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2020 Pharmacology I > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What drugs fall in the class of non-opioid analgesics?

A
  • acetaminophen
  • 1st gen NSAIDs
    • aspirin
    • ibuprofen
    • naproxen
    • indomethacin
    • diclofenac
    • ketorolac
    • meloxicam
  • 2nd gen NSAIDs
    • celecoxib
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2
Q

therapeutic effects of NSAIDs

A
  • ↓ inflammation
  • relieve pain
  • ↓ fever
  • ASPIRIN: ↓ risk of MI and stroke
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3
Q

How do NSAIDs work?

A

by blocking cyclooxygenase

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4
Q

complications of NSAID use

A

↑ risk of

  • GI ulcers
  • bleeding
  • renal impairment
  • MI and stroke (except ASPIRIN, but especially CELECOXIB)
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5
Q

administering NSAIDs

A
  • take with food
  • may need adjuvent med to protect GI
  • monitor for s/sx of GI bleed
  • usually PO, but IV and IM available
  • don’t crush or chew enteric-coated pills
  • notify provider of
    • bleeding
    • N&V
    • abdominal pain
  • increased risk of bleeding with glucocorticoids
  • concurrent use of multiple NSAIDs increases risks
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6
Q

NSAID precautions

A
  • older age
  • smoking
  • alcohol use disorder
  • pre-existing renal or GI issues
  • pregnancy
  • bleeding disorders
  • anticoagulant meds
  • stop before surgery
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7
Q

complications of aspirin use

A
  • Reye syndrome
  • salicylism
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8
Q

ASA

A
  • aspirin
  • acetylsalicylic acid
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9
Q

Reye syndrome

A
  • rare but serious complication when using aspiring to treat fever in children with viral illness
  • don’t use ASA to treat pediatric fever
  • symptoms
    • ​diarrhea
    • tachypnea
    • vomiting
    • severe fatigue
    • fever
    • hypoglycemia → confusion, seizures, LOC
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10
Q

salicylism

A
  • mild ASA toxicity
  • stop med and notify provider
  • symptoms
    • tinnitus
    • sweating
    • headache
    • dizziness
    • respiratory alkalosis
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11
Q

aspiring toxicity

A
  • more serious than salicylism - medical emergency
  • max dose: 4 g/day
  • s/sx
    • high fever
    • sweating
    • acidosis
    • dehydration
    • electrolyte imbalance
    • coma
    • respiratory depression
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12
Q

aspirin toxicity Tx

A
  • gastric lavage/activated charcoal
  • hemodialysis
  • cooling with tepid water
  • IV fluid correction
  • bicarbonate (for acidosis)
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13
Q

acetaminophen

A
  • therapeutic use
    • analgesic
    • antipyretic
  • MOA: slows production of prostaglandins in CNS
  • route
    • usually OTC and PO
    • comes in IV forms by Rx
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14
Q

acute acetaminophen toxicity

A
  • rare at therapeutic doses
  • max dose: 4 g/day
  • causes liver damage
  • s/sx
    • ​N&V
    • diarrhea
    • sweating
    • abdominal pain
    • hepatic failure
    • coma
    • death
  • antidote: acetylcysteine
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15
Q

administering acetaminophen

A
  • before giving acetaminophen or meds mixed with it, take LFT in some pts, and PT/INR in those taking warfarin
  • teach pt to read med labels to avoid accidental overdose (cold meds, headache meds)
  • max dose: 4 g/day
  • ask about alcohol use
  • max dose with > 2 drinks/day: 2 g/day
  • monitor concurrent meds to avoid overdose
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16
Q

opioid agonists

A
  • prototype: morphine
  • fentanyl
  • meperidine
  • methadone
  • codeine
  • oxydocone
  • hydromorphone
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17
Q

morphine SE

A
  • rash
  • respiratory depression
  • bradycardia
  • constipation
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18
Q

morphine admin routes

A
  • PO (TAB, LIQ)
  • IV
  • IM
  • SC
  • PR (rectally)
  • td
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19
Q

