rigidy, shuffling gait, cogwheeling -treated with anti slud drugs (AMANTADINE and PROPRANOLOL)
tardive dyskinesia happens after long term therapy involuntary movement of tongue and face, facial tics, lip smacking, reversible in only 30-50% of cases, treat by switching to antipsychotic with less EPSE
test for tardive dykinesia AIMS (abnormal involuntary movement scale)
sleep hygeine causes of insomnia could be caffeine parkinsons drugs, theophyline, nicotine, corticosterioids, SSRIs SNRIs
sleep aids sedating antihistamines, benzos, non benzos, melatonin receptor agonists,OTC melatonin
sedating antihistamines -diphenhydramine (tylenol PM, advil PM, benadryl) -Doxylamine (unison sleep tab)
Doxylamine MOA block histamine receptors leading to sedation, has strong anticholinergic SEs
Non Benzos -Zolpidem (ambien) -Zaleplon (Sonata) -Esxopiclone (lunesta)
Zaleplon (Sonata) MOA and ADR Sleep aid: enhance binding of GABA, block neuronal activity, hused only as hypnotics, quick onset, cause drowsiness, dizziness, confusion, ataxia, anterograde amnesia, abuse and addiction
Melatonin Receptor agonists Ramelteon (Rozerem) - prescription only with no addiction potential
ADHD neurotransmittors NE and dopamine
ADHD stimulants Methlyphenidate Dexmethylphenidate Dextroamphetamine Lisdexamfetamine
Lisdexamfetamine ADHD stimulant that blocks reuptake of dopamine and NE, allowing concentration, causes GI upset nausea decreased appetite, insomnia, high BP and HR, growth suppression? and hallucination and abnormal movement
ADHD non stimulants Buproprion, Clonidine, Guanfacine, Atomoxetine- (inhibits reuptake of NE, same as stimulants only cost more and have slower onset of action)
Buproprion can also be used for adhd (non stimulant), blocks reuptake of NE and dopamine (also an antidepressant)
drug categories for autism -CNS stimulants -noradrenergic reuptake inhibitors -alpha 2 adrenergic agonists -1st and 2nd gen antipsychotics -anticonvulsant mood stabilizers -SSRIs -Benzos -Non sedating anxiety meds
Treating Acute pain analgesics around the clock dosing using scheduled doses of an IR product, SR product or basal rate with PCA for post surgery
Treating chronic pain NO PRN, best controlled with scheduled around the clock dosing
basal pain management referring to continuous rate of infusion with PCA (IV) also applied to scheduled doses of an SR oral product.
breakthrough pain management referring to the need for additional dosing of an IR drug due to pain that is not adequatley controlled through scheduled / basal control
treating mild/ moderate pain non opiods
treating moderate pain combos of med potency opiods with APAP or NSAIDS
treating severe pain more potent opiods
treating inflammatory pain NSIADs or costocortosteroids
PCA patient controlled analgesia
adult max dos of acetaminophen 3250 mg/ day (10 reg strenth tabs) (6 extra stength tabs)
regular vs extra strength acetaminophen -reg: 325 mg -Extra: 500 mg
Depression involves NE, seotonin and dopamine, syptoms include difficulty concentrating, fatigue, feelings of guilt, hopelessness, insomnia, irritability, loss of interest, overeating, aches and pains, empty feelings, thoughts of suicide
CNS depressant not depression, causes sedation drowsiness and slowed thought process
issues that parents may have with abuse of ADHD stimulants growth suppression or delay (no clear evidence) and Substance abuse
Autism lifelong developmental disorder characterized by core deficits in verbal and nonverbal communication, social skills, play skills and behavior.
Drug catergories for Medications to treat Autism behavior CNS stimulants, noradrenergic reuptake inhibitors, alpha 2 adrenergiv agonists, 1st and 2nd gen antipsychotics, anticonvulsant mood stabilizer, SSRIs, benzos, and non sedating anxiety meds.
