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Pharm Exam 2 > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

Prototype for Salicylates

A

Aspirin (ASA)

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2
Q

Mechanism of action for aspirin?

A

Inhibits prostaglandins

Stop synthesis of thromboxane A2 = decreased platelets

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3
Q

When would you use aspirin

A

Mild moderate pain relief

Cardiac risk reduction

From graph
Antipyretic (adults only)
Osteoarthritis

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4
Q

Aspirins cardiac risk reduction is associated with what dosage?

A

81 mg

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5
Q

Aspirins pain relief is what dosage?

A

Higher dosages.. 325 mg aprox every 6 hours.

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6
Q

What is the risk when you decrease platelets

A

Increasing the risk of bleeding

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7
Q

Side effects of aspirin?

A
  • GI bleeding *

Toxicity, salicylism

Not for children under 18
Reye’s syndrome

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8
Q

What is Reye’s syndrome?

A

A form of potentially fatal encephalopathy

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9
Q

If I child needs pain relief what should we give them?

A

Ibuprofen or Tylenol

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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

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11
Q

How do you handle overdose of aspirin?

A

Gastric lavage ( aka stomach pump)

Activated charcoal

Hemodialysis

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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

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13
Q

What is salicylism

A

toxicity associated with chronic use of aspirin

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14
Q

Signs of salicylism

A

Tinnitus (ear ringing)

Dizziness

Difficultly hearing

Confusion

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15
Q

What drug class is acetaminophen

A

non narcotic analgesic antipyretic

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16
Q

Routes for acetaminophen

A

PO - Tylenol
IV- Ofirmev

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17
Q

Mechanism of action for acetaminophen

A

Acts on hypothalamus directly to cause its therapeutic uses of reducing fever.

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18
Q

Uses for acetaminophen

A

Reduce fever

Mild pain relief

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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

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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!

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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

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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)

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23
Q

What is a prototype for propionic acid

A

Ibuprofen
(Motrin, advil)

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24
Q

What is MOA for ibuprofen

A

Blocks COX 1 and COX 2

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25
Q

Uses for ibuprofen

A

Mild- moderate pain relief

Fever reduction

Treat inflammation from arthritis

Treat initial gout attacks

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26
Q

Adverse effects for ibuprofen

A

Black box warning for increased risk for cardiovascular events (heart attack and stroke)

GI bleeding

Caution with anti clotting agents and around surgeries

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27
Q

Why do first generation NSAIDs cause increased risk for heart attack

A

Cox 1 helps regulate platelet aggregation… so since it’s being blocked so are the bodies natural physiologic good processes

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28
Q

What is the prototype for an oxicam derivative?

A

Meloxicam

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29
Q

What do we use meloxicam for

A

Osteoarthritis and rheumatoid arthritis, juvenile arthritis (2 years or older)

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30
Q

Adverse effects for meloxicam

A

Same as ibuprofen

Black box warning: GI bleeding and cardiovascular risk

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31
Q

Uses for the NSAID indomethacin

A

Pain associated with arthritis and gout

IV can be used to close patent ductus arteriosus ( a heart valve) in premature infants*

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32
Q

Uses for ketorolac

A

An NSAID that is available as IV formulation (top tier pain relief)

Pain relief is comparable to opioids (sometimes better)

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33
Q

Nursing consideration for ketorolac

A

Use is limited to 5 days due to high risk of bleeding and GI problems.. Black box warning!

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34
Q

MOA for selective COX 2

A

Selective COX 2 inhibitor

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35
Q

Prototype for the selective NSAID

A

Celecoxib

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36
Q

Uses for Celecoxib

A

Rheumatoid arthritis
Osteoarthritis
Reduce colorectal polyps

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37
Q

Nursing considerations for Celecoxib

A

Less GI bleed but still a concern

BBW for cardiac risk

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38
Q

Difference between ibuprofen and naproxen (Aleve)

A

Stays active in the body longer, so it’s normally only taken twice daily.

**OTC not recommended in children less than 12

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39
Q

What is the medication administered for gout?

A

Mitotic agent— colchicine

Uricosuric agent—- allopurinol

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40
Q

MOA for colchicine

A

Stops white blood cell movement into areas with urate crystals. Decreases inflammatory reaction.

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41
Q

What is colchicine used for

A

Treatment and prevention of gout

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42
Q

Nursing considerations for colchicine

A

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

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43
Q

Adverse effects of colchicine

A

GI related— N/V.. pain

Hepatotoxicity

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44
Q

MOA for Allopurinol

A

Reduces uric acid production by inhibiting xanthine oxidase (the main enzyme involved in uric acid production)

More of a preventing medication

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45
Q

What is uricosuric medications used for?

A

Allopurinol is used for gout treatment

Cancers that result in higher uric acid levels.