ETOH

A

intoxicated pt

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20
Q

opioid agonist SE

A
  • respiratory depression
    • monitor VS
    • withhold if RR < 12
    • worse with CNS depressants and ETOH
  • sedation
    • fall risk
    • monitor VS
    • avoid risky activities
    • worse with CNS depressants and ETOH
  • constipation
    • prevention: fluid and fiber, docusate sodium
    • acute Tx: stimulant laxative
    • long-term use: opioid antagonist
  • N&V: give antiemetic (promethazine = synergist); ondansetron
  • orthostatic hypotension
    • fall risk
    • move slowly
    • worse with antihypertensive meds
  • urinary retension
    • watch I/O
    • encourage voiding q4hr
    • assess for distention
    • worse with anticholinergics and in pts with BPH
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21
Q

BPH

A

benign prostatic hyperplasia

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22
Q

long-term use of opioid agonists

A
  • physical dependence
    • ≠ abuse or illicit use, but can lead to both
    • withdrawal symptoms when stopped
    • must taper dose
    • methadone clinics treat this
  • tolerance
    • ↓ therapeutic response over time
    • no relief from normal dose
    • no SE from normal dose
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23
Q

acute overdose of opioid agonists

A
  • s/sx
    • respiratory depression
    • coma
    • pinpoint pupils
  • Tx
    • D/C med
    • CPR
    • naloxone
    • mechanical ventilation
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24
Q

PCA

A

patient-controlled analgesia (pump)

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25
Q

patient-controlled analgesia

A
  • allows for self-admin
  • pt must be awake
  • don’t let family push button
  • on-demand only or continuous with extra PRN dose
  • when switching to PO meds, monitor pain level closely
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26
Q

administering opioid agonists

A
  • assess pain level and medicate accordingly
  • reassess pain in appropriate time for route
  • monitor respiratory status
  • be careful - don’t overmedicate
  • severe, chronic pain: fixed schedule
  • acute pain: PRN before pain is severe
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27
Q

opioid agonist-antagonists

A
  • MOA: agonist for kappa, antagonist for mu receptors
  • prototype: butorphanol; used as Tx for opioid abuse
    • nalbuphine
    • buprenorphine
    • penazocine
  • treats: moderate to severe pain
  • ↓ effective than agonists
  • ↓ respiratory depression and risk of abuse
  • ideal for labor pain
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28
Q

opioid agonist-antagonist SE

A
  • sedation
  • respiratory depression (↓ than agonists)
  • dizziness - fall risk, avoid machinery
  • headache
  • interacts with ETOH and other sedating meds
  • abstinence syndrome
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29
Q

abstinence syndrome

A
  • ↓ activity of mu receptors → withdrawal in opioid dependent pts
  • s/sx
    • cramping
    • HTN
    • vomiting
    • fever
    • anxiety
  • contra: in pts with opioid use disorder
  • caution: head injury, chronic dz
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30
Q

opioid antagonists

A
  • MOA: compete for opioid receptors to block action
  • prototype: naloxone
    • ​naltrexone
    • alvimopan
  • reverse repiratory depression, euphoria, constipation, and pain control
  • complications
    • tachycardia
    • tachypnea
  • contra: opioid dependency, except for OD
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31
Q

WHO three-step analgesic ladder

A
  1. mild pain: non-opioid ± adjuvant
  2. persisting/increasing mild-moderate: opioid + non-opioid ± adjuvant
  3. persisting/increasing moderate-severe: opioid ± non-opioid ± adjuvant
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32
Q

tri-cyclic antidepressants for pain

A
  • amitriptyline
  • Tx for
    • depression
    • fibromyalgia
    • nerve pain
  • usually for chronic pain
  • SE
    • orthostatic hypotension - fall risk
    • sedation - avoid driving, etc.
    • anticholinergic effects - increase fluid, comfort measures
  • contra/caution
    • recent MI
    • MAOI use
    • glaucoma
    • BPH
    • seizures
    • liver or kidney dz
33
Q

anticonvulsants for pain

A
  • treat neuropathy
  • carbamazepine, gabapentin
  • common Tx for diabetic neuropathy
  • contra/caution
    • bone marrow suppression
    • MAOI use
    • pregnancy
  • interactions: lots
    • warfarin
    • contraceptives
    • grapefruit
    • other anticonvulsants
    • CNS depressants
  • SE
    • drowsiness
    • GI upset - with food, fluid and fiber, stool softener, laxative
    • bone marrow suppression - monitor for easy bruising, bleeding, sore throat, fever
    • rash - hold med, notify provider
34
Q

