cns drugs part i Flashcards
protoype for strong narcotic agonist
morphine
other strong narcotic agonists
FOMMH
fentanyl
methadone
hydromorphone (Dilaudid)
meperidine (Demerol)
oxycodone (Percocet, Percodan)
morphine
- classification
- moa
- indications/contraindications
- adverse effects
morphine
classification: opioid (strong narcotic agonist) analgesic
moa: occupies mu and kappa receptors –> reduce release of neurotransmitters - prevent transmission of nociceptive pain
indications: pain relief, cough suppressant
contra: resp depression, alcoholics, addicts, stroke pts (no cough reflex), pregnancy, hypersensitivity
adverse effects:
- cns: sedation, mental clouding
- resp: resp arrest
- cv: orthostatic hypotension
- GI: constipation, emesis, epigastric distress
- GU: urinary retention, hesitancy
- eyes/skin, urticaria, pinpoint pupils
- increased ICP
morphine
- route and onset
- drug interactions
morphine
route: PO, IM, IV, SUBCUT, IC
onset: IV 7min, IM 30min, SQ 90min
drug interactions: barbituates, warfarin, hypotensive drugs, CNS depressors
interventions after admin morphine (strong narcotic opioid analgesics)
- assess pain prior to and 1HR AFTER GIVING
- vitals (RR!)
- cont pulse ox
- laxatives and stool softeners, monitor UO
education for admin of morphine (strong narcotic opioid analgesics)
- pca
- fears/misconceptions, reassurance
- avoid heavy machinery
- high fiber diet
prototype for opioid (moderate narcotic agonist) analgesics
codeine
other moderate narcotic agonists
HO!
hydrocodone (Vicodin)
oxycodone (OxyContin)
codeine
- classification
- moa
- indications/contraindications
- adverse effects
codeine
classification: opioid (moderate narcotic agonist) analgesic
moa: acts on opioid receptors mu and kappa to produce analgesia, euphoria, sedation. acts on medullary cough center to depress cough reflex
indications: cough suppressant (can dry sputum)
contra:
adverse effects: dry mouth, drowsiness, sedation (similar to morphine)
prototype for opioid agonist antagonists
pentazocine (Talwin) - mu antagonist
other opioid agonist antagonists
BNB
buprenorphine (Buprenex) - partial mu agonist and antagonist
nalbuphine (Nubain) - mu antagonist
butorphanol (Stador) - mu antagonist
pentazocine (Talwin)
- classification
- moa
- indications/contraindications
- adverse effects
pentazocine (Talwin)
classification: opioid agonist antagonist
moa: mixed opioid effects, mu antagonist and kappa agonist; blocks opioid effects on mu
indications: mild-moderate pain, thought to have been better med to decrease danger of mu activation
contraindications:
adverse effects: similar to morphine EXCEPT INCREASES CARDIAC WORK, major withdrawal symptoms in pts still heavily addicted to opioids
prototype for opioid antagonist
naloxone (Narcan)
naloxone (Narcan)
- classification
- moa
- indications/contraindications
- adverse effects
naloxone (Narcan)
classification: opioid antagonist
moa: high affinity for opioid receptors but cause no affect
indications: opioid antidote
contraindications:
adverse effects: hypotension, hypertension
adjuvant drugs
- ex?