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46
Q

Adverse effects for allopurinol

A

Uric acid kidney stones

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47
Q

Nursing considerations for allopurinol

A

Since it can cause kidney stones make sure patient is well hydrated.

Take after meals

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48
Q

Special contraindication for allopurinol

A

If patient or family has history of hemochromatosis (iron overload) then they can’t use this medication.

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49
Q

What is acute pain?

A

Sharp, cutting.

Often proportional to amount of damage done. Sudden onset

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50
Q

What is chronic (non cancer) pain?

A

Burning, aching, throbbing.

Lasting 3 months or longer. “Slow pain”.

May show signs of social withdrawal/ depression

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51
Q

What is cancer pain?

A

Can be acute or chronic; constant or intermittent.

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52
Q

What is somatic pain

A

Sharp, burning, gnawing, throbbing, cramping.

Sprains and other traumatic injuries. Joint pain from arthritis is another. (Can be acute or chronic)

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53
Q

Visceral pain

A

Deep, aching, dull, cramping. Diffuse and not well localized pancreatitis, cholecystitis, uterine disorders, liver disease

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54
Q

What is neuropathic pain

A

Shooting, severe, burning, stabbing. Caused by injury to nerves.

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55
Q

What is the prototype for an opioid agonist?

A

Morphine Sulfate

56
Q

What is the MOA for morphine?

A

Binds to receptors in brain, spinal cord which blocks transmission.

57
Q

What is the uses for morphine?

A

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
Q

Adverse effects of morphine?

A

CNS depressant
Respiratory depressant
Constipation

59
Q

What is a contraindication for a opioid agonist?

A

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
Q

Nursing considerations for morphine?

A

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
Q

Immediate or regular release opioids vs extended relief opioids.. which one has higher risk for abuse?

A

Extended relief.. it’s a higher dose when crushed or opened

62
Q

What is a correct morphine order prescribed?

A

No ranges.

The only thing that is ok to have a range for is pain level.. but not time or mg

63
Q

What is the opioid agonist/antagonist prototypes name

A

Butorphanol

64
Q

What is butorphanols MOA?

A

Mixed agonist and antagonist

From graph
Agonist of kappa opiate receptors, partial mu agonist, antagonist at other receptors

65
Q

What is butorphanol uses?

A

Moderate-severe pain relief not managed with alternative options

66
Q

What is a ceiling effect?

A

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
Q

What is the nursing consideration for butorphanol?

A

Ceiling effect

Less potential for abuse but normally considered 2nd line option

Nasal spray is available- used for migraines.

68
Q

Adverse effects for butorphanol

A

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
Q

What is the prototype for an opioid antagonist?

A

Naloxone

70
Q

MOA for naloxone

A

Blocks opioids at receptor sites

71
Q

Uses for naloxone

A

Drug of choice to reverse opioid overdose

72
Q

Nursing considerations for naloxone

A

Usually takes several doses to reverse overdose

IV and nasal spray formulations

may cause opioid withdrawal

73
Q

Adverse effects for naloxone

A

Tremors, drowsiness, sweating, N/V, HTN

74
Q

What does LAST stand for?

A

Local anesthetic systemic toxicity

75
Q

What is L.A.S.T

A

It’s an overdose from a high dose of local anesthetics

It can take minutes or hours to manifest

76
Q

What is the cure for LAST

A

Stop anesthetic injection

Manage symptoms

20% lipid emulsion therapy is an antidote/treatment

77
Q

What is the prototype for amide local anesthetics

A

Lidocaine

78
Q

What’s the MOA for lidocaine?

A

Decrease neuron permeability to sodium ions, blocking nerve conduction.

79
Q

What is the purpose for lidocaine?

A

Local anesthesia

Uses depends on % and dosage form

80
Q

Adverse effects for lidocaine?

A

LAST

Anxiety

Precursor to seizures

Allergic reaction (rash, itching, hives, etc)

81
Q

Nursing considerations for lidocaine

A

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
Q

What drug class is bupivacaine

A

Amide local anesthetics

83
Q

MOA for bupivacaine (differences)

A

Longer duration and more potent than lidocaine but higher risk of toxicity

84
Q

Adverse effects of bupivacaine

A

BBW for use of 0.75% formulation in pregnant women.
Cardiac arrest
Difficult resuscitation

Therefore, test dose often given before full dose

85
Q

What is the significance of preservative free local anesthesia?

A

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
Q

How can you tell if a lidocaine is preservative free?

A

Anything that says multiple dose has preservatives in it

The bottle will say for caudal and epidural use

Single dose vial = preservative free

87
Q

Initial symptoms of LAST?

A

Metallic taste, tinnitus, auditory changes, agitation

88
Q

What is the ester local anesthetic

A

Chloroprocaine

89
Q

Prototype for general anesthetic agents- inhalation anesthetic?

