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Pathopharm III > Chapter 18: Drugs for the Control of pain - Prototype Drugs > Flashcards

Chapter 18: Drugs for the Control of pain - Prototype Drugs Flashcards

1
Q

What is the prototype drug for an Opiod Agonist?

A

morphine

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2
Q

What is the MOA of morphine

A
  • acts by stimulating mu and kappa receptor sites
  • causes euphoria, constriction of the pupils, and stimulation of cardiac muscles
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3
Q

What is morphine used for?

A
  • symptomatic relief of serious acute and chronic pain after nonnarcotic analgesics have failed
  • preanesthetic medication
  • relief of SOB associated with HF and pulmonary edema
  • Acute chest pain connected with MI
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4
Q

What are the Adverse Effects of morphine?

A
  • Respiratory depression
  • Sedation
  • N/V
  • orthostatic hypotension d/t peripheral vasodilation
  • hallucinations
  • Constipation
  • Itiching sensation
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5
Q

Can tolerance develop to sedative, nausea-producing, and euphoric effects of morphine?

A

Yes

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6
Q

Can cross-tolerance develop between morphine and other opioids such as heroin, methadone, and meperidine?

A

Yes

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7
Q

What happens when high doses of morphine are taken for prolonged periods?

A

physical and psychological dependence

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8
Q

What is the route for morphine?

A
  • PO (capsules, liquid, or sublingual)
  • IV
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9
Q

should a patient open a morphine capsue or crush extended release forms?

A

No, unless directed to do so by your HCP

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10
Q

What is the pregnancy category of morphine?

A
  • pregnancy category B
  • chages to category D in long-term use or with high doeses
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11
Q

What is the Black Box Warning for morphine?

A
  • when admin as epidural drug - pts must be observed in a fully equipped and staffed environment for at least 24 hours
  • when admin as extended release tablet - has abuse liability
  • Schedule II drug
  • take whole, do not break, chew, dissolve, or crush
  • avoid alcohol
  • if warnings are not followed it could result in fatal respiratory depression
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12
Q

Whar are the contraindications of morphine?

A
  • acute or severe asthma
  • GI obstruction
  • severe kidney or liver impairment
  • Gallbladder disease
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13
Q

What happens with the concurrent use of CNS depressants with opioids (morphine, etc)?

A

it potentiates the action of opiates (morphine, etc) and increases the risk of severe respiratory depression and death

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14
Q

What are some examples of other CNS depressants that should be avoided when taking morphine or other opioids?

A
  • alcohol
  • other opioids
  • general anesthetics
  • sedatives
  • antidepressants (MAOIs and tricyclic antidepressants)
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15
Q

which herbal/foods may potentiate the effect of morphine?

A
  • Kava
  • valerian
  • st John’s wort
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16
Q

What is the result of morphine OD?

A

severe respiratory depression or cardiac arrest

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17
Q

What is the specific treatment of morphine OD?

A

IV admin of nalaxone

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18
Q

what are some other treatments for morphine OD?

A
  • activated charcoal
  • laxatives
  • counteracting narcotic antagonist (multiple doses may be needed)
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19
Q

What is the prototype Drug for Opioid Antagonist?

A

Naloxone

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20
Q

What is the MOA of Naloxone?

A
  • acts by blocking mu and kappa receptors
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21
Q

What is Naloxone used for?

A
  • used for reversal of opioid effects in emergency situations when acute opioid OD is suspected
  • used to treat postoperative opioid depression
  • cause opioid withdrawal symptoms in patients physically dependent on opiods
  • occasionally given as adjunctive therapy to reverse hypotension caused by septic shock
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22
Q

What are the Adverse Effects of naloxone?

A
  • minimal toxicity
  • rapid loss of analgesia
  • increased blood pressure
  • tremors
  • hyperventilation
  • N/V
  • Aggigtation
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23
Q

What is the route of naloxone?

A
  • IV, IM, SubQ, nasal spray
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24
Q

How quickly does Naloxone start to reverse opioid-initiated CNS and respiratory depression when administered IV

A

1-2 minutes

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25
Q

At how many breaths/minute should you administer Naloxone?

A
  • fewer than 10 breaths per minute
  • keep resuscitative equipment accessible
26
Q

What pregnancy category is Naloxone?

A

Pregnancy category B

27
Q

What are the contraindications of naloxone?

A
  • should not be used for respiratory depression caused by non-opioid medications
  • hepatic injury or acute liver disease
28
Q

what are some interactions for naloxone?