CNS stimulant ADRs irritabilty, anxiety, agitation, worsening of underlying behaviors, sleep disturbance, loss of appetite, dissatisfaction, social withdrawal, and sedation and lethargy.
noradrenergic reuptake inhibitors ADRs fatigue, sleep disturbance, nausea, irritablity, anxiety, weight loss
when to call 911 for a seizure last more than 2-5 minutes, person not normal after the seixure (signs of status epilepticus), another seizure starts soon after, 1st time having a seizure, if person is in the water, if person is pregnant, diabetic or injured, no medical id bracelet
status epilepticus repeateed seizures wo recovery in between, considered a neuronal emergency if not stopped within minutes (leads to permanent brain damage) treated w IV lorazepam or IV diazepam
neurotransmitters involved in seizure activity glutamate (excitatory) and GABA (inhibitory)
ADRs of all AEDs cognitive difficulty, drowsiness, sedation, lethargy, confusion, eye tremor, diplopia (double vision), ataxia, vertigo, dizziness, osteoporosis risk, and rash
AED induced rash mild or steven johnson syndrom or toxic epidermal necrolysis. SJS and TEN progress rapidly and are medical emergencies due to pt having to stop meds immediatley
TU for AEDs besides seizures, also used for diabetic neuropathy, shingles pain, HIV neuropathy, fibromyalgia pain, (all treated with pregabalin), neuromuscular disorders like essential tremor (primidone) and RLS, also bipolar and anxiety disorders
phenobarbital older AED Barbiturate, enhances effects and binding of GABA, direct acting GABA agonist
primidone (mysoline) older AED: phenobarbital is an active metabolite of primidone, they have similar MOA
Phenytoin (dilantin) older AED: blocks sodium channels, possibly blocks calcium channels
valproic acid, valproate (depakene) older AED: blocks sodium channels and enhances GABA activity
Carbamazepine (tegretol) older AED: blocks sodium channels
Oxcarbazepine (trileptal New AED
Gabapentin New AED: enhances GABA activity and blocks opening of calcium channels, also causes weight gain, edima, and paradoxical responses in children
Pregabalin (lyrica) New AED: similar to gabapentin w less SE best AED for diabetic neuropathy, shingles pain, HIV neuropathy and fibromyalgia
parkinsons symptoms tremor, rigidity, bradykinesia, posture and gait abnormalities, sleep disturbance, speech problems, dysphagia, vision probs, O. hypotn, incontinence
Neurotransmitters involved in parkinsons dopamine (inhibitory), and acetycholine (excitatory) decrease in dopamine and increase in ACh in the substantia nigra of brain
Drug therapy for parkinsons either increase dopamine or block effects of ACh
Levodopa/ carbidopa Slow PD progression. levadopa is converted into dopamine in the CNS, certain level of active neurons must be present to convert drug into active form. carbidopa blocks dopa decarboxylase and allows more dopamine to get to BBB
Levadopa carbidopa ADRs N/V constipation, O. hypotension, dysrhythmias, restlessness, insomnia, confusion, dyskinesias, on-off phenomenon
on off phenomenon w/ levadopa/ carbidopa abrupt fluctuations of PD severity (bradykinesias vs dyskinesias). after long term therapy TW gets narrower and narrower and cause more toxicity and less benefits
dopamine receptor agonists for PD rotigotine, Ropinirole, Pramipexole, bromocriptine. these directly stimulate CNS dopamine receptors
COMT inhibitors for PD ENTACAPONE, targets the COMT enzyme that breaks down levadopa before it gets to the CNS and is used to reduce the on off phenomenon
MAO-B inhibitors for PD RASAGILINE, SELEGILINE/ blocks enzyme that breaks down dopamine (MAO-B) and enhance the action of levodopa and allow for smaller doses
Amantadine less effective treatment for PD than levodopa, tolerance rapidly develops, only effective for MILD PD symptoms
anticholinergic agents for PD BENSTROPINE/ TRIHEXYPHENIDYL/ PROCYCLIDINE/ used for tremor and drooling and for mild PD, also treat EPSE/ commonly used w dopamine active med
drugs that worsen PD drugs that block dopamine/ antipsychotics, antiemetics, pyridoxine (vitamin B6)
treatment of Restless leg syndrome dopamine receptor agonists ROPINIROLE (requip) and PRAMIPEXOLE (mirapex)
