(incomplete)Drug Slides - Week 2 - Exam 1

Question 1

Morphine: Opioid Agonist

Answer 1

trade name: Astramorph PF, Duramorph

therapeutic class: opioid analgesic

pharmacologic class: opioid receptor agonist

pharmacokinetics:
onset: less than 60 minutes
peak:
- PO: 60 minutes
- Rectally: 20-60 min.
- SQ: 50-90 min
- IM: 30-60 min
- IV: 20 min
duration: up to 7 hours

actions and uses:
morphine binds with both mu and kappa receptor sites to produce PROFOUND analgesia. It causes euphoria, constriction of pupils, and stimulation of cardiac muscle. It is used for symptomatic relief of series ACUTE and CHRONIC pain AFTER nonnarcotic analgesics have failed

administration alerts:
- oral solution may be given sublingually
- causes peripheral vasodilation which results in orthostatic hypotension

adverse effects:
- may cause dysphoria (restlessness, depression, anxiety, itching), respiratory depression, cardiac arrest.
- tolerance develops, cross- tolerance also develops between morphine and other opioids such as heroin, methadone.
- physical and psychological dependence

BLACK BOX WARNING:
- when admin as epidural drug patient must be observed for 24 hours
- ER tablets have abuse liability
- Schedule 2
- No alcohol
- failure to follow warnings may lead to fatal respiratory depression

contraindications:
- may intensify or mask the pain of gallbladder disease.
- avoid in cases of acute asthma, GI obstruction, and severe hepatic or renal impairment

treatment of overdose:
- IV admin of naloxone
- activated charcoal, laxative, a counteracting narcotic antagonist

drug-drug:
several, e.g., concurrent use of CNS depressants such as alcohol, other opioids, general anesthetics, sedatives, antidepressants

Question 2

Nalaxone: Opioid Antagonist

Answer 2

therapeutic class: drug for the treatment of acute opioid overdose and misuse

pharmacologic class: opioid receptor antagonist

pharmacokinetics:
onset:
- IV: 1-2 min
- IM: 2-5 min
- SQ: 2-5 min
peak: 5-15 min
duration: 45 min

actions and uses:
pure opioid antagonist, blocking both mu and kappa receptors.
used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected.
it will immediately cause opioid withdrawal symptoms in patients physically dependent on opioids

** approved prescription to be used by family members or caregivers to treat a person known or suspected to have had an opioid overdose
- Evizio (naloxone SQ injection)

administration alerts:
admin for a RR of fewer than 10 breats/min, keep resuscitative equipment close

interactions:
drug-drug - reversal of analgesic effects of opioid agonists
herbal-food - echinacea may increase risk of liver toxicity

treatment of overdose:
naloxone overdose requires use of oxygen, iv fluids, vasopressors, etc

adverse effects:
minimal toxicity
**however, reversal of the effects of opioids may result in rapid loss of analgesia, increased BP, tremors, hyperventalation, nausea, vomiting

BLACK BOX WARNING:
none
**HOWEVER, naltrexone, a similar opioid receptor antagonist has the capacity to produce hepatic injury when taken in excessive doses

contraindications:
should not be used for respiratory depression caused by nonopioid medications

Question 3

NSAID - Aspirin - Salicylates

Answer 3

prototype drug: aspirin

therapeutic class: nonopioid analgesic; NSAID (nonsteroidal anti-inflammatory drug); antipyretic; anticoagulant

pharmacologic class:
salicylate; cyclooxygenase (COX) inhibitor

pharmacokinetics:
onset: 1 hour
peak: 2-4 hours
duration: 24 hours

action and uses:
aspirin inhibits prostaglandin synthesis involved in the processes of pain and inflammation and produces mild to moderate relief of fever. It has limited effects on peripheral blood vessels, causing vasodilation and sweating.
aspirin has SIGNIFICANT anticoagulant activity, which reduces the risk of mortality following MI and reduces incidence of strokes.

administration alerts:
- platelet aggregation inhibition caused by aspirin is irreversible. aspirin should be discontinued 1 week prior to surgery.

contraindications:
aspirin increases bleeding time, it should not be given to patients receiving anticoagulant therapy such as warfarin and heparin

adverse effects:
- at high doses, used to treat severe inflammatory disorders, aspirin may cause gastric discomfort and bleeding because of its antiplatelet effects
- enteric coated tab are availiable to patients who experience gi side effects

drug-drug:
Concurrent use of phenobarbital, antacids, and glucocorticoids may decrease aspirin’s effects. Aspirin may potentiate the action of oral
hypoglycemic drugs. Effects of N SAIDs, uricosuric drugs such as probenecid, beta blockers, spironolactone, and sulfa drugs may be decreased
when combined with aspirin. Insulin, methotrexate,
phenytoin, sulfonamides, and penicillin may increase
effects. When aspirin is taken with alcohol, pyrazolone derivatives, steroids, or other N SAIDs, there is an increased risk for gastric ulcers.

lab tests:
aspirin may cause prolonged prothrombin time by decreasing prothrombin production.

Question 3

Sumatriptan - Imitrex

Answer 3

therapeutic class: antimigraine drug

pharmacologic class: triptan; 5-HT (serotonin) receptor drug, vasoconstrictor of intracranial arteries

pharmacokinetics:
onset:
- Nasal: 15 min
- PO: 30 min
- SQ: 10 min
peak:
- Nasal: 60-90min
- PO: 2 hr
- SQ: 12 min
duration:
24-48 hours

actions and uses:
- newer group of drugs called triptans
- act by vasoconstriction of cranial arteries

administration alerts:
- may cause cardiac ischemia
- sumatriptan is a systemic vasoconstrictor, may cause hypertension
- monitor LOC and observe for seizures

adverse effects:
dissy, drowsy, warming sensation

SERIOUS adverse effects:
CORONARY ARTERY VASOSPASM, MI, CARDIAC ARREST

contraindications:
- again, vasoconstrictor! should be used cautiously or not at all, in patients with recent MI
- serious renal or hepatic impairment

interactions:
drug-drug: several, increased effect may occur with SSRIs