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SMC - Pharmacology - TSparks > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is the fifth Vital sign in fully assessing a patient?

A

Pain.

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2
Q

What do Narcotics (opiates/opioids) do?

A

Like Endorphans, they they attached to opiate receptors in the brain to decrease the perception of pain.

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3
Q

What are the pharmacology effects narcotics have on the CNS?

A
  1. Behavioral changes ( euphoroia (exaggerated state of well being) or dysphoria (feeling very bad about themselves)
  2. Blocks the CNS cough reflex.
  3. Analgesia w/o loss of consciousness
  4. Nauseant and Emetic
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4
Q

What are the toxic Effects of Narcotics?

A
  1. Toxic levels decrease the CNS respiratory drive (especially with head injuries) and lead to fatalities.
  2. Overdose are pin point pupils (miosis).
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5
Q

What are the pharmacology effects of morphine (a narcotic) has on Cardiovascular system?

A

Morphine is useful in patients who have suffered myocardial infarction. Morphine decreases cardiac workload. Morphine blocks perception of pain in the CNS, and also stops the cause of pain. By decreasing cardiac workload, cardiac oxygen demand decreases, therefore cardiac tissue is preserved. Also orthostatic hypotension.

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6
Q

Why is there pain following a heart attack/myocardial infarction?

A

Because there is an imbalance of cardiac oxygen demand vs. oxygen delivery.

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7
Q

What is cardiac workload?

A

Stroke volume x Blood volume (?)

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8
Q

What are the pharmacology effects of narcotics on the Gastro-intestinal (GI) system?

A

Narcotic decrease GI motility, which causes constipation (can be beneficial suffering from diarrhea). Narcotics also increase biliary pressure with enhances the pain associated with biliary obstruction.

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9
Q

Why can narcotics not be used to treat infectious diarrhea?

A

Narcotics slow down the GI Tract which will keep the bacteria and toxins in the GI tract longer and cause greater harm.

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10
Q

How are narcotics used in labor?

A

They are used to relieve pain, but can have an adverse reaction of slowing uterine contraction.

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11
Q

What are narcotic antagonists?

A

Narcotic antagonists block the narcotic receptor and can displace narcotics sitting on a receptor. Can reverse narcotic overdose.

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12
Q

What is Naloxone?

A

Naloxone is a narcotic antagonists blocks the narcotic receptor and reverses a narcotic overdose.

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13
Q

How do narcotic addicts go into withdrawals?

A

Narcotic addicts require that their narcotic receptors be constantly stimulated. When narcotic antagonist are used, they block the receptor causing the addict to go into withdrawal. When Narcotic Agonist/Antagonist are used, addicts go into withdrawals because some of the receptors are blocked.

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14
Q

What are Narcotic Agonist/Antagonist?

A

Narcotic Agonist/Antagonist are medications which either stimulate or block narcotic (opiate) receptors. These have lower abuse potential and addiction, because not all receptors will stimulate at the same time. Not effective in server pain.

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15
Q

What are PCAs

A

Patient controlled analgesia (PCA) allows the patient to administer their own narcotic analgesic by pressing a button connected to a pump.

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16
Q

What are some therapeutic uses for narcotics?

A

Analgesia, Antitussive (blocks cough reflexes), antidiarrheal

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17
Q

Types of Non-Narcotics

A
  1. Salicylates (Aspirin)
  2. Acetaminophen
  3. NSAIDs (Non-Steroidal Anti-Inflammatory)
  4. COX-2 Inhibitors
  5. Hydroxycholoroquine
  6. Intra-Articular Steriods
  7. Systemic Steriods
  8. Disease Modifying Antirheumatic Drugs (DMARD’s)
  9. Chemotherapeutic Agents
  10. Gouty Arthritis
  11. Migraine (Acute and Prophylactic Therapy)
18
Q

Salicylates are what?

A

Analgesic: Useful for mild to moderate pain including headaches, arthralgias, and myalgias.
Antipyretic: Lowers body temperature in febrile individuals.
Anti-inflammatory: Decreases inflammation especially for rheumatoid arthritis.

19
Q

Acetylalicylates posses what?

A 
Only acetylsalicylate (aspirin) possesses anti-platelet properties in low doses (i.e. baby aspirin 81mg tablets). Anti-platelet property prevents clotting. This is useful to
prevent heart attacks, prevent transient ischemic attacks (i.e. pre-stroke), and prevent clotting from cardiac valve replacements.
20
Q

What are the side effects of Saiculates?

A

These can cause GI ulcerations, can be life threatening by causing metabolic acidosis.

21
Q

What is tinnitus

A

Ringing in the ears, usually a sign of toxicity related to Salicylate Toxicity.

22
Q

What are high doses of salicylates used for?

A

Used in the treatment of rheumatoid arthritis are “uricosuric” and increase elimination of uric acid. Low doses of salicylate cause uric acid retention, which is an issue for patients that are prone to gouty arthritis.

23
Q

What are topical uses for salicylates?

A

Topical use. High liquid concentrations are keratolytic which dissolve the top layer of skin to remove warts. Lower concentrations (methlsalicylate aka oil of wintergreen) are utilized in sports creams to relieve muscle pain.

