First Test Flashcards
Blood brain barrier
Only lipid soluble drugs cross the barrier, the blood brain barrier is relatively in peneturable, usually protective
I Can PresCribE A Drug
Indication Contraindications Precautions Cost/compliance Efficacy Adverse effects Dose/duration/direction
Controlled substance schedule I
No accepted medical use
No legal use permitted
For registered research facilities only
Ie- heroin, lsd, marijuana
Controlled substance II
No refills permitted
Written prescriptions only no telephone orders
Prescriptions expire 72 hours if not filled
Ie- narcotic, stimulants- cocaine, amphetamine, methylphenidate
Depressants- pentobarbital, secobarbital
Controlled substance III
Prescriptions must be rewritten after 6 months or 5 refills- telephone prescriptions accepted
Ie- narcotics and stimulants
Controlled substances IV
Same as III, penalties for illegal possession are different
Controlled substances V
Same as all prescription drugs may be dispensed without a prescription unless regulated by the state
Ie- loperamide, diphenoxylate
Adverse drug reaction
An adverse drug reaction is any undesirable or unintended effect occurring after administration of a medical product
What are the two types of adverse drug reactions
Pharmacological which is 85% of 90% of adverse drug reactions and idiosyncratic or unpredictable
Type one allergic response
Type two allergic response
Tape three allergic response
Type 4allergic response
Pain involves the interactions of three major systems
Sensory/discriminative
Motivational/affective
Cognitive/ evaluative
Pain threshold
The point at which that stimulus is experienced as pain it differs from person to person
Pain tolerance
The duration of time or the intensity of pain that a person will endure before taking over action to relieve the pain. Decreases with repeated exposure to pain. Decreased by fatigue anger fear and sleep deprivation
Acetaminophen
Action: Work centrally in the central nervous system to inhibit prostaglandin. Used for mild to moderate pain. Safer than NSAIDs for most. Safe in pregnancy is. Save an infant. Safe and most older adults
Cox inhibitors
NSAIDS- ketorolac, naproxen, ibuprofen
Salicylates: aspirin
COX-2 inhibitors- celecoxib (celebrex)
NSAIDS
Action is to inhibit proto Landon formation. Used for fever pain inflammation anti platelet. Not all have the same action
Avoid NSAIDs in pregnancy older adults in renal dysfunction. True or false
True
Drug interactions for NSAIDs are
Alcohol, anticoagulants, and antiplatelets
Salicylates aspirin
Action is to inhibit prostaglandin formation. It is used for fever pain inflammation and anti-platelet
Adverse drug reactions for aspirin include
G.I. upset abdominal pain G.I. bleed renal impairment and tinnitus
Celebrex or Cox – 2inhibitors
Action is to inhibit prostaglandin formation it is used for pain, and information
Celebrex is used with caution in patients with
Congestive heart failure, hypertension, and fluid retention
Phase 1 assessment for prescribing pain medication
Begin with a chief complaint that identifies the impact of the pain. Sleep disturbances, secondary physical problem, anxiety, depression, cognitive disorders, stress and functional disabilities. He was a pain scale. Use non-pharmacological strategies. Refer to the state board of pharmacy prescription drug monitoring program report
Phase 2. Trial of an opioid
Non-opioid therapy is preferred. Prior to initiating therapy sign the patient provider agreement and the informed consent form. Set realistic goals. Start with immediate release opioid when starting therapy. Start low, and go slow. Consider naloxone prescription
Phase 3. Long-term treatment.
End of trial and onto chronic management. Patient has satisfactory pain relief. Patient can manage ADLs. There are consistent pain scores unreliable skills. There are no misuses. There are no legal issues or incarcerations. Patient is not relocating.
Phase 4. Termination of chronic opioid treatment.
Play some ethical decision making, driven by practice policies, and discussions and decisions are documented. Minimization withdrawal symptoms. Abrupt sensation can lead to seizures or withdrawal symptoms examples are nausea diarrhea muscle pain and myclonus