what percent of all body calcium is in the bone >98%
osteoclast resorb (dissolve) old bone
osteoblast deposit (build) new bone
how are calcium levels regulated by controlling intestinal absorption, renal excretion, and resorption/ deposition of bone calcium
3 factors that control calcium levels parathyroid hormone, vitamin D and calcitonin
calcitonin producted by thyroid gland in response to high blood calcium, blocks the resorption of calcium from the bone(keeps calcium in the bone). released when calcium levels are too high to maintain blood calcium homeostasis
who should be tested for bone density strong family history, hypogonadal states, endocrine or gi disorders, corticosteroid users, high risk of falls, all women over 65 and men over 70
how is bone mineral density measured DEXA, a measurement of the hip and spine, osteopenia is a t score between -1 and -2.5 while osteoporosis is t score below -2.5
non FDA regulated calcium shark cartilage, coral calcium
calcium supplements calcium carbonate, oyster shell calcium, calcium citrate
adrs of calcium constipation and flatulence, kidney stone, atherosclerosis.
vitamin d supplements 400-1000 IU/ day for adults <50 y for general bone health and 800-1000 IU/day for adults >50 y with osteoporosis meds, reduces falls by 20%
adrs of vitamin D NV anorexia, confusion, constipation, weakness, weight loss, hyperphosphatemia, hypercalcemia
bisphosphonates osteoporosis prevention (dronates) ALENDRONATE, IBANDRONATE, RISEDRONATE, ZOLEDRONATE/ reduce osteoclast activity
bisphosphonate adrs poorly absorbed from the gut= esophageal ulceration, bone pain, osteonecrosis of the jaw, atypical femur fractures, stop taking after 5 years
Estrogen agonist/ antagonist RALOXIFENE (EVISTA) estrogen agonist effect osteoclasts, estrogen antagonist on breast and uterine tissue. 3rd line in post menopausal women, prevents breast cancer
Raloxifene adrs estrogen agonist/antagonist/ risk of thrombosis, stopping therapy will trigger accelerated bone loss
calcitonin nasal spray osteoporosis prevention, decreases osteoclasts and increse osteoblast/ 4th line treatment, treat pain associated w fractures
teriparatide (forteo) parathyroid hormone for osteoporosis prevention/ encourages bone formation/ 2nd line osteoporosis (bc of high cost) 1st line for sever osteoporosis
teriparatide (forteo) ADRs bone pain, leg cramps, weakness, O. hypotension
Denosumab (prolia) RANKL- inhibitor (osteoporosis prevention)- blocks osteoclast formation and increases bone mass ans strength, used in postmenopausal women at hgih risk of fracture or intolerant to other treatment.
Denosumab (prolia) ADRs back pain, pain in extremities, hypercholesterolemia, increased risk of infection, localized injection site reactions
Meds that increase the risk of osteoporotic fractures bisphosphonates (femur fractures)/ estrogen agonist/ antagonist (due to withdrawal)
pt instruction for taking bisphosphonates take in morning on empty stomach, full glass of water, remain upright for 30 mins
drugs associated with increased risk of falls/ fractures in older adults long acting benzos/ short acting benzos/ TCAs, antipsychotics, diphenhydramine
drugs associated with impaired cognition in older adults drugs with CNS side effects, drugs with anticholinergic side effects
pt's with constipation should stay away from CCBs, TCAs, anticholinergics
pt's with COPD should stay away from long acting benzos
pt's with parkinsons should stay away from dopamine blockers
pt's with insomnia should stay away from decongestants, theophyline, SSRIs, nicotine, and caffeine
pt's with BPH should stay away from anticholinergics
Pt's who take anticoagulants should stay away from nsaids and aspirin
pt's who have gastric ulcers should stay away from nsaids and aspirin
pt's with HTN should stay away from pseudoephedrine and amphetamines
pt's with heart failure should stay away from negative inotropes
have more CNS side effects and psychotomimetic effects then the other opiods PENTAZOCIN AND MEPERIDINE
meds that are problematic in older adults long and short acting benzos, TCAs, diphenhydramine(benadryl), antipsychotics, pentazocin and meperidine.
