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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
Q

BQ: What is the drug that causes “dissociative” anesthesia? / “trans like state”

A

Ketamine

  • conscious mind separated from body
  • “trans like state”
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26
Q

BQ: What type of drugs are contraindicated to glaucoma

A

Diazepam

Anticholinergic drugs

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27
Q

Ano nakikita ng patient na may glaucoma?

A

“Tunnel vision”

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28
Q

BQ: type of NARCOTIC drug contraindicated to glaucoma?

A

Meperidine (may slight anticholinergic effect)

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29
Q

BQ: Drug contraindicated to glaucoma
choices: one of “DiTriBeAM” bec it has slight anticholinergic

A

Is Diphenhydramine contraindicated to glaucoma? Yes. (All DiTriBeAM sa boards)

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30
Q

Drug used for severe orofacial pain

A

Codeine

  • “prodrug” : converted to morphine
  • orally
  • common na ginagamit sa dental: bec low drug dependence
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31
Q

Acetaminophen is similar with what drug in ph

A

Acetaminophen : Paracetamol

Tylenol ~~~~~~~ Biogesic

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32
Q

Other term for acetaminophen

A

“APAP”

N-acetyl paraminophenol

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33
Q

Oxycodone + Acetaminophen = what brand name?

A

“Tylox”

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34
Q

“Percocet”

A

Oxycodone

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35
Q

“Molly”

A

Ecstasy

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36
Q

What is the route of administration of morphine and meperidine

A

Parenteral (IV)

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37
Q

More potent than morphine

A

Fentanyl

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38
Q

BQ: “Diacetylmorphine”

A

Heroin

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39
Q

BQ: strip name of drugs

  • “Horse”
  • “Big H”
  • “Brown sugar”
A

Heroin

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40
Q

Strip name of cocaine

A

Coke

Candy

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41
Q

“Poor man’s cocaine”

Shabu/meth/crystals

A

Methamphetamine HCl

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42
Q

Dental disease assoc with Methamphetamine HCl

A

“Meth mouth”

  • Meth = enhances sympathetic nervous system
  • Saliva during symp = ⬇️ = Xerostomia ➡️ Caries and Perio dse = METH MOUTH!!!
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43
Q

Strip name of “MJ” / “Weed” / “Blunt”

A

Marijuana (Cannabis sativa)

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44
Q

BQ: Drug that shouldnt be combined with MAO-Inhibitors

A

Meperidine

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45
Q

BQ: Narcotic antagonists

A

Naloxone

“naltrexone” : pag wala sa choices ung naloxone

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46
Q

BQ: Give 4 drugs that are associated with respiratory depression and dependence

A 
"SNAB"
Sedative hypnotics
Narcotics
Alcohol
Benzodiazepines
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47
Q

BQ: “non schedules narcotic” (no prescription needed)

A

Tramadol

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48
Q

BQ: Drugs with different classification

Opioid/Non opioid

A

Tramadol
Propoxyphene (Darvon)
Pentazocine (Talwin)

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49
Q

BQ: Some narcotics(depressant) that are metabolized to a CNS stimulant by the LIVER

A

Meperidine (Demerol) ➡️ “nor”meperidine

Propoxyphene (Darvon) ➡️ “nor”propoxyphene

50
Q

BQ: Study SCHEDULE II drugs : HIGH potential for abuse or dependence

A
  1. Hydromorphone (Dilaudid)
  2. methadone (Dolophine)
  3. Meperidine (Demerol)
  4. Oxycodone (percocet)
  5. fentanyl (sublimaze, duragesic)
  6. Morphine
  7. Opium
  8. Codeine
51
Q

BQ: Impaired control over taking the drug

Pag nasa isip mo ung drug

A

Psychic dependence

52
Q

Continued administration of the drug is required to prevent unpleasant “withdrawal syndromes” ✅ (Ex. Alcoholic, smokers)
- “hinahanap ng body mo yung drug”

A

Physical dependence

53
Q

BQ: Increasingly large dose of narcotics are required to produce the same degree of analgesia (Ex. Caffeine)

A

Tolerance

54
Q

BQ: Opioid withdrawal: Life threatening or not?

