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Pharm > Exam One Review Sheet > Flashcards

Exam One Review Sheet Flashcards

1
Q

What are other drugs in the same class as Morphine

A 
fentanyl
hydromorphone (Dilaudid)
levorphanol
meperidine (Demerol)
Methadone
oxycodone (Percodan, Percocet)
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2
Q

Morphine is considered what kind of opioid?

A

Strong Narcotic Agonist

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3
Q

fentanyl is ______ times more potent than morphine.

A

80-100%

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4
Q

Mechanism of Action of morphine

A
  • occupies mu and kappa in brain and dorsal horn of SC
  • decreased release of neurotransmitters in presynaptic space
  • Results in hyperpolarization of post synaptic dorsal horn neurons
  • Prevent transmission of nociceptor pain
  • Decreased relsear of substance P - modulates pain perception
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5
Q

Indications for morphine

A

Moderate to severe pain

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6
Q

Metabolism of morphine happens in the __________

A

Liver

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7
Q

Elimination of morphine is through the __________

A

Feces (PO)

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8
Q

Onset of morphine

A

15-30 minutes

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9
Q

Duration of morphine

A

3-7 hrs

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10
Q

Contraindications of morphine

A

Head injury patients (masks signs and symptoms)
Patients on other CNS depressants
Elderly may need dose reduction
Prostate patients due to urinary retention

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11
Q

Adverse Effects of morphine

A

CNS: Mood change, lethargy, delirium, euphoria, pupillary constriction
Respiratory: Decrease RR, Resp arrest, apnea
CV: hypotension, bradycardia, cardiac arrest, shock, coma
GI: N/V, constipation
GU: Urinary retention
Histamine: Itching and hives

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12
Q

Drug interactions with morphine

A

Hepatically cleared drugs: H2 Blockers, barbituates, warfarin
CNS depressants: ETOH

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13
Q

What type of opioid is codeine?

A

Mild Narcotic agent

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14
Q

What other drugs are in the same class as codeine?

A

hydrocodone (Vicodin)

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15
Q

Codeine is _____ as potent as morphine

A

1/6

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16
Q

Mechanism of action of codeine

A

Similar to morphine
acts on opioid receptors in CNS to prduce analgesia, euphoria, and sedation
Acts on medullary cough center to depress cough reflex
Drying effects on mucous membranes

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17
Q

Indications for codeine

A

Mild to moderate pain

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18
Q

Metabolism of codeine happens in the ________

A

Liver

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19
Q

Elimination of codeine happens in the __________

A

Kidneys

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20
Q

Onset of codeine

A

15-30 min

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21
Q

Duration of codeine

A

3-7 hours

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22
Q

Contraindications of codeine

A

Pre/post op patients who need to cough and deep breathe
CVA patients
Resp patients

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23
Q

Adverse effects of codeine

A 
Similar to morphine
Dry mouth
Drowsiness
Sedation
Depress cough reflex
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24
Q

Drug interactions with codeine

A

Other CNS depressants

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25
Q

True or false: Codeine is safer for brain injury patients than morphine

A

True: Doesn’t depress the CNS as much or mask s/s of brain injury

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26
Q

What kind of opioid is pentazocine (Talwin)?

A

Narcotic Agonist

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27
Q

What other drugs are in the same class as pentazocine (Talwin)?

A

buprenophine (Bupranex)
butorphanol (Stadol)
nalbuphine (Nubain)

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28
Q

Mechanism of action of pentazocine (Talwin)

A

Mixed opioid effects
Agonist at some receptors and antagonist at other receptors
Get opioid effect without over doing it.

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29
Q

Indications for pentazocine (Talwin)

A

Moderate to severe pain

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30
Q

pentazocine (Talwin) is metabolized in the ________

A

Liver

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31
Q

pentazocine (Talwin) is eliminated through the _____

A

Kidneys

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32
Q

Onset of pentazocine (Talwin)

A

15-30 min

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33
Q

Duration of pentazocine (Talwin)

A

3-7 hours

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34
Q

Contraindications of pentazocine (Talwin)

A

Resp depression patients

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35
Q

Adverse effects of pentazocine (Talwin)

A 
Withdrawl effects in unknown addicts
Resp depression
Circulatory depression
N/V
Dizziness
Lightheadedness
Euphoria
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36
Q

Drug interactions with pentazocine (Talwin)

A

Other CNS depressants

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37
Q

True or false: pentazocine (Talwin) is used in patients with hx of addiction

A

True

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38
Q

Street name for pentazocine (Talwin)

A

T’s and blues

39
Q

naloxone (Narcan) is what kind of opioid?

