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Block 4 Drugs
| 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 |
Created by:
glavik
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