24
Q

What is Acetaminophen?

A

Acetaminophen (Tylenol®) possesses two therapeutic properties: analgesic and antipyretic. It is not anti-inflammatory nor anti-platelet. This is also known as Paracetamol.

25
Q

Overdose of acetaminophen can what?

A

Are hepatotoxic and be fatal if the antidote is not administered.

26
Q

What is the acetaminophen antidote?

A

The antidote is acetylcysteine (Mucomyst). This is a mucolytic agent that is utilized in respiratory therapy and breaks up mucous plugs in the respiratory tract. Administered orally, which is difficult because it smells like rotten eggs.

27
Q

What is rheumatoid arthritis

A

This is a progressive auto-immune disease, that are worse if it begins at an earlier stage in life. Treatment begins with the least toxic agents (i.e. salicylates, non-steroidal antiinflammatory agents). But as the disease progresses, more toxic agents are utilized.

28
Q

What is Gold Therapy?

A

This is the preferred method of treating rheumatoid arthritis. This can be administered either via injection every few weeks (gold thiomalate) or orally every day (auronofin)

29
Q

Disease Modifying Antirheumatic Drugs are what?

A

These agents may be used with methotrexate (chemotherapeutic drug) to slow progression of rheumatoid arthritis by blocking inflammation.

30
Q

What are Chemotherapeutic Agents

A

These agents are used to treat cancer and are extremely toxic and reserved for late stage treatment. These kill cancer cells but also decrease the body’s immune response.

31
Q

What is Rheumatoid Arthritis?

A

Rheumatoid Arthritis is an auto-immune disease in which the body produces antibodies that destroy their own joints. Drugs that treat RA are chemotheraputic and decrease the immune response will slow the progression of rheumatoid arthritis, but there are toxicities associated with this therapy that include bone marrow depression.

32
Q

What is Gouty Arthritis?

A

Gouty arthritis is an inborn error of one of two causes.
1. metabolic error of over production of uric acid due to the breakdown of cells and the nucleic acid of those cells.
2. an error in the kidney’s ability to eliminate uric acid
which leads to a blood build up of uric acid. Excess concentrations of uric acid builds up in the blood stream and then crystallizes in the joints causing joint damage.

33
Q

What are migraines?

A

A headache, also known as cephalaglais, is defined as pain in the head or neck region and there are several
possible causes. Headaches can be chronic (more than 15 in a month) or non-chronic and are typically categorized by primary and secondary headaches. Treatment of headaches usually consists medications that act on the peripheral and central nervous systems. These medications relieve the pain and are known as painkillers (analgesics).

34
Q

What is Acute Therapy?

A

Acute therapy consists of medications that severe vasoconstriction of cranial blood vessels, so that those blood vessels no longer impinge on nerves. Overuse of these medications can cause severe vasoconstriction of other blood vessels, that can lead to heart attacks and gangrene of the extremities.

35
Q

What is Prophylactic Therapy?

A

These medications are reserved for patients who have 2 to 3 bouts of migraines a month, to help prevent a migraine from developing.

36
Q

What are NSAID’s

A

Non-Steroidal Anti-Inflammatory are analgesic, antipyretic, and anti-inflammatory. treat pain by blocking COX-1 and COX-2 in the central nervous system. NSAIDs are divided by into several categories. The most common are salicylates (aspirin), and propionic acid derivatives (Ibuprofen, naproxen).
NSAID’s block two receptors, Cox-1 and Cox-2 (cyclo-oxygenase receptors).

37
Q

What are side effects of NSAID’s

A

GI Effects, nausea, ulcerations, sodium and water retention, decreased renal function, anti-platelet properities

38
Q

Types of COX Inhibitors

A
  1. Cox-1 causes cytoprotection of the GI mucosa. Blocking Cox-1 can lead to ulceration, which is an adverse reaction associated with NSAID’s.
  2. Cox-2 inhibitors are a new class of anti-inflammatory agents that only block Cox-2 receptors. Blocking Cox-2 receptors decrease inflammation, which is therapeutic for
    arthritis. The Cox-2 inhibitors supposedly have a lower incidence of GI ulceration, but are no more effective than NSAID’s in treating arthritis.
39
Q

What is Hydroxcholorquine?

A

These are more toxic and are reserved when lesser toxic drugs are no longer effective. These requires three months until onset of action, therefore another agent must be utilized at the same time. Patients require eye
exams while on this agent. Once retinopathies are noted, therapy must be stopped.

40
Q

What are Intra-Articular Steroids?

A

Steroid injections directly into the affected joint is utilized, when only a few joints are involved. There is little concern of systemic steroid adverse reactions, because the medication stays localized in the joint area following the injection.

41
Q

What are Systemic Steroids?

A

There is concern of systemic adverse reactions when oral systemic steroids are administered. There are many consequences listed on the slide associated with prolonged systemic use. In order to decrease these systemic effects, the drug is administered every other day instead of daily.

SMC - Pharmacology - TSparks (13 decks)

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