A

Opioid Antagonist

40
Q

What other drugs are in the same class as naxolone (Narcan)?

A

naltrexone (Revia)

41
Q

Mechanism of Action of naloxone (Narcan)

A

High affinity for opioid receptor but produce no effect

OPIOID OD ANTIDOTE

42
Q

Indications for naloxone (Narcan)

A

Opioid antidote

43
Q

naloxone (Narcan) onset

A

When given IV 2-5 minutes

44
Q

naloxone (Narcan) duration

A

Short half life

45
Q

naloxone (Narcan) adverse effects

A

HTN, N/V, Sweating, Tachy, tremors

46
Q

Narcan has a short half life therefore….

A

drug may wear off before narcotic and require multiple doses

47
Q

With Narcan, Assess and monitor __________

A

Vital signs frequently

48
Q

True or false: With Narcan have resuscitation equiptment near by

49
Q

Prototype for Salicylates

50
Q

Other drugs in the same class as Aspirin

A

diflunisal

salsalate

51
Q

Mechanism of action of aspirin

A

Non-selective COX inhibitor

  • anti-pyretic (hypothalamus)
  • anti-inflammatory (inhibits prostaglandin synthesis)
  • analgesic (inhibits COX 2 and decrease prostaglandins which sensitize pain receptors
  • antiplatelet (irrevesible inhibition prostaglandin = decrease platelet aggregation
52
Q

Indications for aspirin

A

Fever (adults only)
Pain
Inflammation
Arthritis

53
Q

Absorption of Aspirin

A

30 minutes
Mostly absorbs in the small intestines
Suppositories absorb slower

54
Q

Distribution of aspirin

A

Highly protein bound
Onset = 30 min
Inflammatory response takes weeks
T 1/2 = 1.5 to 50 hours

55
Q

Aspirin is metabolized in the __________

56
Q

Aspirin is excreted through the _________

57
Q

Contraindications of Aspirin are:

A

Peptic ulcers or other bleeding disorders
Anti-coagulation treatment
Gout (increase uric acid, renal or liver patients)
Kids with fever or flu sx = Reye’s Syndrome
Smokers and ETOH patients = decreased gastric mucosa = increase GI bleed

58
Q

Adverse effects of aspirin

A 
GI: ulcers, bleeding
Sedation, confusion
Rash, fever
Tachy
Acute bronchospasm
Renal impairement, Na & H20 ret.
HA, dizziness
Tinnitus
59
Q

Aspirin drug interactions

A

Anticoagulants and antiplatelets = increase bleeding

Metabolism of digoxin, phenytoin, cyclosporine, fluconazole

60
Q

Pregnancy category for Aspirin

A

1st and 2nd Trimester = C

3rd trimester = D

61
Q

Aspirin Hypersensitivty

A

Tinnitus
Vertigo
Bronchospasm

62
Q

Aspirin Toxicity

A

Salicylism
-Occurs with long term or high dose tx
S&S: HA, Tinnitus, GI Distress, Resp stim (Increase CO2 loss = alkalosis), drowsiness, confusion

63
Q

Aspirin Poisoning

A 
Life threatening, 
Adult 20-25 g
Peds 4 g
S/S same as toxicity but occur quicker
No antidote
Tx with gastric suctioning (NG), charcoal to induce vomiting & life support
64
Q

Drug prototype of Prostaglandin Synthetase inhibitors

A

Ibuprofen (Advil, Motrin)

65
Q

Other drugs in the same class as ibuprofen (Advil, Mortim)

A 
Propionic acids
-fenoprofen
-naproxen (Aleve)
-fetoprofen
Acetic Acids
-indomethacin (Indocin)
-ketorolac (Toradol)
66
Q