A

Not life threatening

55
Q

Most common drug assoc with withdrawal symptoms

A

Alcohol (life threatening)

56
Q

4 na kailangan para makapag induce ng General anesthesia = which results to COMA

A

Sedation
Amnesia
Muscle paralysis
Analgesia

57
Q

Stage na delikado or critical sa patient

A

Stage 2

  • dapat maging stage 3 na agad
  • uses FAST ACTING / Ultrashort
58
Q

End of stage 1 and start of stage 2

A

Unconsciousness

59
Q

Desirable stage during GA

A

Stage 3

60
Q

Guerin’s stages of General Anesthesia

A

Stage 1 - Amnesia and analgesia
Stage 2 - Excitement and Delirium
Stage 3 - Surgical anesthesia
Stage 4 - Medullary Paralysis

61
Q

Inhalational drugs used in GA

A

Halothane

Desflurane

62
Q

Short acting hypnotic agent

A

Propofol

63
Q

Used for dissociative anesthesia

A

Ketamine (trans like state)

64
Q

Blocks pain mainly in the PERIPHERAL NERVOUS SYSTEM

  • Doesn’t have CNS depression effects
  • Doesn’t act in Opioid receptors
A

Non narcotic analgesics

65
Q

Non narcotic analgesics

A

Acetaminophen
Aspirin
NSAIDS

66
Q

General pharmacological effects of Non narcotics

A

Mild to mod pain
Controls fever / antipyretic
Anti inflammatory

67
Q

Non narcotic analgesics block what enzyme resulting to decrease prostaglandin production

A

Cyclooxygenase

68
Q

BQ: Prostaglandins produced in CNS causes:

A

Fever and pain

69
Q

BQ: Prostaglandins produced in PNS causes:

A

Pain
Inflammation (vasodilation)
Gastric protection

70
Q

Enzyme that breaksdown PHOSPHOLIPID BILAYER during tissue damage

A

Phospholipase A2

71
Q

Breakdown of Phospholipid bilayer by Phospholipase A2 results to production of what chemical?

A

Arachidonic acid

72
Q

Once arachidonic acid goes to the RESPIRATORY SYSTEM, It will bind to what enzyme?

A

Lipooxygenase

73
Q

Arachidonic acid + Lipooxygenase =

A

Production of LEUKOTRIENES

74
Q

Binding site of Leukotrienes

A

Leukotriene-Receptor sa Lungs

75
Q

Binding of Leukotrienes to Leukotriene-receptor sa lungs = it will result to?

A

Bronchoconstriction

- main reason kaya nagkaka-ASTHMA

76
Q

Drug that inhibits “lipooxygenase pathway”
✅ It creates a barrier = so that Leukotrienes can’t bind to the receptors.
✅ prevents Bronchoconstriction

A

Leukotriene receptor blocker

77
Q

BQ: Example of a “Leukotriene receptor blocker” that prevents ASTHMA

A

Montelukast

78
Q

If yung Arachidonic acid nakarating sa CNS - it will meet what enzyme?

A

COX2

79
Q

COX2 in CNS converts AA into:

A

Prostaglandins: (pain and fever)

80
Q

COX1 in PNS converts AA into:

A

Thromboxane A2 (platelets: blot clotting)
Prostaglandins
- protects stomach
- Inc renal blood flow

81
Q

Prostaglandin that protects stomach and increases renal blood flow is derived from?

A

AA + “COX1” in PNS

82
Q

COX2 in PNS converts AA into:

A

Prostaglandins

  • pain
  • inflammation (vasodilation=inc blood flow)

Prostacyclins
- inflammation/swelling

83
Q

Enzyme responsible pag nagkakaroon ng WOUND

A

COX2 of PNS

Converts AA into Prostaglandins and Prostacyclins = pain and inflammation

84
Q

Produced mainly by platelets: Helps in blood clotting

A

Thromboxane A2

85
Q

BQ: What are the 3 end products of cyclooxygenase pathway?

A

Thromboxane A2
Prostaglandins
Prostacyclins

86
Q

BQ: An Exception: CENTRALLY ACTING Non-narcotic analgesic

non narcotic=PNS acting

A

Acetaminophen

87
Q

Acetaminophen inhibits what enzyme?

A

Cyclooxygenase (COX2 in CNS)

-inhibits pain and fever

88
Q

Is acetaminophen/paracetamol an NSAID?

A

No. Not an NSAID!