CNS stimulant for pain

A
  • methylphenidate
  • ↑ analgesia, ↓ sedation
  • monitor for weight loss
  • causes insomnia - take before 1600, ↓ caffeine
  • caution: HTN, Hx of substance use disorder, OTC meds
  • contra: MAOI
35
Q

antihistamines for pain

A
  • hydroxazine, promethazine (adjuvant to opioid)
  • ↓ anxiety, N&V
  • ↑ pain relief and sedation
  • contra: acute asthma
  • caution: pregnancy, breastfeeding, older age (↓ dose
  • SE
    • sedation
    • dry mouth - increase fluids, suck hard candy
36
Q

glucocorticoid steroids for pain

A
  • dexamethasone, prednisone
  • ↓ inflammation, ICP, spinal cord compression
  • ↑ appetite
  • common for injuries
  • SE
    • adrenal insufficiency
    • hypotension
    • dehydration
    • infection
    • weakness
    • lethargy
    • vomiting
    • diarrhea
    • electrolyte imbalance - monitor, eat K-rich foods, ↓ Na intake, monitor for edema
  • contra: fungal infections
  • caution: HTN, diabetes, osteoporosis, liver dz
  • interact: live virus vaccines
  • do not D/C abruptly
37
Q

adjuvants in general

A
  • typically for chronic pain
  • glucocorticoids, NSAIDs, antihistamines may be used for acute
  • pts need fixed schedule
  • typically off-label use
  • therapeutic effect depends on condition
38
Q

muscle relaxants

A
  • centrally acting: diazepam (Valium)
    • baclofen
    • cyclobenzaprine
    • tizanidine
  • peripherally acting: dantrolene
39
Q

contraindications, cautions, and interactions of muscle relaxants

A
  • baclofen and dantrolene: pregnancy risk category C
  • diazepam
    • controlled substance: Schedule IV
    • pregnancy risk category D
  • caution: impaired liver or renal function
  • interact: CNS depression ↑ with alcohol, opioids, antihistamines
    • avoid concurrent use
40
Q

migraine meds

A
  • acute: not more than 2x/week
    • NSAIDs
    • acetaminophen
    • triptans
    • ergots
  • prophylactic: check for ↓ frequency, ↓ meds needed for acute
    • TCAs
    • anticonvulsants
    • beta blockers
    • estrogens
41
Q

triptans

A
  • contra: ischemic heart dz, liver failure, uncontroled HTN
  • do not give with other triptans or ergots
  • serotonin syndrome if given with SSRIs
42
Q

ergots

A

contra: renal or liver dysfunction, CAD, HTN, pregnancy (category X, use contraceptive)

43
Q

beta blockers

A
  • all names end in LOL
  • monitor for orthostatic hypotension
44
Q

lidocaine

A
  • local anesthetic
  • parenteral or topical
  • complications (↑ risk with systemic use)
    • hypotension - monitor VS and EKG
    • urinary retention
  • with epi
    • causes vasoconstriction
    • med stays local
    • controls bleeding
    • gangrene risk - avoid areas with end arteries (fingers, toes, penis, nose)
45
Q

neuromuscular blocking agents

A
  • succinylcholine, pancuronium
  • beyond RN scope
  • block ACh at neuromuscular junction
    • muscle relaxation
    • hypotension
    • paralysis
    • no loss of consciousness
    • no analgesic effect
  • use: help with intubation, control activity in ECT
  • must have airway and mechanical vent stat
  • reverse with neostigmine
  • monitor for return of repiratory function
46
Q