assist primary drugs in relieving pain
- NSAIDs, antidepressants, anticonvulsants, corticosteroids
3 rules to pain management
- low dose
- titrate up
- around the clock is better than PRN
first gen NSAIDs
- used for
inhibit both COX1 and COX2
used for: inflammatory disorders (RA, OA, bursitis)
- suppress inflammation = risk for harm
- suppress fever, dysmenorrhea
second gen NSAIDs
- used for
inhibit COX2
used for: treat inflammation without gastric issues
- lower GI risks
- higher MI and stroke risks, impaired renal function
- edema and HTN
prototype for first gen NSAID (salicylates)
aspirin
aspirin
- classification
- moa
- indications/contraindications
- adverse effects
aspirin
classification: first gen NSAID - salicylate
moa: non selective inhibitor of COX1 and COX2 enzyme
- antipyretic effect
- analgesic effect
- antiplatelet effect
indications: mild-moderate pain, RA, OA, bursitis, dysmenorrhea
contraindications: peptic ulcers (+other bleeding), anticoagulation therapy, gout pts, renal/liver failure, children
adverse reactions: GI bleed, renal impairment, tinnitus, REYE’S SYNDROME, hypersensitivity
aspirin
- route and onset
- drug interactions
aspirin
route: PO
onset: within 30min, mostly absorbed in small intestine
drug interactions: avoid diflunasal
- salicylism (toxicity) and salicylate poisoning
reye’s syndrome
adverse effect of aspirin; if taken by children with virus = swelling in brain
prototype for first gen NSAID - prostaglandin synthetase inhibitor
ibuprofen (Motrin, Advil)
other first gen NSAIDs – prostaglandin synthetase inhibitors
“NIK”
naproxen (Aleve)
indomethacin (Indocin)
ketorolac (Toradol)
ibuprofen (Motrin, Advil)
- classification
- moa
- indications/contraindications
- adverse effects/ benefits compared to aspirin
ibuprofen (Motrin, Advil)
classification: first gen NSAID - prostaglandin synthetase inhibitor
moa: inhibits COX1 and COX2
- anti-inflammatory
- analgesic
- antipyretic
indications: fever, mild-moderate pain, arthritis
contra: ulcers, bleeding disorders, heart/renal failure pts
benefits vs aspirin: less GI bleeding, less inhibition of plt agg
adverse effects: stevens johnson syndrome (SJS)
stevens johnson syndrome
adverse effect of ibuprofen (Motrin, Advil) where the pt experiences blistering hypersensitivty
ibuprofen (Motrin, Advil)
- route and onset
- drug interactions
ibuprofen (Motrin, Advil)
route: PO or SUPP
onset: 2-4hrs = analgesic and antipyretic effect
drug interactions: SSRIs (selective serotonin reuptake inhibitors) = GI bleeding
prototype for second gen NSAIDs - selective COX2 inhibitors
celecoxib (Celebrex)
celecoxib (Celebrex)
- classification
- moa
- indications/contraindications
- adverse effects
celecoxib (Celebrex)
classification: second gen NSAID - selective COX2 inhibitor
moa: selectively inhibits COX2, inhibits prostaglandin synthesis
indications: arthritis, dysmenorrhea, acute pain
contraindications: avoid pts with sulfa allergy (give aspirin instead)
adverse effects: dyspepsia, ab pain, sulfonamide allergy
INCREASE RISK FOR STROKE, MI, CV EVENTS (bc no inhibition of plt agg)
celecoxib (Celebrex)
- route and onset
- drug interactions
celecoxib (Celebrex)
route: PO
onset: peak after 3hrs, half life = 11hrs
drug interactions: warfarin + celecoxib = increase risk of bleeding
prototype of para-aminophenol derivatives
acetaminophen (Tylenol)
what makes a difference between para-aminophenol derivatives with other NSAIDs
para aminophenol derivatives = no actual anti-inflammatory response bc not acting on COX1 or COX2, instead works on cns directly
acetaminophen (Tylenol)
- classification
- moa
- indications/contraindications
- adverse effects
acetaminophen (Tylenol)
classification: para-aminophenol derivative
moa: inhibition of CNS (not on COX enzymes)
- no plt agg
- no prostaglandin synthesis
- no vasodilation and sweating
indications: **best drug for fever, mild-moderate pain, drug of choice for infants/children with flu, **analgesic choice for pregnancy
contra: hepatic disease, viral hepatitis, alcoholism, exacerbation of anemia
adverse effects: (rare); **HEPATOTOXICITY, rash, nausea, thrombocytopenia, jaundice
acetaminophen (Tylenol)
- route and onset
- drug interactions
-OD patho and antidote?
acetaminophen (Tylenol)
route: PO
onset: 30min, peak: 1-2hrs, duration 4hrs
OD = glutathione depletion –> FATAL
antidote: acetylcysteine
glutathione
body’s antioxidant that is needed to fight liver toxicity; depletes when OD in acetaminophen
what is the #1 adverse effect you need to watch out for when taking acetaminophen (Tylenol)
hepatotoxicity