- bec it doesnt have an anti inflammatory effect/ doesnt control swelling

89
Q

Centrally acting analgesics

A

Narcotic analgesics

90
Q

Peripherally acting analgesics

A

Non-narcotic analgesics

{*except: ACETAMINOPHEN}

91
Q

NSAIDS acts on CNS/PNS???

A

Nsaids - PNS

92
Q

NSAIDS inhibits what enzymes?

A

Cox1 and Cox2 in PNS

93
Q

Toxic effects of NSAIDS

A
  • “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
Q

Therapeutic effects of NSAIDS

A

Anti-inflammatory
Analgesic
(-inhibits prostaglandins and prostacyclins)

95
Q

Aspirin is an active or inactive drug?

A

Inactive / “prodrug”

- converted to SALICYLATES

96
Q

Aspirin: CNS/PNS?

A

Peripherally acting drug

97
Q

BQ: Side effect of aspirin pag binigay sa child with viral infection

A

Reye’s syndrome

Viral inf presents “fever”: Aspirin has mild effects on CNS kaya mej anti pyretic dati!now anticoagulant na!

98
Q

Is Aspirin sometimes classified as “NSAID”?

A

Yes: Aspirin = NSAID ✅

Has mild anti inflammatory effect

99
Q

BQ: MOA of aspirin? Why is ASPIRIN used as a “blood thinner” or “anticoagulant”?

A

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
Q

BQ: How many days prior to surgery must the patient stop taking Aspirin?

A

7 days (stop!)

101
Q

NSAIDS that selectively blocks COX 2

A

COX 2-inhibitors

*Cox2 lang iniinhibit therefore:
Cox1❌: No adverse effects: gastric irritation, renal damage, inc bleeding tendency

102
Q

Drug examples of Cox2-inhibitors

A

Celecoxib
Etoricoxib (Arcoxia)
Valdecoxib

103
Q

BQ: which of the ffg drugs na wag ibibigay sa patient prior to surgery?

A

NSAID (ung nasa choices)

specifically: Aspirin dapat: but aspirin is considered a NSAID

(Nsaids like mefenamic acid ok lang ibigay before surgery)

104
Q

Only non narcotic analgesic WITHOUT anti inflammatory effects

A

Acetaminophen

  • no anti inflammatory effect bec: Centrally acting
  • anti pyretic and analgesic only
105
Q

3 drugs that are HEPATOTOXIC (“Hart”)

A

Hepatotoxic:

  • Acetaminophen
  • Rifampicin
  • Tetracyclines
106
Q

“Overdose of aspirin”

A

Salicylism

107
Q

Toxic effects of ASPIRIN:

A

✅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
Q

Aspirin and other NSAIDS can enhance the effects of

A

Warfarin(Coumadin) and Coumarin

*wag icocombine: anticoagulant + anticoagulant = BLEEDING!!!!!

109
Q

BQ: Drug used to treat Salicylism?

A

Sodium bicarbonate

110
Q

BQ: What is the parent drug that is converted to acetaminophen?

A

Phenacetin

111
Q

BQ: Excessive doses of these 2 drugs can lead to “Narcotic-like” adverse effects

A

Pentazocine

Propoxyphene

112
Q

BQ: Drug interaction of PNS acting and CNS acting Non-narcotic analgesics

A

Pns + Cns non-narcotic analgesic are SYNERGISTIC!!! (1+1=>2)

Example: Ibuprofen(nsaid:pns) + Paracetamol(cns) = Alaxan

113
Q

Non scheduled drug: dont need prescription

A

Tramadol

114
Q

NSAID + another NSAID cannot be combined ❌

A

⬆️⬆️ Toxic effects!!!!

✅ Nsaid + Paracetamol = Synergistic

115
Q

Brand name of Ibuprofen

A

Alaxan, medicol, midol

116
Q

Generic name of flanax

A

Naproxen

117
Q

Examples of NSAIDS:

A 
Ibuprofen
Naproxen
Diclofenac
Mefenamic acid
Sulindac
Piroxicam
Oxaprozin
Indomethacin
Nabumetone
118
Q

Toxic effects of COX2-inhibitors

A

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
Q

Ideally: Cox2-inhibitors are taken maximum of how many days

A

Maximum of 7 days

120
Q

NSAIDS that reduces pain, fever(minor), and inflammation WITHOUT having GI problems

A

Cox2-inhibitors

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