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d b review > 24. Pharmacology: Part II (Narcotics-Non narcotics) > Flashcards

24. Pharmacology: Part II (Narcotics-Non narcotics) Flashcards

1
Q

Gold standard of narcotics

A

Morphine

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2
Q

Narcotics are derived from what type of plant?

A

Poppy plant : Papaver somniferum

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3
Q

Narcotics are also known as (3Os)

A

Opioids
Opiates
Opium

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4
Q

3 receptors of narcotics

A

Mu
Kappa
Delta

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5
Q

Drugs with morphine-like properties that acts in CNS

A

Morphine

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6
Q

Opioid receptors (mu kappa delta) nakikita sa: Limbic system (emotion center)

  • Narcotics = controls pain and reaction to pain
    : (because inaalter ung limbic system)
A 
Limbic system:
🔺Hippocampus - memory center
🔺Amygdala - resp for fear,anger, arousal; (almond shape)
🔺substantia nigra - dopamine production
🔺basal ganglia - voluntary motor movts
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7
Q

Most common side effect of narcotics

A

Nausea

- (Area Postrema)

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8
Q

Part of nervous system that controls
✅cough reflex
✅gastric motility
📌 action of narcotics???

A

Solitary nuclei - gag,cough reflex..

📌 Narcotics suppresses cough reflex

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9
Q

Narcotics that suppresses Cough reflex

A

“anti tussive” (Dextromethorphan)

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10
Q

Drug taken to inhibit gastric motility

A

Loperamide (Diatabs)

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11
Q

BQ: “gate” in gate control theory

A

Substantia gelatinosa of Rolando

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12
Q

Most accepted theory for pain;

  • painful stimulus: gate opens
  • non painful: gates closes
A

Gate control theory

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13
Q

BQ: What are the endogenous opioids produced by our body?

A

Enkephalins

Endorphins

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14
Q

BQ: Narcotic agents blocks pain in the “peripheral” nervous system. True/False?

A

False - blocks pain in CNS!

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15
Q

BQ: What is the combination of Diphenoxylate and Atropine

A

Lomotil

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16
Q

Induces gastric motility

A

Laxatives (Bisacodyl)

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17
Q

Therapeutic effects of Narcotics: (ASEE)

A

Analgesia
Euphoria
Sedation
Eliminates cough

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18
Q

BQ: what kind of drug is Guaifenesin?

A

Expectorant

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19
Q

Most common side effect of narcotics

A

Nausea

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20
Q

BQ: drug that puts patient in “trans like state”

A

Ketamine

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21
Q

Adverse effect of narcotics which is opposite of euphoria

A

Dysphoria

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22
Q

Most serious side effect of narcotics

A

Respiratory depression

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23
Q

BQ: Morphine Triad (due to overdose)

A

Miosis (pupillary constriction:pinpoint)
Respiratory depression
Coma

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24
Q

BQ: What are the components of Neuroleptic analgesia? (Anesthetic technique that puts px in stage 1 anesthesia)