A
  • reversal of the analgeisc effects of opioid agonists and mixed agonist drugs
  • Echinacea may increase the risk of hepatotoxicity
29
Q

What is the prototype drug for Salicylates

A

aspirin

30
Q

What is the MOA of aspirin

A

inhibits prostaglandin synthesis involved in the process of pain and inflammation and produces mild to moderate relief of fever

31
Q

Does aspirin cause vasodilation and sweating

A

yes, aspirin has limited effects on peripheral blood vessels, causing vasodilation and sweating

32
Q

What is aspirin used for?

A
  • it has significant anticoagulant activity
  • it reduces the risk of mortality following an MI
  • it reduces the incidence of strokes
33
Q

What are the adverse effects of aspirin

A

high doses may cause GI distress and bleeding d/t antiplatelet effects

34
Q

What is the route for aspirin

A
  • PO
  • enteric coated tablets available for pts who experience GI side effects
35
Q

The platelet aggregation inhibition caused by aspirin is irreversible. true or false?

A

True

36
Q

How long before surgery should you discontinue aspirin?

A

1 week

37
Q

What pregnancy category is aspirin

A

pregnancy category D

38
Q

What is contraindicated for aspirin?

A

Do not give to patients receiving anticoagulant therapy such as warfarin and heparin

39
Q

the action of which drug will be increased with concurrent use with aspirin?

A

oral hypoglycemic agents

40
Q

Which drugs will decrease aspirins effects?

A

phenobarbital, antacids, and glucocorticoids

41
Q

The effects of which drugs will be decreased when used with aspirin?

A

NSAIDs, betablockers, spironolactone, and sulfa drugs

42
Q

Which drugs may increase the effects of aspirin?

A

Insulin, methotrexate, phenytoin, sufonamides, and penicillins

43
Q

What may increase the risk for gastric ulcers when taken with aspirin?

A

alcohol, pyrazolone derivatives, steroids, or other NSAIDs

44
Q

What herbal/foods will increase the risk for bleediong when taken with aspirin?

A

feverfew, garlic, ginger, and ginkgo

45
Q

how might aspirin affect lab tests?

A
  • its excreted in urine and affects urine testing for glucose and other metabolites
  • may cause prolonged prothrombin time by decreasing prothrombin production
  • may interfere with pregnancy tests
  • may decrease serum levels of cholesterol, potassium, T3 and T4
  • hight salicylate levels may cause abnormalities in liver function test
46
Q

What is the treatment for aspirin OD?

A
  • activated charcoal
  • gastric lavage
  • laxative
  • drug therapy for OD symptoms such as dizziness, drowsiness, abdominal pain and seizures
47
Q

What is the prototype drug for Triptans?

A

sumatriptan

48
Q

What is the MOA of sumatriptan?

A

Acts as serotonin agonists, constricting certain intracranial vessels

49
Q

What is sumatriptan used for?

A

used to abort migraines with or without auras

50
Q

How quickly does sumatriptan work?

A

10-30 minutes

51
Q

Is sumatriptan effective for long-term prophylaxis of migraines?

A

NO

52
Q

What are Sumatriptan’s Adverse Effects?

A
  • GI upset
  • Dizziness
  • Drowsiness
  • Warming sensation
53
Q

What is the route for sumatriptan?

A
  • oral, intranasal, and SubQ
54
Q

What might sumatriptan produce in indiviudals with no previous cardiac events?

A

cardiac ischemia

55
Q

Sumatrptan’s systemic vasoconstrictor activity may cause what?

A

Hypertension which may result in dysrhythmias or MI

56
Q

What pregnancy category is sumatriptan?

A

Pregnancy category C

57
Q

What are the contraindications for sumatriptan?

A
  • use cautiously in pts with recent MI hx or angina pectoris, hypertension, or diabetes d/t vasoconstricting action
  • pts with acute kidney injury or hepatic impairment
58
Q

Which drugs may increase the effects of sumatriptain when takn concurrently

A

MAOIs and SSRIs

59
Q

what may occur when taken with ergot alkaloids or other triptans?

A

further vasoconstriction

60
Q

What may increase triptan toxicity?

A

ginkgo, ginseng, echinacea, and St. Johns’s wort

61
Q
A
62
Q

What is the treatment of OD for sumatriptan

A

drug therapy for the following symptoms: weakness, lack of coordination, watery eyes and mouth, tremors, seizures, or breathing problems

Pathopharm III (9 decks)

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