Mechanism of Action of ibuprofen

A

Non-selective COX inhibitor
SAME AS ASPIRIN
Anti-pyretic (Hypothalamus)
Anti-inflammatory (Inhibits prostaglandin synthesis)
Analgesic (Inhibits COX 2 and decrease prostaglandins which sensitize pain receptors)
Anti-platelets (irreversible inhibition prostaglandin = decrease platelet aggregation

67
Q

Indications for ibuprofen

A

Same as aspirin

Fever, Pain, Inflammation, Arthritis

68
Q

Absorption of ibuprofen

A 
Mostly GI
Slower with food
Analgesic and anti-pyretic effects with in 2-4 hours
Anti-inflammatory = days to weeks
Highly protein bound
69
Q

Distribution of ibuprofen

A

Highly protein bound
Onset = 30 min
Inflammatory response takes weeks
T 1/2 = 1.5-50 hours

70
Q

Metabolism of ibuprofen

71
Q

Excretion of ibuprofen

72
Q

Contraindications of Ibuprofen

A

Ulcer or bleeding disorder
Heart pts (Increase risk MI/CVA)
HTN pts
Renal Patients

73
Q

Adverse effects of ibuprofen

A

GI: Ulcers, bleeding
HTN
Decreased renal blood flow = renal toxicity
Vision change

74
Q

Drug prototype for selective COX 2 inhibitor

A

celecoxib (Celebrex (Rx)

75
Q

Mechanism of Action of celecoxib (Celebrex)

A

Selective COX 2 inhibitor

Inhibits prostaglandin synthesis

76
Q

Indications for celecoxib (Celebrex)

A

Arthritis

Dysmenorrhea

77
Q

Absorption of celecoxib (Celebrex)

A

1-2 weeks for anti-inflam response

78
Q

celecoxib (Celebrex) is metabolized in the ________

79
Q

celecoxib (Celebrex) is excreted through the ____

80
Q

Drug interations with celecoxib (Celebrex)

A

Ace inhibitors

Coumadin = Increase INR

81
Q

Pregnancy category or celecoxib (Celebrex)

A

1st and 2nd trimester: C

3rd trimester: D

82
Q

Drug prototype for Para-aminophenol derivatives

A

Acetaminophen (Tylenol)

83
Q

Mechanism of Action of acetaminophen (Tylenol)

A

Reversible COX inhibitor in periphery
anti-pyretic (hypothalamus)
Inhibits action of chemical that causes vasodilation and sweating
Pain: unk. MOA
ON ANTI-INFLAM EFFECT OR PLATELET AGGREGATION INHIBITION
Does not decrease kidney function
Does not change gastric mucosa (ok for GI ulcer pts.

84
Q

Indications for acetaminophen

A

Fever
Mild to mod pain
PEDS
PG women

85
Q

Absorption of acetaminophen

A

Rapid and completely absorbed orally

86
Q

Distribution of acetaminophen

A

Onset: 30 min
Peak: 1-2 hrs
Duration: 4 hours

87
Q

Metabolism of acetaminophen

A

Liver (Hard on the liver)

88
Q

Excretion of acetaminophen

89
Q

Contraindications of acetaminophen

A

Liver pts
Viral hepatitis
ETOH pts (Will increase hepatotoxicity)
Anemia (will exacerbate anemia

90
Q

Adverse effects of acetaminophen

A

RARE

Rash, Uticaria, Nausea, Fever, Neutropenia (CA pt), Thrombocytopenia, Jaundice

91
Q

Pregnancy category for acetaminophen

A

Ok for PG and lactating women

92
Q

Acetaminophen toxicity

A

Signs and Symptoms: Anorexia, N/V, Pallor, Abd Discomfort (RUQ), Jaundice (Later stage)

93
Q

Acetaminophen Overdose

A

Can be fatal
Partially metabolized into a toxic metabolite that body converts to a non-toxic form with glutathione
In OD, GLUTATHIONE is quickly depleted
Accum of toxic metabolite occurs = liver damage

94
Q

Acetaminophen Poisoning

A

ACETYLCYSTEINE is the antidote

Activated charcoal also used to induce vomiting

Pharm (11 decks)

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