succinylcholine contraindications

A
  • pseudocholinesterase deficiency
  • hyperkalemia
  • risk for hyperkalemia (burn pts, multiple trauma)
  • family Hx of malignant hyperthermia
47
Q

malignant hyperpthermia

A
  • MH
  • genetic
  • reaction to succinylcholine
  • s/sx
    • fever up to about 109F
    • muscle rigidity
  • Tx
    • stop med
    • give 100% O2
    • cooling measures: iced IV, lavage, etc.
    • give dantrolene (muscle relaxant)
48
Q

IV anesthetics

A
  • additional training required for admin in anesthetic context
  • sedatives (non-opioid)
    • barbituates: phenobarbital sodium
    • benzodiazepines (pre-op, procedures)
      • midazolam
      • diazepam
      • lorazepam
    • propofol
    • ketamine
  • analgesics (opioid)
    • fentanyl
    • morphine
49
Q

administration of anesthetics

A
  • pt monitored continuously (1-on-1)
  • ACLS and training in sedation admin required
  • give slowly
  • after admin, make sure
    • VS return to baseline
    • pt oriented x4
    • voiding within 8 hr
    • N&V controlled
    • no driving
50
Q

pain-mediating chemicals

A
  • ↑ pain, inflammation
    • substance P
    • prostaglandins
    • bradykinins
    • histamine
  • ↓ pain, produce analgesia - bind with opioid receptors, inhibit conduction of pain impulses
    • serotonin
    • enkephalins
    • endorphins
51
Q

opioid receptors

A
  • mu
    • analgesia
    • euphoria
    • sedation
    • respiratory depression
    • physical dependence
  • kappa
    • analgesia
    • sedation
    • psychic effects, e.g. hallucinations, delusion
  • delta: no pharm-related effects
52
Q

inflammation

A
  • 2/2 injury
    • pain
    • inflammation
    • fever
    • edema
  • chemical mediators
    • bradykinins
    • histamine
    • prostaglandins
53
Q

ACTH

A

adrenocorticotropic hormone

54
Q

suppression of inflammation

A
  • hypothalamus → pituitary → ACTH
  • ACTH → adrenal glands → corticosteroids
    • cortisol
    • aldosterone
  • ↓ inflammation and immune response
55
Q

tramadol

A
  • class: centrally acting non-opioid
  • use: moderate pain
  • MOA
    • binds to opioid receptors
    • blocks norepinephrine and serotonin reuptake
  • SE
    • sedation
    • dizziness
    • headache
    • N&V
    • constipation
    • repiratory depression (rare)
    • seizures (rare, check for Hx)
    • urinary retention
56
Q

tramadol admin

A
  • monitor pts when ambulating
  • lowest possible dose, short-term
  • give with food
  • antiemetic if N&V
  • baseline VS, monitor RR
  • respiratory depression: stimulate breathing, naloxone (not super effective)
  • monitor for seizure, take precautions
  • monitor I/O for retention
  • onset: up to 1 hr
  • do not crush or chew extended-release
57
Q

tramadol pt education

A
  • don’t drive, etc.
  • sit or lie if lightheaded
  • change positions gradually
  • ↑ fluid and fiber
  • ↑ activity, exercise
  • take only PRN
  • report urinary retention
58
Q

tramadol contraindications and precautions

A
  • contra
    • acute intoxication
    • seizure disorders
    • respiratory depression
    • children < 16 yr
  • caution
    • substance abuse hx
    • liver or kidney dz
    • ↑ ICP
    • older adults
59
Q

interactions with tramadol

A
  • MAOIs - htn crisis
  • SNRI, TCA, MAOI, triptans: ↑ risk of serotonin syndrome
  • ↑ responses to CNS depressants
  • St. John’s wort: ↑ sedation
  • ↓ levels: carbamazepine
60
Q

anti-thrombin anticoagulants

A
  • indirect: inhibit thrombin and factor Xa
  • heparin (unfractionated)
  • enoxaparin (low-molecular-weight heparin)
  • fondaparinux
61
Q

