Lecture 1 Flashcards
1
Q
Prototype for Salicylates
A
Aspirin (ASA)
2
Q
Mechanism of action for aspirin?
A
Inhibits prostaglandins
Stop synthesis of thromboxane A2 = decreased platelets
3
Q
When would you use aspirin
A
Mild moderate pain relief
Cardiac risk reduction
From graph
Antipyretic (adults only)
Osteoarthritis
4
Q
Aspirins cardiac risk reduction is associated with what dosage?
A
81 mg
5
Q
Aspirins pain relief is what dosage?
A
Higher dosages.. 325 mg aprox every 6 hours.
6
Q
What is the risk when you decrease platelets
A
Increasing the risk of bleeding
7
Q
Side effects of aspirin?
A
- GI bleeding *
Toxicity, salicylism
Not for children under 18
Reye’s syndrome
8
Q
What is Reye’s syndrome?
A
A form of potentially fatal encephalopathy
9
Q
If I child needs pain relief what should we give them?
A
Ibuprofen or Tylenol
10
Q
Nursing consideration of aspirin
A
Give with food to help decrease GI irritation that could possible lead to GI bleeding
Avoid near surgeries
2 weeks before and after
11
Q
How do you handle overdose of aspirin?
A
Gastric lavage ( aka stomach pump)
Activated charcoal
Hemodialysis
12
Q
What are the signs of bleeding?
A
Petechiae ( tiny purple or red spots under the skin)
Bruising
for GI bleeding.. black or tarry stool,
Vomiting blood
13
Q
What is salicylism
A
toxicity associated with chronic use of aspirin
14
Q
Signs of salicylism
A
Tinnitus (ear ringing)
Dizziness
Difficultly hearing
Confusion
15
Q
What drug class is acetaminophen
A
non narcotic analgesic antipyretic
16
Q
Routes for acetaminophen
A
PO - Tylenol
IV- Ofirmev
17
Q
Mechanism of action for acetaminophen
A
Acts on hypothalamus directly to cause its therapeutic uses of reducing fever.
18
Q
Uses for acetaminophen
A
Reduce fever
Mild pain relief
19
Q
Side effects for acetaminophen
A
Hepatotoxicity
If someone has pre existing liver problems than the dose may need to be lowered
Can be toxic for alcohol abusers
From graph:
Renal failure
alternative to NSAIDs due to lack of GI effects
20
Q
Nursing considerations for acetaminophen
A
Max 4g daily
It’s an aspirin substitute
Easy to confuse dosing.. meaning easy to exceed by accident with OTC
Antidote is acetylcysteine
Signs of toxicity is jaundice
Don’t confuse children’s dose with infant dose!
21
Q
What are the first generation NSAIDs
A
They are non selective and blocks both COX 1 and COX 2 enzymes
Propionic acid derivatives
Oxicam derivatives
Acetic acid derivatives
22
Q
What are the second generation NSAIDs
A
They are selective and they only block COX 2 enzymes
Celecoxib (only one in US market)
23
Q
What is a prototype for propionic acid
A
Ibuprofen
(Motrin, advil)
24
Q
What is MOA for ibuprofen
A
Blocks COX 1 and COX 2
25
Uses for ibuprofen
Mild- moderate pain relief
Fever reduction
Treat inflammation from arthritis
Treat initial gout attacks
26
Adverse effects for ibuprofen
Black box warning for increased risk for cardiovascular events (heart attack and stroke)
*GI bleeding*
Caution with anti clotting agents and around surgeries
27
Why do first generation NSAIDs cause increased risk for heart attack
Cox 1 helps regulate platelet aggregation… so since it’s being blocked so are the bodies natural physiologic good processes
28
What is the prototype for an oxicam derivative?
Meloxicam
29
What do we use meloxicam for
Osteoarthritis and rheumatoid arthritis, juvenile arthritis (2 years or older)
30
Adverse effects for meloxicam
Same as ibuprofen
Black box warning: GI bleeding and cardiovascular risk
31
Uses for the NSAID indomethacin
Pain associated with arthritis and gout
**IV can be used to close patent ductus arteriosus ( a heart valve) in premature infants***
32
Uses for ketorolac
An NSAID that is available as IV formulation (top tier pain relief)
Pain relief is comparable to opioids (sometimes better)
33
Nursing consideration for ketorolac
Use is limited to 5 days due to high risk of bleeding and GI problems.. Black box warning!