A
  1. neuroleptic agents/antipsychotics
    - Butyrophenones : (induces hallucinations)
  2. Narcotics
  3. Nitrous oxide (optional)
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25
BQ: What is the drug that causes "dissociative" anesthesia? / "trans like state"
Ketamine - conscious mind separated from body - "trans like state"
26
BQ: What type of drugs are contraindicated to glaucoma
Diazepam | Anticholinergic drugs
27
Ano nakikita ng patient na may glaucoma?
"Tunnel vision"
28
BQ: type of NARCOTIC drug contraindicated to glaucoma?
Meperidine (may slight anticholinergic effect)
29
BQ: Drug contraindicated to glaucoma choices: one of "DiTriBeAM" bec it has slight anticholinergic
Is Diphenhydramine contraindicated to glaucoma? Yes. (All DiTriBeAM sa boards)
30
Drug used for severe orofacial pain
Codeine - "prodrug" : converted to morphine - orally - common na ginagamit sa dental: bec low drug dependence
31
Acetaminophen is similar with what drug in ph
Acetaminophen : Paracetamol | Tylenol ~~~~~~~ Biogesic
32
Other term for acetaminophen
"APAP" | N-acetyl paraminophenol
33
Oxycodone + Acetaminophen = what brand name?
"Tylox"
34
"Percocet"
Oxycodone
35
"Molly"
Ecstasy
36
What is the route of administration of morphine and meperidine
Parenteral (IV)
37
More potent than morphine
Fentanyl
38
BQ: "Diacetylmorphine"
Heroin
39
BQ: strip name of drugs - "Horse" - "Big H" - "Brown sugar"
Heroin
40
Strip name of cocaine
Coke | Candy
41
"Poor man's cocaine" | Shabu/meth/crystals
Methamphetamine HCl
42
Dental disease assoc with Methamphetamine HCl
"Meth mouth" - Meth = enhances sympathetic nervous system - Saliva during symp = ⬇️ = Xerostomia ➡️ Caries and Perio dse = METH MOUTH!!!
43
Strip name of "MJ" / "Weed" / "Blunt"
Marijuana (Cannabis sativa)
44
BQ: Drug that shouldnt be combined with MAO-Inhibitors
Meperidine
45
BQ: Narcotic antagonists
Naloxone | "naltrexone" : pag wala sa choices ung naloxone
46
BQ: Give 4 drugs that are associated with respiratory depression and dependence
``` "SNAB" Sedative hypnotics Narcotics Alcohol Benzodiazepines ```
47
BQ: "non schedules narcotic" (no prescription needed)
Tramadol
48
BQ: Drugs with different classification | Opioid/Non opioid
Tramadol Propoxyphene (Darvon) Pentazocine (Talwin)
49
BQ: Some narcotics(depressant) that are metabolized to a CNS stimulant by the LIVER
Meperidine (Demerol) ➡️ "nor"meperidine | Propoxyphene (Darvon) ➡️ "nor"propoxyphene
50
BQ: Study SCHEDULE II drugs : HIGH potential for abuse or dependence
1. Hydromorphone (Dilaudid) 2. methadone (Dolophine) 3. Meperidine (Demerol) 4. Oxycodone (percocet) 5. fentanyl (sublimaze, duragesic) 6. Morphine 7. Opium 8. Codeine
51
BQ: Impaired control over taking the drug | Pag nasa isip mo ung drug
Psychic dependence
52
Continued administration of the drug is required to prevent unpleasant "withdrawal syndromes" ✅ (Ex. Alcoholic, smokers) - "hinahanap ng body mo yung drug"
Physical dependence
53
BQ: Increasingly large dose of narcotics are required to produce the same degree of analgesia (Ex. Caffeine)
Tolerance
54
BQ: Opioid withdrawal: Life threatening or not?
Not life threatening
55
Most common drug assoc with withdrawal symptoms
Alcohol (life threatening)
56
4 na kailangan para makapag induce ng General anesthesia = which results to COMA
Sedation Amnesia Muscle paralysis Analgesia
57
Stage na delikado or critical sa patient
Stage 2 - dapat maging stage 3 na agad - uses FAST ACTING / Ultrashort
58
End of stage 1 and start of stage 2
Unconsciousness
59
