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Pharmacology > Addiction and Abuse - Medications > Flashcards

Addiction and Abuse - Medications Flashcards

1
Q

opioid use/indications (what about low dose)

A
  1. analgesia
  2. low dose: antitussive codeine
  3. super low dose: antidiarrheal immodium
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2
Q

opioid MOA

A

mu, delta, kappa opioid receptor agonist

decreases pain signaling, increases reward signaling

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3
Q

opioid actions

A

euphoria, sedation

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4
Q

opioid toxicity/OD

A

respiratory depression

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5
Q

opioid withdrawal S/S (initial vs later)

A

initial: sweating, runny nose, tearing, yawning, diarrhea (everything hyperactive and runny)

Later: insomnia, chills, weakness, N/V, muscle aches, HTN

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6
Q

What is anticholinergic action and why is it important?

A

“everything dries out” - constipation, anhidrosis, urinary retention

can occur with opioid overdose

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7
Q

Examples of opioids

A
  1. Hydromorphone/Dilaudid
  2. Oxymorphone/Opana
  3. Hydrocodone/Vicodin/Norco (Vicodin has acetaminophen in it too)
  4. Oxycodone
    - perocet = oxycodone + acetaminophen
    - percodan = oxycodone + aspirin
    - oxycontin (long acting)
  5. Methadone
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8
Q

opioid contraindications

A
  1. h/o addiction/abuse
  2. decreased level of consciousness
  3. co-administration w/ sedative/benzodiazepine
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9
Q

opioid SE

A
  1. respiratory depression
  2. pruritus
  3. urinary retention
  4. N/V, constipation
  5. miosis
  6. Sphincter of Oddi spasms –> abdominal pain in RUQ
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10
Q

Signs of opioid overdose/abuse

A
  1. track marks
  2. hypoventilation
  3. miosis
  4. decreased LOC
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11
Q

opioid withdrawal signs

A
  1. diarrhea
  2. hyperthermia
  3. nausea/vomiting
  4. muscles aches
  5. mydriasis
  6. increased anxiety, goose bumps
  7. hyperventilation
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12
Q

opioid overdose antidote

A

naloxone/narcan

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13
Q

naloxone/narcan indication

A

reversal of opiate effects

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14
Q

naloxone/narcan MOA

A

synthetic opiate antagonist

has higher affinity for mu receptor than opiates so it kicks of opiate from mu receptor

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15
Q

naloxone/narcan considerations

A
  1. causes addicts to go into withdrawal (few min - 2hrs) - vomiting, restlessness, abdominal cramps, increased BP and temp, hyperthermia
  2. short duration of action - may wear off before opiate if opiate half life is longer
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16
Q

What do should monitor after giving naloxone/narcan?

A

RR, HR/rhythm, BP, LOC for 3-4 hours after peak of drug in system –> if opioid replaces narcan, then can go back into overdose and cause decreased RR & LOC

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17
Q

Ethanol MOA

A

CNS depressant, decreases glutamate (excitatory), increases GABA (inhibition)

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18
Q

Ethanol actions

A
  1. Low dose: flushing, sedation, loss of inhibition
  2. Moderate dose: slow reaction time, impaired concentration
  3. High dose: impaired judgement, confusion, irrational thinking, impaired memory
19
Q

levels of Ethanol to cause death

A

5000 mg/L or BAC 0.5%

20
Q

Ethanol metabolism

A

liver

21
Q

chronic Ethanol toxicity

A
  1. liver: cirrhosis, liver failure
  2. brain: cognitive impairment
  3. CV: HTN, arrhythmias, cardiomyopathy, stroke
  4. Nutrition: Wernicke Korsakoff Syndrome
  5. Fetal Alcohol Syndrome: mental retardation
22
Q

Ethanol withdrawal

A
  1. excessive excitation –> seizures, hallucinations, tremor, tachycardia, HTN, sweating, insomnia, anxiety
23
Q

Treatment for Ethanol Withdrawal

A

maintain respiration, IV fluids, benzos

24
Q

maintaining sobreity

A

antabuse - blocks enzyme that breaks down acetaldehyde

25
Q

what is the schedule of tramadol/ultram

A

IV, but has less addictive properties than opioids

26
Q

tramadol/ultram MOA

A
  1. milder opioid mu receptor agonist

2. serotonin/norepinephrine reuptake inhibitor

27
Q

tramadol/ultram indications

A

mild/moderate analgesia

28
Q

tramadol/ultram contraindicaitons

A
  1. H/O SEIZURE
  2. other meds that lower seizure threshold
  3. concurrent MAOI use
29
Q

tramadol/ultram SE

A

flushing, rash, constipation, orthostatic hypotension, seizures, serotonin syndrome, Steven-Johnson syndrome (tutors emphasized last 4)

30
Q

what is serotonin syndrome?

A

when there is a build up of serotonin in synapses –> agitation, confusion, high HR and BP, dilated pupils, etc.

31
Q

tapentadol/nucynta MOA

A

opioid receptor agonist, norepinephrine reuptake inhibitor

32
Q

tapentadol/nucynta contraindications

A
  1. respiratory depression
  2. concurrent MAOI use
  3. paralytic ileus
33
Q

tapentadol/nucynta SE

A
  1. constipation
  2. orthostatic hypotension
  3. dizziness, nausea
34
Q

drug class of acetaminophen

A

aniline

35
Q

acetaminophen MOA

A

COX-3 inhibitor, works by increasing pain threshold, blocks heat regulating center in brain

No antiplatelet or anti-inflammatory activity

36
Q

acetaminophen indications

A

anti-pyretic, pain relief

37
Q

where is acetaminophen metabolized?

A

liver

38
Q

metabolism process of acetaminophen

A
  1. converted to NAPQI
  2. body makes GSH to counteract NAPQI
  3. if you take too much, then you run out of GSH
39
Q

What is considered an overdose of acetaminophen and who is at risk?

A
  1. 10x therapeutic dose (6500 mg)

2. children under 10, malnourished, alcoholics, CYP2E1 deficiency

40
Q

antidote for acetaminophen overdose

A

N-acetyl cysteine (NAC)

41
Q

contraindications for acetaminophen

A
  1. liver disease

2. combination drugs that include acetaminophen (ie. vicodin)

42
Q

acetaminophen SE

A
  1. liver failure –> renal failure

2. hypersensitivity (rash, hives)

43
Q

use of methadone

A

control withdrawal from heroin

Pharmacology (27 decks)

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