A

Isoflurane

90
Q

MOA for isoflurane

A

Not sure how it works. maybe it amplifies GABA 

91
Q

Uses for isoflurane

A

Induction and maintenance of general anesthesia

92
Q

Adverse effects of isoflurane

A

Post operative N/V… because has strong skunk like smell

Malignant hyperthermia
Treat with IV dantrium

CV and respiratory depression

93
Q

Contraindications of isoflurane

A

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
Q

What is malignant hyperthermia

A

Hyper metabolic response

Potential fatal

95
Q

What causes malignant hyperthermia

A

Inhalation anesthetics

Succinylcholine (neural muscular blockers)

Linked to muscular disorders like Duchenne muscular dystrophy

96
Q

How to treat malignant hyperthermia

A

IV dantrolene sodium (Dantrium)

Body cooling

97
Q

Signs and symptoms of malignant hyperthermia

A

Muscle tension

Mouth masseter muscle tension

Tachycardia and dysthymias

Raising temp

98
Q

Prototype for the general anesthetic agents- intravenous anesthetics

A

Propofol

99
Q

MOA of propofol

A

Depresses CNS via GABA amplification
No analgesia

100
Q

Uses for propofol

A

Induction and maintenance of general anesthesia

Sedation

101
Q

Contraindications for propofol

A

Soy or egg allergy. Lipid metabolism disorders.

Risk of mishandling is high.. so always use aseptic technique

102
Q

MOA for ketamine

A

Produces analgesia without using opioid receptors

103
Q

Uses for ketamine

A

Often used in critically ill patients because it maintains low blood pressure and heart rate

104
Q

Adverse effects for ketamine

A

BBW for emergence delirium, hallucinations, unpleasant dreams

105
Q

Differences between inhalation anesthetics and IV anesthetics

A

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
Q

Prototype for neuromuscular blocking agents (aka muscle relaxants)

A

Vecuronium

107
Q

MOA of vecuronium

A

Suspends nerve impulses at the neuromuscular junction

108
Q

Use for vecuronium

A

Skeletal muscles paralysis for operations

intubation, mechanical ventilation

109
Q

Nursing considerations for vecuronium

A

Recurarization which is the return of a weakness after assumed recovery. And signs are.. Difficulty swallowing, weak cough, trouble talking

110
Q

BBW for succinylcholine

A

Sudden cardiac arrest

malignant hyperthermia

111
Q

What are the drugs for adjuvant medications used in general anesthesia.

A

Benzodiazepines.. prototype is Midazolam

Opioid.. prototype is fentanyl

112
Q

Use for midazolam

A

Pain relief.. or to reduce anxiety

113
Q

BBW for midazolam

A

Respiratory depression

114
Q

Reversal for benzodiazepines

A

Flumazenil

115
Q

What are some pre-anesthesia assessments

A

History of malignant hyperthermia

Last food / liquid intake?

Last medications taken?

Pre meds ( if consent is given)

116
Q

What are some post anesthesia assessments?

A

Emergency kits available

Monitor vital signs

Anticipate N/V and pain

117
Q

What are sinus headaches?

A

Pain is behind browbone and/or cheekbones

118
Q

What is cluster headaches

A

Pain is in and around one eye

Recurrent (up to 8 times a day)

Severe

Unilateral

119
Q

What is tension headache

A

Pain is like a band squeezing the head.

Bilateral

120
Q

What is a migraine?

A

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
Q

What is the NSAID used to treat a headache?

A

Naproxen

122
Q

Uses for naproxen

A

Reduce pain from acute migraine

123
Q

Prototype for triptans?

A

Sumatriptan

124
Q

MOA for sumatriptan

A

Binds to serotonin receptors (5-HT) which causes vasoconstriction and relief of migraine symptoms.

125
Q

Uses for sumatriptan

A

Treatment of migraine and cluster headaches

126
Q

Adverse effects of sumatriptan

A

Serotonin syndrome which is a hyper metabolic response that can cause fever, muscle rigidity and seizures

CNS effects, CV effects

127
Q

What is Treximet

A

Type of triptan that combines sumatriptan and naproxen

128
Q

Adverse effects of mixing a triptan and an NSAID

A

2 BBW

GI bleed

CV risk ( heart attack, stroke)

129
Q

Prototype for ergot alkaloids

A

Ergotamine

130
Q

MOA for ergottamine

A

Constrict cranial and peripheral blood vessels

131
Q

Uses for ergotamine

A

Prevent or stop migraine, cluster, or vascular headaches.

Not for children

132
Q

Adverse effects for ergotamine

A

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
Q

What is the prototype for anti emetic drugs

A

Chlorpromazine

134
Q

MOA for chlorpromazine

A

Suppresses chemoreceptor zone

135
Q

What are menstrual migraine headaches

A

Drop in estrogen 2-3 days prior to menses

Similar manifestation to migraine

Pharm Exam 2 (7 decks)

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