ADRs are _____ times more common in older adults 7
liver mass in older adults decreases by 20-30%
hepatic blood flow in older adults decreases by 40%
metabolic clearance in older adults decreases by 20-40%
what type of drug should be especially paid attention to in older adults drugs cleared renally due to decreases in renal excretion
Theophyline Toxicity ( Oral bronchodialator) very narrow TW: NV/ diarrhea/insomnia/ anxiery/ shaking and twitching/ restlessness/ tachycardia/ v fib hypoglycemia/ seizure
Rhematoid Arthritis Chronic systematic inflammatory disease that occurss in the synovial membranes of many joints in the body
Drug of choice for RA DMARDS (disease modigying anti rheumatic drug) treat pain and modify the disease
DMARD of choice for RA Mathotrexate: non biological
methotrexate non biological DMARD that suppresses the immune system to help the inflammation in the joints, reduces M/M w/ RA. given with folic acid to reduce ADRs
methotrexate ADRs DMARD: Gi irritation, loss of appetite, thromboxytopenia, hepatotoxicity,
MOA of DMARDs suppress the immune system to be beneficial to the joints
Hydroxychloriquine (plaqueril) non biological DMARD, antimalarial drug, alternitive to MTX in mild RA
hydroxychloriquine ADR DMARD: well tolerated, may have vision loss, neuropathies and reversible MYOPATHYS of skeletal and cardiac muscle
non biological DMARDs besides methotrexate and hydroxychloriquine: leflunomide, sulfasalazine, minocycline (these are minimally effective in RA)
TNF inhibitors- biological DMARDS inhibit TNF which is a proinflammatory present in the synovial of those with RA, these may be more effective than non biological in limiting joint damage (but cost more) also treat psoriasis
TNF dmard ADRs injection site reactions, bone marrow suppression, serious infection, worsening heart failure, liver failure , must monitor liver function and CBC
name of TNF-Is (biological DMARDS) ENTANERCEPT/ adalimumab/ certolizumab/ rituximab/ golimumab/ inflixmab/ abatacept
difference between DMARDs and other drugs for RA dmards treat RA AND modify the disease, other drugs (like corticosteroids, nsaids, and cox2 inhibitors) only treat the symptoms
DMARDs as a class Side effect they are immunoseppressants so they increase the risk of infection
osteoarthritis most common form of arthritis, caused by overuse of a joint and cartilage damage that results in pain, commonly treated non pharmacologically
drug of choice for osteoarthritis shceduled acetaminophen (bc there is not much inflammation and it has fewer adr's than dmards)
options for osteoarthritis acetaminophen, nsaids, cox2 i's, topical analgesics or steroid inj, glucosamine sulfate/ chondroitin (building block for cartilage), opiods
skeletal muscles relaxants (SMRs) treat muscle spasticity vs SMRs to treat muscle spasms, CNS depressants and keep person sedated
SMRs for muscle spasticity only dantrolene (reserved for acure spasticity associated w brain injury. blocks influx of Ca during muscle contraction
Drugs for muscle spasm only NSAIDs- 1st line, muscle relaxants -2nd line
ALL SMRs for muscle Spasm NSAIDs and muscle relaxants, carisoprodol, chlorzaxazone, cyclobenzapine, metaxalone (skelaxin), orphenadrine
orphenadrine (norflex) SMR for muscle spasm known for abuse/ addiction, analgesic properties, strong anticholinergic, causes syncope
cyclobenzaprine (flexeril) SMR for muscle spasm that causes CNS depression, strong anticholinergic effects, DONT give to older adults, some pt's abuse (makes you loopy)
SMRs used for spasticity and spasm Baclofen (CNS depressant) , benzos (diazepam and clonazepam), tizanadine and clonidine (a2 agonists)
oral baclofen SMR surgically implanted for severe muscle spasticity
examples or muscle spasticity movement disorders of CNS: MS, cerebral palsy, traumatic spinal cord lesions, stroke
muscle spasm involuntary contraction of muscle or muscle group, painful and decrease level of function, could be caused by epilepsy, hypocalcemia, pain, trauma, treated with nsaids and SMRs
