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pharmacology > cns drugs part i > Flashcards

cns drugs part i Flashcards

1
Q

protoype for strong narcotic agonist

A

morphine

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2
Q

other strong narcotic agonists

A

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

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3
Q

morphine
- classification
- moa
- indications/contraindications
- adverse effects

A

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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4
Q

morphine
- route and onset
- drug interactions

A

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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5
Q

interventions after admin morphine (strong narcotic opioid analgesics)

A
  • assess pain prior to and 1HR AFTER GIVING
  • vitals (RR!)
  • cont pulse ox
  • laxatives and stool softeners, monitor UO
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6
Q

education for admin of morphine (strong narcotic opioid analgesics)

A
  • pca
  • fears/misconceptions, reassurance
  • avoid heavy machinery
  • high fiber diet
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7
Q

prototype for opioid (moderate narcotic agonist) analgesics

A

codeine

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8
Q

other moderate narcotic agonists

A

HO!
hydrocodone (Vicodin)
oxycodone (OxyContin)

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9
Q

codeine
- classification
- moa
- indications/contraindications
- adverse effects

A

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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10
Q

prototype for opioid agonist antagonists

A

pentazocine (Talwin) - mu antagonist

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11
Q

other opioid agonist antagonists

A

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

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12
Q

pentazocine (Talwin)
- classification
- moa
- indications/contraindications
- adverse effects

A

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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13
Q

prototype for opioid antagonist

A

naloxone (Narcan)

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14
Q

naloxone (Narcan)
- classification
- moa
- indications/contraindications
- adverse effects

A

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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15
Q

adjuvant drugs
- ex?

A

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

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16
Q

3 rules to pain management

A
  1. low dose
  2. titrate up
  3. around the clock is better than PRN
17
Q

first gen NSAIDs
- used for

A

inhibit both COX1 and COX2

used for: inflammatory disorders (RA, OA, bursitis)
- suppress inflammation = risk for harm
- suppress fever, dysmenorrhea

18
Q

second gen NSAIDs
- used for

A

inhibit COX2

used for: treat inflammation without gastric issues
- lower GI risks
- higher MI and stroke risks, impaired renal function
- edema and HTN

19
Q

prototype for first gen NSAID (salicylates)

A

aspirin

20
Q

aspirin
- classification
- moa
- indications/contraindications
- adverse effects

A

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

21
Q

aspirin
- route and onset
- drug interactions

A

aspirin

route: PO
onset: within 30min, mostly absorbed in small intestine

drug interactions: avoid diflunasal
- salicylism (toxicity) and salicylate poisoning

22
Q

reye’s syndrome

A

adverse effect of aspirin; if taken by children with virus = swelling in brain

23
Q

prototype for first gen NSAID - prostaglandin synthetase inhibitor

A

ibuprofen (Motrin, Advil)

24
Q

other first gen NSAIDs – prostaglandin synthetase inhibitors

A

“NIK”
naproxen (Aleve)
indomethacin (Indocin)
ketorolac (Toradol)

25
Q

ibuprofen (Motrin, Advil)
- classification
- moa
- indications/contraindications
- adverse effects/ benefits compared to aspirin

A

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)

26
Q

stevens johnson syndrome

A

adverse effect of ibuprofen (Motrin, Advil) where the pt experiences blistering hypersensitivty

27
Q

ibuprofen (Motrin, Advil)
- route and onset
- drug interactions

A

ibuprofen (Motrin, Advil)

route: PO or SUPP
onset: 2-4hrs = analgesic and antipyretic effect

drug interactions: SSRIs (selective serotonin reuptake inhibitors) = GI bleeding

28
Q

prototype for second gen NSAIDs - selective COX2 inhibitors

A

celecoxib (Celebrex)

29
Q

celecoxib (Celebrex)
- classification
- moa
- indications/contraindications
- adverse effects

A

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)

30
Q

celecoxib (Celebrex)
- route and onset
- drug interactions

A

celecoxib (Celebrex)

route: PO
onset: peak after 3hrs, half life = 11hrs

drug interactions: warfarin + celecoxib = increase risk of bleeding

31
Q

prototype of para-aminophenol derivatives

A

acetaminophen (Tylenol)

32
Q

what makes a difference between para-aminophenol derivatives with other NSAIDs

A

para aminophenol derivatives = no actual anti-inflammatory response bc not acting on COX1 or COX2, instead works on cns directly

33
Q

acetaminophen (Tylenol)
- classification
- moa
- indications/contraindications
- adverse effects

A

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

34
Q

acetaminophen (Tylenol)
- route and onset
- drug interactions

-OD patho and antidote?

A

acetaminophen (Tylenol)

route: PO
onset: 30min, peak: 1-2hrs, duration 4hrs

OD = glutathione depletion –> FATAL
antidote: acetylcysteine

35
Q

glutathione

A

body’s antioxidant that is needed to fight liver toxicity; depletes when OD in acetaminophen

36
Q

what is the #1 adverse effect you need to watch out for when taking acetaminophen (Tylenol)

A

hepatotoxicity

pharmacology (15 decks)

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