Final Exam Study Guide- Meds Flashcards
What are the prototypes of first generation NSAIDs?
aspirin and ibuprofen
What class are first generation NSAIDs?
COX-1 and COX-2 inhibitors
What is the pharmacologic action of first generation NSAIDs?
inhibit the action of COX-1 and COX-2 which stimulates the release of prostaglandins
What are adverse reactions of first generation NSAIDs?
- gastric upset
- heartburn nausea
- gastric ulceration
- bleeding tendencies
- renal dysfunction
- increased thromboembolic events
- aspirin toxicity
- Reye’s syndrome
What are interventions for first generation NSAIDs?
- monitor for signs of bleeding such as dark stool, hematemesis, bruising, and excessive bleeding from minor injury such as shaving
- monitor I/O, creatinine, BUN
- assess for signs of toxicity such as tinnitus, dizziness, headache, diaphoresis, and tachypnea
- use acetaminophen instead of aspirin for children under 18 yo
What is the correct administration of first generation NSAIDs?
- swallow
- do not crush or chew enteric coated or sustained release
- avoid alcohol
- take with food, milk, or water
What are contraindications of first generation NSAIDs?
- teratogenic
- peptic ulcer disease
- hemophilia
- vitamin D deficiency
- current diagnosis of chickenpox or flu
- older adults
- smokers
- alcohol use disorders
- impaired kidney function
- heart failure
- hypertension
- helicobacter pylori
What are precautions for first generation NSAIDs?
discontinue a week before surgery
What are interactions of first generation NSAIDs?
- use of aspirin with anticoagulants
- glucocorticoids and alcohol increase risk for bleeding
- use with ACE inhibitors and angiotensin receptor blockers increase risk of renal failure
- toxicity of lithium carbonate and methotrexate
What is the prototype of second generation NSAIDs?
celecoxib
What is the class of second generation NSAIDs?
COX-2 inhibitors
What is the pharmacologic action of 2nd generation NSAIDs?
inhibit the action of COX-2 which stimulates the prostaglandins
What are adverse reactions of 2nd generation NSAIDs?
- renal dysfunction
- increased thromboembolic events
- cardiovascular events
What are interventions for 2nd generation NSAIDs?
- monitor for signs of bleeding such as dark stool, hematemesis, bruising, and excessive bleeding from minor injury such as shaving
- monitor I/O, creatinine, BUN
- assess for signs of myocardial infarction and cerebrovascular accident
What is the correct administration of 2nd generation NSAIDs?
- take 2 hours before or after magnesium or aluminum based antacids
- take with food, milk, or water
What are contraindications of 2nd generation NSAIDs?
- teratogenic
- children under the age of 18
- alcohol use disorders
- impaired kidney or liver function
- heart failure
- hypertension
- Helicobacter pylori
- allergy to sulfonamides
What are precautions to 2nd generation NSAIDs?
- changes in weight gain
- signs of fluid retention, such as edema and bloating
What are interactions of 2nd generation NSAIDs?
- use with furosemide decreases its diuretic effect and decreases the effect of antihypertensives
- increases the effect of warfarin and lithium levels increasing the chance of toxicity
- glucocorticoids and alcohol increase the risk of bleeding
What is the prototype of acetaminophen?
acetaminophen
What class is acetaminophen?
nonopiod analgesic
What is the pharmacologic action of acetaminophen
inhibit the action of COX-1 and COX-2 but is limited to the CNS, therefore relieves pain and reduces fever but does have anti-inflammatory or anti-coagulant effects
What are some adverse reactions of acetominophen?
liver damage with toxic doses and hypertension when taken daily
What are some interventions for acetaminophen?
- Monitor for signs of overdose or poisoning such as abdominal discomfort, nausea, vomiting, sweating and diarrhea
- Monitor blood pressure if taking on a regular basis.
What is the correct administration of acetaminophen?