34
MOA for selective COX 2
Selective COX 2 inhibitor
35
Prototype for the selective NSAID
Celecoxib
36
Uses for Celecoxib
Rheumatoid arthritis
Osteoarthritis
Reduce colorectal polyps
37
Nursing considerations for Celecoxib
Less GI bleed but still a concern
BBW for cardiac risk
38
Difference between ibuprofen and naproxen (Aleve)
Stays active in the body longer, so it’s normally only taken twice daily.
**OTC not recommended in children less than 12
39
What is the medication administered for gout?
Mitotic agent— colchicine
Uricosuric agent—- allopurinol
40
MOA for colchicine
Stops white blood cell movement into areas with urate crystals. Decreases inflammatory reaction.
41
What is colchicine used for
Treatment and prevention of gout
42
Nursing considerations for colchicine
**Good for treating acute attacks of gout**
From graph:
Do not take with grapefruit juice or alcohol. The juice increases colchicine levels, and alcohol increases urate levels.
Also keep hydrated to decrease risk of kidney stones
43
Adverse effects of colchicine
GI related— N/V.. pain
Hepatotoxicity
44
MOA for Allopurinol
Reduces uric acid production by inhibiting xanthine oxidase (the main enzyme involved in uric acid production)
More of a preventing medication
45
What is uricosuric medications used for?
Allopurinol is used for gout treatment
Cancers that result in higher uric acid levels.
46
Adverse effects for allopurinol
Uric acid kidney stones
47
Nursing considerations for allopurinol
Since it can cause kidney stones make sure patient is well hydrated.
Take after meals
48
Special contraindication for allopurinol
If patient or family has history of hemochromatosis (iron overload) then they can’t use this medication.
49
What is acute pain?
Sharp, cutting.
Often proportional to amount of damage done. Sudden onset
50
What is chronic (non cancer) pain?
Burning, aching, throbbing.
Lasting 3 months or longer. “Slow pain”.
May show signs of social withdrawal/ depression
51
What is cancer pain?
Can be acute or chronic; constant or intermittent.
52
What is somatic pain
Sharp, burning, gnawing, throbbing, cramping.
Sprains and other traumatic injuries. Joint pain from arthritis is another. (Can be acute or chronic)
53
Visceral pain
Deep, aching, dull, cramping. Diffuse and not well localized pancreatitis, cholecystitis, uterine disorders, liver disease
54
What is neuropathic pain
Shooting, severe, burning, stabbing. Caused by injury to nerves.
55
What is the prototype for an opioid agonist?
Morphine Sulfate
56
What is the MOA for morphine?
Binds to receptors in brain, spinal cord which blocks transmission.
57
What is the uses for morphine?
Prevent or treat acute or chronic pain.
Graph
Examples: pre/during surgery to promote anesthesia; during labor and delivery; severe cough; severe pulmonary edema
58
Adverse effects of morphine?
CNS depressant
Respiratory depressant
Constipation
59
What is a contraindication for a opioid agonist?
Black box warning
Combined CNS effects
Basically meaning if patient is on another CNS depressant especially benzodiazepines! They are at a higher risk for respiratory depression.
60
Nursing considerations for morphine?
Fall/ injury prevention
Tolerance (develop tolerance to a specific drug, body doesn’t provide pain relief) (just switch to another opioid)
Do not crush or chew (extended release.. XR or ER)
61
Immediate or regular release opioids vs extended relief opioids.. which one has higher risk for abuse?
Extended relief.. it’s a higher dose when crushed or opened
62
What is a correct morphine order prescribed?
No ranges.
The only thing that is ok to have a range for is pain level.. but not time or mg
63
What is the opioid agonist/antagonist prototypes name
Butorphanol
64
What is butorphanols MOA?
Mixed agonist and antagonist
From graph
Agonist of kappa opiate receptors, partial mu agonist, antagonist at other receptors
65
What is butorphanol uses?