vitamin K inhibitor

62
Q

direct thrombin inhibitor

A

dabigatran

63
Q

direct factor Xa inhibitors

A
  • rivaroxaban
  • apixaban
64
Q

contraindications and precautions for anti-thrombin drugs

A
  • heparin, enoxaparin, fondaparinux
  • contra
    • low platelets (thrombocytopenia)
    • uncontrolled bleeding
    • during or following eye, brain, spinal cord surgery; LP; or regional anesthesia
  • caution
    • hemophilia
    • PUD
    • severe HTN
    • liver or kidney dz
    • threatened abortion
65
Q

heparin

A
  • MOA: activates anti-thrombin, inhibits fibrin formation
  • use: evolving stroke, PE, massive DVT
  • adjunct Tx: open heart surgery, dialysis
  • prophylaxis: DVT prevention after hip/knee surgery
66
Q

anti-thrombin drug interactions

A
  • antiplatelets: aspirin, NSAIDs
  • other anticoagulants
  • nursing actions
    • avoid concurrent use
    • monitor for bleeding
    • avoid injury
    • limit venipuncture, injections
    • eval
      • heparin: aPTT 1.5-2x baseline (40-80 sec)
      • all anti-thrombin: no more or bigger thrombi or emboli
67
Q

hemorrhage signs

A
  • tachycardia
  • tachypnea
  • hypotension (later)
68
Q

signs of bleeding

A
  • bruising
  • bleeding gums
  • abd pain
  • nosebleed
  • coffee-ground emesis
  • tarry stool
  • petechiae
69
Q

warfarin

A
  • antagonizes vitamin K, prevents synthesis of 4 coagulation factors
  • uses
    • tx of venous thrombosis
    • tx of thrombosis formation in pts with A fib or prosthetic heart valve
    • prevention of recurrent MI, TIA, PE and DVT
70
Q

warfarin complications

A
  • hemorrhage - check vitamin K, give vitamin K if low; if continuing, give FFP or whole blood
  • hepatitis - notify provider, LFT
  • toxicity/overdose - give vitamin K
71
Q

nursing actions for hemorrhage

A
  • monitor VS
  • tell pt to check for s/sx of bleeding
  • baseline PT and monitor PT, INR
  • overdose: D/C warfarin, give vitamin K
72
Q

INR

A
  • international normalized ratio
  • WHO standard for reporting clotting test results
  • test every 4 wks for warfarin
73
Q

hepatitis

A
  • liver inflammation
  • labs: liver function test/enzymes
  • signs: jaundice, RUQ pain, N&V, dark urine
74
Q

administering vitamin K

A
  • give slowly in diluted solution to prevent anaphylactoid reaction
  • does not control bleeding; give FFP or whole blood
75
Q

warfarin contraindications, precautions

A
  • contra
    • pregnancy risk category X (fetal hemorrhage, death, CNS defects); use heparin instead
    • thrombocytopenia
    • uncontrolled bleeding
    • during/after surgeries for eyes, brain, spinal cord; LP; regional anesthesia
    • vitamin K deficiency
    • liver disorder
    • alcohol use disorder (↑ bleeding risk)
76
Q

warfarin interactions

A
  • ↑ effect:
    • heparin
    • aspirin
    • NSAIDs
    • acetaminophen
    • glucocorticoids
    • sulfonamides
    • parenteral cephalosporins
  • ↓ effect:
    • carbamazepine
    • phenytoin
    • phenobarbital
    • oral contraceptives
    • vitamin K
    • foods high in vitamin K
77
Q

warfarin administration

A
  • orally once daily at the same time
  • monitor PT (18-24 sec) and INR (depends on use)
  • notify provider if levels exceed therapeutic range
  • baseline and monitor CBC (platelet and hct)
  • onset: 8-12 hr
  • full effect: 3-5 days
  • in hospital: continue heparin drip when starting warfarin PO

2020 Pharmacology I (21 decks)

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