- do not take more than 4 g in 24 hours
- Often is found in combination cold and flu products so be careful reading labels
What are contraindications of acetaminophen?
alcoholism
What are precautions for taking acetaminophen?
- anemia
- immunosuppression
- liver or kidney disease
What are interactions of taking acetaminophen?
- increases risk of bleeding when also taking warfarin
- if reduced absorption when taking cholestyramine
What is the prototype of centrally acting nonopioids?
tramadol
What is the class of centrally acting non opioid?
centrally acting non opioid
What is the pharmacologic action of centrally acting non opioids?
binds to selected opioid receptors and blocking reuptake of of norepinephrine and serotonin in the CNS
What are adverse reactions of centrally acting non opioids?
rare but include:
- sedation and dizziness
- headache
- nausea
- constipation
- seizures
What are interventions for centrally acting non opioids?
- monitor during ambulation
- vital signs particularly respiratory rate
- seizure activity
- urinary retention
What is the correct administration of centrally acting nonopiods?
- effects typically not felt until an hour after administration
- swallow extended release do not chew or crush
What are some contraindications for centrally acting non opiods?
- alcoholism
- taking opioids or psychotropics
- seizure disorders
- respiratory depression
- under the age of 12
- liver or kidney disease
- increased intracranial pressure
What are precautions for taking centrally acting non opioids?
- avoid taking before driving or performing activities
- change positions slowly
What are interactions of taking centrally acting non opioids?
- taking with MAOIs increased risk for hypertensive crisis
- increases effects of CNS depressants
- taking with St. Johns wort increases its sedative effects
What is the prototype of opioid agonists?
morphine
What class are opioid agonists?
opioid agonists
What is the pharmacologic action of opioid agonists?
mimics naturally occurring opioids, endorphins, and enkephalins by binding with the mu receptors
What are some adverse reactions of taking opioid agonists?
- respiratory depression
- sedation
- dizziness
- lightheadedness
- drowsiness
- constipation
- orthostatic hypotension
- high potential for abuse
What are some interventions for taking opioid agonists?
- monitor vital signs particularly respiration rate and oxygen saturation
- if RR less than 12 hold medication and consider administering naloxone
- monitor for constipation
- urinary retention
- dependence
What is the correct administration of opioid agonists?
- orally, intramuscularly, intravenously, subcutaneously, rectally, or epidurally
- have naloxone and resuscitation equipment readily available
What are contraindications for taking opioid agonists?
- pregnant women because it can cause newborn respiratory depression or neonatal withdrawal syndrome
- renal failure
- increased intracranial pressure
- biliary surgery
What are precautions for taking opioid agonists?
- avoid taking before driving or performing activities
- change positions slowly
What are interactions of taking opioid agonists?
- interact with CNS depressants causing increased CNS suppression
- anticholinergics: increases risk for constipation and urinary retention
- taking with MAOIs increases risk for hyperpyrexic syndrome
- taking with St. John’s wort increases its sedative effects
What are the prototypes of opioid agonists-antagonists?
butorphanol and pentazocine
What class are opioid agonists-antagonists?
opioid antagonists
What is the pharmacologic action of opioid agonists-antagonists?
mu receptors antagonists and kappa receptor agonists
What are adverse reactions of opioid agonists-antagonists
- respiratory depression and sedation
- dizziness
- lightheaded
- drowsiness
- headache
- nausea
- increased cardiac workload
What are interventions for opioid agonists-antagonists?
- ask if they are taking an opioid before administering as it can precipitate withdrawal symptoms
- monitor vital signs particularly respiratory rate and oxygen saturation
- if RR less than 12 hold medication
What is the correct administration of opioid agonists-antagonists
intramuscularly, intravenously, intranasally
What are contraindications for taking opioid agonists-antagonists?
- acute myocardial infarction
- renal or liver disease
- increased intracranial pressure
- cardiac insufficiency
- hypertension
What are precautions of taking opioid agonists-antagonists?