Moderate-severe pain relief not managed with alternative options
66
What is a ceiling effect?
As you increase the dose, eventually the amount of pain relief will just even out even if you keep increasing the dose. Because as you increase the dose, you’re increasing both the amount of agonist and antagonist activity and eventually it just evens out, and the patient doesn’t get anymore pain relief.
67
What is the nursing consideration for butorphanol?
Ceiling effect
Less potential for abuse but normally considered 2nd line option
Nasal spray is available- used for migraines.
68
Adverse effects for butorphanol
BBW
respiratory depression
Neonatal withdrawal syndrome (all opioids have this) if mom uses opioids.. some of the drug gets into the fetus.. so baby is born partially addicted to opioids. Basically baby will have withdrawals after they are born.
69
What is the prototype for an opioid antagonist?
Naloxone
70
MOA for naloxone
Blocks opioids at receptor sites
71
Uses for naloxone
Drug of choice to reverse opioid overdose
72
Nursing considerations for naloxone
Usually takes several doses to reverse overdose
IV and nasal spray formulations
*may cause opioid withdrawal*
73
Adverse effects for naloxone
Tremors, drowsiness, sweating, N/V, HTN
74
What does LAST stand for?
Local anesthetic systemic toxicity
75
What is L.A.S.T
It’s an overdose from a high dose of local anesthetics
It can take minutes or hours to manifest
76
What is the cure for LAST
Stop anesthetic injection
Manage symptoms
20% lipid emulsion therapy is an antidote/treatment
77
What is the prototype for amide local anesthetics
Lidocaine
78
What’s the MOA for lidocaine?
Decrease neuron permeability to sodium ions, blocking nerve conduction.
79
What is the purpose for lidocaine?
Local anesthesia
Uses depends on % and dosage form
80
Adverse effects for lidocaine?
LAST
Anxiety
Precursor to seizures
Allergic reaction (rash, itching, hives, etc)
81
Nursing considerations for lidocaine
Effects are prolonged with epinephrine
Takes about 2-5 mins onset
Administration: topical (gel, patches), IV (0.5%-2%, 4%), oral, patches, nebulizer (4%)
82
What drug class is bupivacaine
Amide local anesthetics
83
MOA for bupivacaine (differences)
Longer duration and more potent than lidocaine but higher risk of toxicity
84
Adverse effects of bupivacaine
BBW for use of 0.75% formulation in pregnant women.
Cardiac arrest
Difficult resuscitation
Therefore, test dose often given before full dose
85
What is the significance of preservative free local anesthesia?
We don’t want to be putting anything with artificial preservatives in the epidural space because that is kinda one of the most pure non contaminated areas in the body. So anything that is used as an epidural should be preservative free.
86
How can you tell if a lidocaine is preservative free?
Anything that says multiple dose has preservatives in it
The bottle will say for caudal and epidural use
Single dose vial = preservative free
87
Initial symptoms of LAST?
Metallic taste, tinnitus, auditory changes, agitation
88
What is the ester local anesthetic
Chloroprocaine
89
Prototype for general anesthetic agents- inhalation anesthetic?
Isoflurane
90
MOA for isoflurane
Not sure how it works. maybe it amplifies GABA 
91
Uses for isoflurane
Induction and maintenance of general anesthesia
92
Adverse effects of isoflurane
Post operative N/V… because has strong skunk like smell
Malignant hyperthermia
Treat with IV dantrium
CV and respiratory depression
93
Contraindications of isoflurane
If patient or family has history of malignant hyperthermia then they should not use inhalation anesthetics
Or if they have history of PONV they should not use
Substitute with TIVA ( total intravenous anesthesia) 
94
What is malignant hyperthermia
Hyper metabolic response
Potential fatal
95
What causes malignant hyperthermia
Inhalation anesthetics
Succinylcholine (neural muscular blockers)
Linked to muscular disorders like Duchenne muscular dystrophy
96
How to treat malignant hyperthermia
IV dantrolene sodium (Dantrium)
Body cooling
97
Signs and symptoms of malignant hyperthermia
Muscle tension
Mouth masseter muscle tension
Tachycardia and dysthymias
Raising temp
98
Prototype for the general anesthetic agents- intravenous anesthetics
Propofol
99
MOA of propofol
Depresses CNS via GABA amplification
No analgesia
100
Uses for propofol
Induction and maintenance of general anesthesia
**Sedation**
101
Contraindications for propofol
Soy or egg allergy. Lipid metabolism disorders.
