cns drugs part i Flashcards by kyle camryn

protoype for strong narcotic agonist

morphine

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other strong narcotic agonists

FOMMH
fentanyl
methadone
hydromorphone (Dilaudid)
meperidine (Demerol)
oxycodone (Percocet, Percodan)

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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

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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

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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

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education for admin of morphine (strong narcotic opioid analgesics)

pca
fears/misconceptions, reassurance
avoid heavy machinery
high fiber diet

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prototype for opioid (moderate narcotic agonist) analgesics

codeine

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other moderate narcotic agonists

HO!
hydrocodone (Vicodin)
oxycodone (OxyContin)

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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)

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prototype for opioid agonist antagonists

pentazocine (Talwin) - mu antagonist

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other opioid agonist antagonists

BNB
buprenorphine (Buprenex) - partial mu agonist and antagonist
nalbuphine (Nubain) - mu antagonist
butorphanol (Stador) - mu antagonist

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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

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prototype for opioid antagonist

naloxone (Narcan)

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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

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adjuvant drugs
- ex?

assist primary drugs in relieving pain
- NSAIDs, antidepressants, anticonvulsants, corticosteroids

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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