SMRs with strong anticholinergic side effects Cyclobenzapine (flexeril), orphenadrine (norflex), and metaxalone (skelaxin)
digestive S&S of liver failure pain/ swelling in abdomen, decreases appetite and weight loss, NV, fatigue, dry mouth, esophagagal bleeding
skin S&S of liver failure jaundice, spider veins on skin, dark or pale skin, redness of feel and hands, itching.
Brain and NS S&S of liver failure problems w thinking, memory and mood, fainting, numbness of legs and feet.
different names for acetaminophen APAP and Paracentomol (mexican)
Cyclocygenase (COX pathway) when tissues are injured COX enzyme is releases and release prostaglandins which cause pain
Aspirin (bayer) inhibits COX 1 and COX 2: high dose= cox1 and 2 low dose= just cox1. decreases prostaglandins, causing antiinflammatory and antiplatelet effects
ADRs of ALL NSAIDs GI upset, GI bleed, PSeudoallergy (itching hives) intersitial nephritis, nephrotoxicity and edema,
Aspirin ADR prolonged bleeding time, toxicity/ overdose, Reye's syndrom
NSAIDs ibprofen, naproxen, ketprofen, aspirin, Ketorolac(toradol)=IV or Nasal, and ibprofen injection
Ketorolac (toradol) IV or nasal NSAID, post op pain and non opiod alternative, dont use over 5 days due to GI bleed risk, works fast
Topical NSAIDs diclofenac (voltaren gel) used for osteoarthritis pain
prevention of NSAID induced bleeding misoprostol, double dose H2 blocker, PPIs (WORK BEST)
S&S of GI bleed fatigue, weakness, SOB, abd pain, pale appearance, blood vomit, bloody stool, anemia
non acetylated salicylates choline magnesium trisalicylat, difunisal, salsalate, sodium salicylate
Non Acetylated Salicylate MOA and TU block PG syntheses, anti inflammatory and analgesis, less effective than aspirin or NSAIDs, no antiplatlet issues,
COX 2 Inhibitor Anti inflammatory and analgesic that has lower ADRs such as GI bleed and antiplatelet effects that COX 1 I have, it may increase risk of clots so dont use post MI
nociceptive pain somatic pain (skin, bone, joint, muscle) or visceral pain (internal organs), involves stimulation of pain receptors through release of mediators (bradykinins and prostaglandins) pain is highly modifiable
Factors that lower pain threshold anxiety, depression, fatigue, fear, anger, loss of self control, fear of death, loss of physical ability, resentment of illness
factors that raise the pain threshold rest, mood elevation, sympathy, comfort, diversion, understanding why they are having pain
neuropathic pain pain sustained by abnormal processing or sensory input from peripheral or CNS, nerve damage or persistent stimulation may cause pain circuits to re wire which produce spontaneous nerve stimulation (post stroke, diabetic neuropathy, AIDS, polyneuropathy)
Functional pain new concept, abnormal processing or functioning of the CNS in response to normal stimuli (irregular firing of neurons( fibromyalfia, irritable bowel syndrome)
pain scale in dementia patients unable to use usual scales, use wong baker. watch for changes in behavior or increases in confusion, agitation or aggression, try an analgesic such as acetaminophen
drug of choice for mild/ moderate pain in older adults acetaminophen
opiates for moderate/ severe pain in older adults can increase chance of falls, risks of cognitive impairment, dizziness, O. hypotension and sedation. Only use for chronic pain
Beer's criteria aboid meperidine/ pentazocine in older adults
Treat neuropathic pain with antidepressants in older adults SSRIs and SNRis are preferred over TCAs bc of anticholinergic SE's in the elderly
opiods and OTCs containin acetaminophen cough/cold, sinus, migraine, percocet, roxicet, lortab 5, vicodin
effect of chronic alcohol and acetaminophen impacts liver (hepatoxicity) will occur w 2-4 drinks per day and acetaminophen bc alcohol causes increase in p450 reaction and turns tylenol toxic
long term opiod use (>20 weeks) causes dependance (not life threatening) symptoms last 7-10 days so taper meds, NOT addiction
classes of opiods C1: no TU (heroin, cocaine) CII: controlled substance, most addictive and are Rx. CIII: less tightly controlled but still addictive potentials.