Risk of mishandling is high.. so always use aseptic technique
102
MOA for ketamine
Produces analgesia without using opioid receptors
103
Uses for ketamine
Often used in critically ill patients because it maintains low blood pressure and heart rate
104
Adverse effects for ketamine
BBW for emergence delirium, hallucinations, unpleasant dreams
105
Differences between inhalation anesthetics and IV anesthetics
Inhalation
Risk of malignant hyperthermia
Risk of hepatotoxicity
Effects dissipate after 30 minutes
Higher chances of post op N/V
Odor may limit used to maintenance.
IV
No risk of malignant hyperthermia
Assess for food allergies (egg, soy)
Effects dissipate quickly
Post- op N/V less likely
Aseptic technique (handling)
Pain at IV site
106
Prototype for neuromuscular blocking agents (aka muscle relaxants)
Vecuronium
107
MOA of vecuronium
Suspends nerve impulses at the neuromuscular junction
108
Use for vecuronium
Skeletal muscles paralysis for operations
*intubation, mechanical ventilation*
109
Nursing considerations for vecuronium
Recurarization which is the return of a weakness after assumed recovery. And signs are.. Difficulty swallowing, weak cough, trouble talking
110
BBW for succinylcholine
Sudden cardiac arrest
malignant hyperthermia
111
What are the drugs for adjuvant medications used in general anesthesia.
Benzodiazepines.. prototype is Midazolam
Opioid.. prototype is fentanyl
112
Use for midazolam
Pain relief.. or to reduce anxiety
113
BBW for midazolam
Respiratory depression
114
Reversal for benzodiazepines
Flumazenil
115
What are some pre-anesthesia assessments
History of malignant hyperthermia
Last food / liquid intake?
Last medications taken?
Pre meds ( if consent is given)
116
What are some post anesthesia assessments?
Emergency kits available
Monitor vital signs
Anticipate N/V and pain
117
What are sinus headaches?
Pain is behind browbone and/or cheekbones
118
What is cluster headaches
Pain is in and around one eye
Recurrent (up to 8 times a day)
Severe
Unilateral
119
What is tension headache
Pain is like a band squeezing the head.
Bilateral
120
What is a migraine?
Pain, nausea and visual changes are typical of classic form.
Unilateral
4 phases: prodrome, aura, headache, recovery
May or may not have aura phase
121
What is the NSAID used to treat a headache?
Naproxen
122
Uses for naproxen
Reduce pain from acute migraine
123
Prototype for triptans?
Sumatriptan
124
MOA for sumatriptan
Binds to serotonin receptors (5-HT) which causes vasoconstriction and relief of migraine symptoms.
125
Uses for sumatriptan
Treatment of migraine and cluster headaches
126
Adverse effects of sumatriptan
Serotonin syndrome which is a hyper metabolic response that can cause fever, muscle rigidity and seizures
CNS effects, CV effects
127
What is Treximet
Type of triptan that combines sumatriptan and naproxen
128
Adverse effects of mixing a triptan and an NSAID
2 BBW
GI bleed
CV risk ( heart attack, stroke)
129
Prototype for ergot alkaloids
Ergotamine
130
MOA for ergottamine
Constrict cranial and peripheral blood vessels
131
Uses for ergotamine
Prevent or stop migraine, cluster, or vascular headaches.
Not for children
132
Adverse effects for ergotamine
Numerous CV effects:
Fibrosis
Gangrene which is dead tissue caused by lack of blood flaw
Narrow therapeutic level
BBW for use with CYP3A4 inhibitor drugs… increased risk of toxicity from ergotamine due to this interaction
133
What is the prototype for anti emetic drugs
Chlorpromazine
134
MOA for chlorpromazine
Suppresses chemoreceptor zone
135
What are menstrual migraine headaches
Drop in estrogen 2-3 days prior to menses
Similar manifestation to migraine