Desirable stage during GA
Stage 3
60
Guerin's stages of General Anesthesia
Stage 1 - Amnesia and analgesia Stage 2 - Excitement and Delirium Stage 3 - Surgical anesthesia Stage 4 - Medullary Paralysis
61
Inhalational drugs used in GA
Halothane | Desflurane
62
Short acting hypnotic agent
Propofol
63
Used for dissociative anesthesia
Ketamine (trans like state)
64
Blocks pain mainly in the PERIPHERAL NERVOUS SYSTEM - Doesn't have CNS depression effects - Doesn't act in Opioid receptors
Non narcotic analgesics
65
Non narcotic analgesics
Acetaminophen Aspirin NSAIDS
66
General pharmacological effects of Non narcotics
Mild to mod pain Controls fever / antipyretic Anti inflammatory
67
Non narcotic analgesics block what enzyme resulting to decrease prostaglandin production
Cyclooxygenase
68
BQ: Prostaglandins produced in CNS causes:
Fever and pain
69
BQ: Prostaglandins produced in PNS causes:
Pain Inflammation (vasodilation) Gastric protection
70
Enzyme that breaksdown PHOSPHOLIPID BILAYER during tissue damage
Phospholipase A2
71
Breakdown of Phospholipid bilayer by Phospholipase A2 results to production of what chemical?
Arachidonic acid
72
Once arachidonic acid goes to the RESPIRATORY SYSTEM, It will bind to what enzyme?
Lipooxygenase
73
Arachidonic acid + Lipooxygenase =
Production of LEUKOTRIENES
74
Binding site of Leukotrienes
Leukotriene-Receptor sa Lungs
75
Binding of Leukotrienes to Leukotriene-receptor sa lungs = it will result to?
Bronchoconstriction | - main reason kaya nagkaka-ASTHMA
76
Drug that inhibits "lipooxygenase pathway" ✅ It creates a barrier = so that Leukotrienes can't bind to the receptors. ✅ prevents Bronchoconstriction
Leukotriene receptor blocker
77
BQ: Example of a "Leukotriene receptor blocker" that prevents ASTHMA
Montelukast
78
If yung Arachidonic acid nakarating sa CNS - it will meet what enzyme?
COX2
79
COX2 in CNS converts AA into:
Prostaglandins: (pain and fever)
80
COX1 in PNS converts AA into:
Thromboxane A2 (platelets: blot clotting) Prostaglandins - protects stomach - Inc renal blood flow
81
Prostaglandin that protects stomach and increases renal blood flow is derived from?
AA + "COX1" in PNS
82
COX2 in PNS converts AA into:
Prostaglandins - pain - inflammation (vasodilation=inc blood flow) Prostacyclins - inflammation/swelling
83
Enzyme responsible pag nagkakaroon ng WOUND
COX2 of PNS | Converts AA into Prostaglandins and Prostacyclins = pain and inflammation
84
Produced mainly by platelets: Helps in blood clotting
Thromboxane A2
85
BQ: What are the 3 end products of cyclooxygenase pathway?
Thromboxane A2 Prostaglandins Prostacyclins
86
BQ: An Exception: CENTRALLY ACTING Non-narcotic analgesic | *non narcotic=PNS acting*
Acetaminophen
87
Acetaminophen inhibits what enzyme?
Cyclooxygenase (COX2 in CNS) | -inhibits pain and fever
88
Is acetaminophen/paracetamol an NSAID?
No. Not an NSAID! | - bec it doesnt have an anti inflammatory effect/ doesnt control swelling
89
Centrally acting analgesics
Narcotic analgesics
90
Peripherally acting analgesics
Non-narcotic analgesics | {*except: ACETAMINOPHEN}
91
NSAIDS acts on CNS/PNS???
Nsaids - PNS
92
NSAIDS inhibits what enzymes?
Cox1 and Cox2 in PNS
93
Toxic effects of NSAIDS
- "reduces formation of blood clot" (TXA2) - "gastric irritation/ulcers" (removes prostaglandins that protects stomach) - "kidney damage" (removes prostaglandins na nagiincrease ng renal blood flow)
94
Therapeutic effects of NSAIDS
Anti-inflammatory Analgesic (-inhibits prostaglandins and prostacyclins)
95
Aspirin is an active or inactive drug?