Fentanyl CII opiod analgesic. IV, epidural or PCA: used for severe pain, surgical anesthesia, post op pain, immediate Onset
Duragesic patch Opiod analgesic, mod/ severe chronic pain, slow onset, do not cut patches
Morphine CII opiod analgesic: mod/ severe acute or chronic pain, not 1st line drug, also an antitussive, has interactions with CNS depressants and respiratory depressants
hydromorphone CII CII opiod analgesic, rectal suppository
Oxymorphone and Levorphanol CII opiod anagesics
Methadone CII opiod analgesic for mod/ severe chronic pain, neuropathic pain, blocks reuptake of serotonin and NE. used for opiod withdrawal, less euphoria than morphine, use caution with antidepressants (block serotonin and NE) QT interval prolongation
Oxycodone CII opiod analgesic: abused drug, percocet & roxicet (APA+oxycodone), percodan (Aspirin+oxycodone), used for mod/ severe acute or chronic pain.
hydrocodone CII opiod analgesic: Loracet, Vicodin, Lortab (APA+ hydrocodone) and Vicoprofen (ibprophen+hydrocodone) mild/ mod acure or chronic pain
Codeine IV (CII) oral (CIII)- tylonal 2,3, and 4 are APA+ codeine, used for mild, mod acure or chronic pain, also antitussive, 1/10 strong as morphine w/ same SEs
Tramadol weak opiod agonist, blocks serotonin and NE, blocks spinal neurons of pain perception, used for mild/ mod chronic pain, less opiod ADRs, lowers seizure threshold, causes serotonin syndrome
Opioid analgesic relieve pain and anxiety of pain, contain Mu and Kappa receptors
Stimulation causes Analgesia, respiratory depression, euphoria, sedation, physical dependence, decreased GI motility Mu receptors
Stimulation causes spinal analgesia, sedation, dysphoria (BAD) , hallucinations, psychotomimetic effects, decreased GI motility Kappa receptors
Opioid agonist antagonist MOA antagonist at mu receptors and agonist at kappa, analgesic bc it is kappa agonist, blocks MY so less respiratory depression and euphoria, used in labor and as nasal spray for migraine.
warning with opiod agonist antagonists don't administer to people already on a mu agonist (regular opioid) = immediate withdrawal symptoms
ALL opioid ADRs Constipation, CNS depression, respiratory depression, impaired judgment, euphoria/ dysphoria, psychological addiction, O. hypo-tension, NV, miosis, itching, physical dependence, tolerance
Drug Reactions with opiods react with CNS depressants such as phenothiazine, Benzos, barbiturates, sedating antihistamines, hypnotics, alcohol, muscle relaxants.
