200's Pharmo Flashcards
Opioids
Narcotics
- morphine sulfate (Statex) acts on opiate receptor
- fentanyl citrate (Sublimaze) acts on Mu receptors
- meperidine (Demerol) acts on Mu receptors
- nalbuphine (Nubain) acts on opiate receptors
- used for pain management
contraindications
- CNS depressed
- head injury
- resp depressed
- MAOI’s in 14 days
- hypotension
morphine sulfate (generic name)
- MS contin statex (trade)
- class
- opioid
- analgesic
- narcotic
morphine-MOA
- acts on the CNS opiate receptors
- vasodilation due to depression of A receptors and baroreceptors
morphine-dose
STEMI
- 2-4mg SIVP
- 5-15mg IM
PAIN
-2-10mg SIVP q 5-30 min
morphine-indications
- cardiac chest pain
- moderate to server pain (acute or chronic)
morphine-contraindications
- hypotension
- allergy to codeine
- altered LOC
- head injury
- severe resp depression
- MAOI’s within 14 days
- undiagnosed abdo pain
PRECAUTIONS
- use caution with RVI’s
- resp compromised
- pt’s with other CNS depressant
fentanyl citrate (generic)
Sublimaze (trade)
- opioid
- analgesic
- narcotic
fentanyl MOA
- acts on Mu receptors in the CNS altering pain preception
- less emetic effects than other narcotics
- 50-100x stronger than MS but shorter acting
fentanyl indications
- severe pain panagment
- RSI
fentanyl contraindications
- MAOI’s within 14 days
- severe hemorrhage
- head injury
- hypotension
- Myasthenia gravis
Precautions
- bradycardia
- hepatic or renal failure
meperidine (generic)
Demerol (trade)
- opioid
- analgesic
- narcotic
meperidine MOA
- acts on Mu and Kappa opiate receptors in the CNS
- greater affinity for Kappa than morphine causing increased dysphoria but does not have the same hemodynamic properties
meperidine dose
25-50mg IV q 3-4 hours
meperidine indications
-moderate to severe pain
meperidine contracations
MAOI’s or SSRI’s within 14 days
- head injury
- undiagnosed abdo pain
Precautions
-phenytoin may decrease analgesic effects
fentanyl dose
pain managment
-.5-1 mcg/kg SIVP
RSI
-2-5 mcg/kg IV
or
-1-3 mcg/kg IV if hypotensive
nalbuphine (generic)
Nubain (trade)
- opioid
- analgesic
- narcotic
nalbuphine dose
5mg SIVP followed by 2mg titrated to effect
nalbuphine MOA
- decrease pain preception by acting on opioid recptors
- simillar strength to morphine but faster and longer acting
- analgesic effects with antagonist properites to reduce risk of abuse
nalbuphine indications
moderate to severe pain
nalbuphine contraindications
- head injury
- undiagnosed abdo pain
precautions
-may cause withdrawal in opiate dependant patients
naloxone (generic)
Narcan (trade)
-opioid antagonist
naloxone dose
titrate to effect
- .4mg IV/IO/IM to total max 2mg
- 2mg IN q3-5 min
naloxone MOA
- narcotic antagonist
- competes for narcotic (opioid) receptors in the CNS but has a higher affinity
- works with both narcotics and synthetic narcotics
naloxone indication
CNS and resp depression induced by opioids
naloxone contraindications
-hypersensitivity
precautions
- narcotic dependance
- decreases effectiveness of any opioids administered
acetaminophen (generic)
Tylenol (trade)
- analgesic
- antipyretic
acetaminophen dose
- 325-650mg PO q 4 hrs
- to a max of 4gs (4000mg) per day
acetaminophen MOA
- acts on the hypothalamus to produce antipyresis
- may potentially block pain impulses
- may inhabit prostaglandin synthesis in the CNS
acetaminophen indications
- fever
- mild pain
acetaminophen contraindications
- severe acute liver disease
- hypersensitivity
precautions
- altered LOC
- NV
- angioedema
ASA acetylsalicylic acid (generic)
Asprin (trade)
- antiplatelet (platelet inhibitor)
- analgesic
- anti-inflammatory
- antipyretic
ASA MOA
- changes surface of platelets decreasing the ability to clot
- blocks the formation of thromboxane A2
ASA dose
chest pain
-160-325 mg PO (chewed)
mild pain or fever
-325-650 mg PO q 4hrs
ASA indications
- chest pain
- fever
- minor pain
ASA contraindications
- hypersenseitivity ro ASA or NSAIDS
- active bleed (internal or external)
precautions
- bleeding disorder
- active ulcers
- bronchoconstriction in asthmatics
diazepam (generic)
Valium (trade)
diazepam class
Benzodiazepine
anticonvulsant
antianxiety
sedative
diazepam dose
seizure 5-10mg SIVP
cardioversion
5-15mg SIVP
anxiety
2-5mg SIVP/IM
diazepam MOA
potentiating effects of GABA
diazepam indications
- status epilepticus
- seizure
- cardioversion
- sedation
- anxiety
diazepam contraindacations
- substance abuse (relative)
- CNS depressed due to head injury
- resp depression
- severe hypotension
- shock
- hypersensitivity
Precaution
-short acting due to water solubility
lorazepam (generic)
Ativan (trade)
lorazepam class
- Benzodiazepine
- anticonvulsant
- antianxiety
- sedative
lorazepam MOA
-potentiating effects of GABA
lorazepam dose
seizure
0.5-2mg SIVP
anxiety/withdrawal
1-4mg IM
1mg SL
lorazepam indications
- status
- seizure
- cardioversion
- sedation
- anxiety
- withdrawl
lorazepam contracations
- CNS depressed
- headinjury
- resp depression
Benzodiazepines
anticonvulsants
antianxiety
sedatives
lorazepam (Ativan)
diazepam (Valium)
midazolam (Versed)
- all potentiate the effects of GABA
- used for seizures, sedation and anxiety
- contraindications CNS or resp depressed
midazolam (generic)
Versed (trade)
midazolam calss
- benzo
- anticonvulsant
- antianxiety
- sedative
midazolam MOA
potentiates GABA
midazolam dose
sedation
-1-2.5mg SIVP (5-10mg SIVP AHS)
seizure
-1-2.5mg SIVP
RSI
-0.1-0.3mg/kg SIVP
midazolam indications
- seizures
- sedation
- status
- cardioversion
- anxiety
midazolam contraindications
- severe hypotension
- CNS depressed
- head injuried
- resp depression
- substance abuse
flumazenil (generic)
Anexate (trade)