- avoid taking before driving or performing activities
- change positions slowly
What are interactions of taking opioid agonists-antagonists?
- interact with CNS suppressants causing increased CNS suppression
- if given with opioids will decrease the effect of the opioid
What is the prototype of opioid antagonists?
naloxone
What is the class of opioid antagonists?
opioid antagonists
What is the pharmacologic action of opioid antagonists?
block opioid receptors reversing or antagonizing the effects of opioids
What are adverse reactions of opioid antagonists?
ventricular arrhythmias and abstinence syndrome in opioid dependent including hypertension, vomiting, and tremors
What are interventions for opioid antagonists
- closely monitor for dangerous elevations in blood pressure and abnormal heart rhythms
What is the correct administration of opioid antagonists?
intramuscularly, intravenously, or subcutaneously
What are contraindications of opioid antagonists?
- acute myocardial infarction
- renal or liver disease
- increased intracranial pressure
- cardiac insufficiency
- hypertension
What are precautions for opioid antagonists?
- caution in use on cardiac irritability
- head injury with increased intracranial pressure
- brain tumor
- seizure
What are interactions for opioid antagonists
will decrease the effect of opioids
What is the prototype of antiuricemics?
allopurinol
What is the class of antihyperuricemics
antigout/antihyperuricemic
What is the pharmacologic action of antihyperuricemics?
inhibit the conversion of hypoxanthine and xanthine into uric acid and inhibit the reabsorption of uric acid by the kidneys promoting excretion
What are adverse reactions of antihyperuricemics?
- generally tolerated well but some may experience hypersensitivity syndrome
- liver and kidney dysfunction
- GI disturbances
- bone marrow depression
- metallic taste in mouth
- cataracts if taken for an extended period of time
What are interventions for antihyperuricemics
- monitor for hypersensitivity syndrome if taking greater than 2-4 weeks
- monitor kidney and liver function and CBC
- give after meals if GI disturbance occur
- visit opthamologist regularly
What is the correct administration of antihyperuricemics?
- Orally or intravenously
- Tablets can be crushed and mixed with fluid or food
- drink at least 3 L of fluid daily
What are contraindications for antihyperuricemics
- bone marrow depression
- liver or kidney disease
- peptic ulcers
- lower GI tract diseases
What are precautions for antihyperuricemics
minimize exposure of eyes to bright sunlight
What are interactions of antihyperuricemics
- increases the anticoagulant effect of warfarin
- increase risk of toxicity if taken with mercaptopurine, theophylline, and azathioprine
- increases risk for rash if taken with ampicillin
What is the prototype of glucocorticoids?
prednisone
What class are glucocorticoids
glucocorticoids
What is the pharmacologic action of glucocorticoids
mimic cortisol by suppressing inflammation and the immune response resulting in decreasing pain and swelling
What are adverse reactions of glucocorticoids
- hyperglycemia
- myopathy
- peptic ulcer disease
- GI distress
- bone loss
- cataracts
- increased risk for infection
what are interventions for glucocorticoids
- monitor hypertension and fatigue
- monitor glucose levels
- observe for sign of infection
monitor I/O - monitor edema and weight gain
What is the correct administration of glucocorticoids
orally, intramuscularly, intravenously, subcutaneously, topically, intranasally or inhalation. Start with larger doses and progressively decrease doses. Do not stop abruptly.
What are contraindications of glucocorticoids
systemic fungal infection, cataracts, heart failure, peptic ulcer disease, diabetes, hypertension, renal dysfunction, myasthenia gravis and osteoporosis.
What are precautions for glucocorticoids
long term effects even if given for a short period of time
What are interactions of glucocorticoids
prevent the body from responding appropriately to vaccines. Increased risk of hypokalemia if taking furosemide. Increased risk of dysrhythmias when taking digoxin. Increased risk of GI bleed and ulceration if also taking NSAIDs and effects of insulin and oral hypoglycemics decreased