Counter irritants for pain all are topical, over stimulate the nerve endings so that the pain sensation is blocked through warming/ cooling sensations to keep the nerves busy. include menthols, mint oil, capasicin, camphor, biofreeze
Capasaicin creme chemical found in hot peppers that help numb nerve endings to releive pain, zostrix works best if used every day not prn
adjuvants for pain (not counter irritants) lidocaine, caffeine, corticosteroids
types of neuropathic pain post herpetic (shingles, diabetic neuropathy, phantom pain, polyneuropathy, nerve injury (pins and needles, shooting, numbing, stabbing pain)
treatment for neuropathic pain duloxetine (cymbalta) for diabetic neuropathy, and TCAs and SNRIs bc NE plays a role in neuropathy. must be taken daily not prn, and antiepileptics (pregabalin>gabapentin)
NICE guidlines for neuropathic pain 1. try duloxerine or TCA 2. add antother TCA, 3. switch to pregabalin (lyrica) 4. consult pain specialist ask obout tramadol 5. topical lidocaine
Anti inflammatory respiratory drugs Glucocorticoids (corticosteroids): beclomethasone, budesonide, dlunisolide, fluticasone, triamcinolone, dexamethasone, methlyprednisolone, prednisone, prednisolone
ADRs of inhaled corticosteroids dysphonia, ST, oral candida, Rare osteoporosis (to prevent use a spacer or gargle
ADRs of systematic corticosteroids adrenal suppression, edema, HTN, hyperglycemia, osteoporosis and fractures, muscle myopathy, thin skin, CNS effects like mood, afitation, sleep, schizo-like behavior, infection, flaucome, buffalo hump,moon face, growth suppression in chilren
TU of inhaled corticosteroids chronic asthma and COPD
TU of systematic corticosteroids Acute asthma and COPD (not effective right away)
Mast cell stabilizers CROMOLYN, AND NEDOCROMIL/ EIB alternative option to B2 agonists, chronic asthma ( alternative to corticosteroids)
Leukotreine modifiers (anti inflammatory) MONTELUKAST, ZARGIRLUKAST, ZILEUTON/block leukortreines which cause bronchoconstriction, cause insomnia, agitation, anxiety and depression/ used as alternative to contricosteroids for chronic asthma
anticholinergic broncholdilator drugs IPRATROPIUM BROMIDE, TIOTROPIUM BROMIDE/ block muscarinic receptors, reducing respiratory secretions and causing bronchodialation / used for acute asthma/ COPD in combo with B2 agonist and 1st line for CHRONIC COPD
Anticholinergic bronchodilator drugs dry mouth, metalic tast, tiotropium is systematic and will have more anticholinergic SE
B2 Agonist bronchodilating drugs most effective bronchodilator, at high doses cause anxiety tremo tachycardia
Inhaled, fast-short acting B2 agonists (SABAs) ALBUTEROL, LEVABUTEROL/ for acute COPD and asthma/ chronic COPD and athsma / also EIB
inhaled, long acting B2 agonist (LABA SALMETEROL, FORMOTEROL/ used before exercise for EIB, chronic asthma and chronic COPD
Theophyline oral bronchodilator, relaxes smooth muscle of bronchi, very narrow TW, older and rarely used only as alternative
Theophyline ADRs (toxicity) narrow TW: NV diarrhea, insomnia anxiery shaking twitching, seizufe, tachycardia, VFIB, fatal
how to manage asthma Anti inflammatory (fixed schedule): inhaled flucocorticoids, inhaled mast cell stabilizer, oral leukotriene inhibitor.... Brhonchodilators: inhaled SABA prn and inhaled LABA on fixed schedule, also oral theophyline (fixed schedule)
how to manage COPD Anti inflammatory drug: inhaled glucocorticoid... Bronchodilator: SABA prn, anticholinergic ( fixed schedule, LABA (fixed schedule) and oral theophyline (fixed)
Spacers increase amount of drug that reaches the lung from 9-21 % and decrease amount of drug sticking to mouth from 81-22%
key drug class for preventing/ controlling athma attacks corticosteroids
Created by: Melyndabussman