Inactive / "prodrug" | - converted to SALICYLATES
96
Aspirin: CNS/PNS?
Peripherally acting drug
97
BQ: Side effect of aspirin pag binigay sa child with viral infection
Reye's syndrome | Viral inf presents "fever": Aspirin has mild effects on CNS kaya mej anti pyretic dati!now anticoagulant na!
98
Is Aspirin sometimes classified as "NSAID"?
Yes: Aspirin = NSAID ✅ | Has mild anti inflammatory effect
99
BQ: MOA of aspirin? Why is ASPIRIN used as a "blood thinner" or "anticoagulant"?
Aspirin "IRREVERSIBLY blocks COX1" (*Platelets uses COX1 to produce TXA2*) ASPIRIN kahit wala na sa body: causes platelets to be permanently damaged or non functional=hindi na makakaproduce ng TxA2 which is resp for blot clotting = Kaya ginagamit sya as anticoagulant but lasts only until 10 days (lifespan ng platelets) * Unlike sa NSAIDS: Once na nawala NSAID sa body (after 4hrs): platelets will restore cox1 = can produce TXA2 again
100
BQ: How many days prior to surgery must the patient stop taking Aspirin?
7 days (stop!)
101
NSAIDS that selectively blocks COX 2
COX 2-inhibitors *Cox2 lang iniinhibit therefore: Cox1❌: No adverse effects: gastric irritation, renal damage, inc bleeding tendency
102
Drug examples of Cox2-inhibitors
Celecoxib Etoricoxib (Arcoxia) Valdecoxib
103
BQ: which of the ffg drugs na wag ibibigay sa patient prior to surgery?
NSAID (ung nasa choices) *specifically: Aspirin dapat: but aspirin is considered a NSAID* (Nsaids like mefenamic acid ok lang ibigay before surgery)
104
Only non narcotic analgesic WITHOUT anti inflammatory effects
Acetaminophen - no anti inflammatory effect bec: Centrally acting - anti pyretic and analgesic only
105
3 drugs that are HEPATOTOXIC ("Hart")
Hepatotoxic: - Acetaminophen - Rifampicin - Tetracyclines
106
"Overdose of aspirin"
Salicylism
107
Toxic effects of ASPIRIN:
✅gastric irritation: ❌cox1:prostaglandins ✅renal damage: ❌cox1:prostaglandins ✅salicylism: overdose ✅prevents clotting: ❌cox1:txa2 ✅Reye's syndrome - if aspirin is given to a child with viral infection
108
Aspirin and other NSAIDS can enhance the effects of
Warfarin(Coumadin) and Coumarin *wag icocombine: anticoagulant + anticoagulant = BLEEDING!!!!!
109
BQ: Drug used to treat Salicylism?
Sodium bicarbonate
110
BQ: What is the parent drug that is converted to acetaminophen?
Phenacetin
111
BQ: Excessive doses of these 2 drugs can lead to "Narcotic-like" adverse effects
Pentazocine | Propoxyphene
112
BQ: Drug interaction of PNS acting and CNS acting Non-narcotic analgesics
Pns + Cns non-narcotic analgesic are SYNERGISTIC!!! (1+1=>2) Example: Ibuprofen(nsaid:pns) + Paracetamol(cns) = Alaxan
113
Non scheduled drug: dont need prescription
Tramadol
114
NSAID + another NSAID cannot be combined ❌
⬆️⬆️ Toxic effects!!!! | ✅ Nsaid + Paracetamol = Synergistic
115
Brand name of Ibuprofen
Alaxan, medicol, midol
116
Generic name of flanax
Naproxen
117
Examples of NSAIDS:
``` Ibuprofen Naproxen Diclofenac Mefenamic acid Sulindac Piroxicam Oxaprozin Indomethacin Nabumetone ```
118
Toxic effects of COX2-inhibitors
Can lead to heart attack or stroke or any cardiac disease {explanation:} Wall of bv is made up of Prostacyclin and TxA2 Cox2-inhibitors inhibits Prostacyclins; Magdodominate TxA2⬆️=constricted BV dahil lumalapot yung blood: ⬆️obstruction
119
Ideally: Cox2-inhibitors are taken maximum of how many days
Maximum of 7 days
120
NSAIDS that reduces pain, fever(minor), and inflammation WITHOUT having GI problems
Cox2-inhibitors

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