N365 Exam 2 Flashcards
Gaseous general anesthetic
Narcosis, analgesia, amnesia
Free of major toxicities when given w/ O2
Toxic Suppression of CNS can occur, N/V
Best used as induction agent & for short procedures
Nitrous Oxide
Volatile general anesthetic
Progressive depletion of CNS
Respiratory depression, MALIGNANT HYPERTENSION (esp. w/ succinylcholine)
Eases tracheal intubation; good anesthetic NOT analgesic
Shivering when coming out of anesthesia
Isoflurane (Forane)
Respiratory depression
Risk of bacterial infection
Propofol infusion syndrome (fatal)
Antiemetic properties
Smooth, easy induction; contraindicated in severe heart disease or respiratory difficulties
Propofol (Diprivan)
Narcotic analgesic
Morphine-like action (but 100x as potent)
Euphoria, miosis, constipation, respiratory depression
Significant abuse potential
Rapid IV or large dose –> muscle rigidity and apnea
Topical should only be used for those tolerant to opioids (and should not be exposed to heat)
Fentanyl (Sublimaze)
IV anesthetic; benzodiazepine
Neuroleptic effect; CNS depression; prevents seizure activity
Respiratory depression; hypotension; DEC. ALERTNESS, hiccups, loss of dexterity
Anterograde amnesia; post anesthetic effect
Midazolam (Versed)
Local anesthetic; stabilizes or elevates threshold of excitation (prevents transmission of nerve impulses)
Systemic absorption may cause ADRs, cardiac issues
Loss of all sensation but PAIN FIBERS affected first
Vasoconstrictors used to dec. systemic absorption
Lidocaine/Procaine (Xylocaine)
Skeletal muscle relaxant; Nondepolarizing neuromuscular blocking agent; prevents acetylcholine from acting
Tachycardia, hypertension, muscle weakness, salivation
Reversed by anticholinesterase
Rocuronium (Zemeron)
Skeletal muscle relaxant; Depolarizing neuromuscular blocking agent; acts like acetylcholine
Postop muscle pain, hypotension, bradycardia, apnea, hyperthermia
Low level toxicity
Succinylcholine (Anectine)
Narcotic Analgesic (Schedule II); acts on perception of pain at the sensory cortex
Constricted pupils, respiratory depression, N/V, postural hypotension, release of histamine, constipation, urinary retention
DO NOT USE WITH HEAD INJURY (INC. ICP)
High potential for tolerance and abuse
Has high first pass metabolism
Morphine sulfate
Narcotic antagonist; acts as a pure antagonist and blocks opioid receptors
Will cause withdrawal sx in opioid addicted
Reverses narcotic effects of anesthesia or overdose
Suboxone is used for Tx of opioid dependence
Naloxone (Narcan)
Narcotic agonist antagonist; produces analgesia
Sedation, respiratory depression, sweating, anxiety, NIGHTMARES
CAN be reversed by Narcan
Low abuse potential
Nalbuphine (Nubain)
Narcotic analgesic & antitussive
Binds to opioid receptors and produces mild to moderate pain relief; CONVERTED TO MORPHINE WHEN METABOLIZED
Respiratory depression, constipation, urinary retention, miosis (lesser SE than morphine)
Requires higher dosing to achieve pain relief
200 mg Codeine = 30 mg Morphine
Codeine
Hypnotic, Non-benzodiazepine
Next day drowsiness, sleep-related behaviors
Acts like benzodiazepines
Not associated with withdrawal
Zolpidem (Ambien)
Inhibits prostaglandin synthesis = analgesia and anti-inflammatory
Acts on heat regulating center in hypothalamus = anti-pyretic
*Irreversibly inhibits platelet aggregation
Stimulates vomiting center in brain (more acid, less mucus = ULCERS)
Taken once a day for anticoagulation
Acetylsalicylic Acid (ASA, Aspirin)
Non-anti-inflammatory analgesic
Large doses are toxic to the liver
Chronic use can lead to kidney damage
Used in similar instances treated with aspirin
Antidote = acetylcysteine
Acetaminophen (Tylenol)
NSAID; inhibits prostaglandin synthesis
FRONTAL HEADACHE; aggravate psychiatric disturbances, Parkinsonism, epilepsy, OCULAR CHANGES
Can MASK INFECTION
Give with food or milk
Given IV to close PDA in premature infants
Indomethacin (Indocin)
NSAID, inhibits prostaglandin synthesis
Heartburn, blurred vision, fluid retention
ALL NSAIDs HAVE DAMAGING EFFECTS ON KIDNEYS
Give with food
Contraindicated in hx of aspirin-induced bronchospasm
Visual disturbances –> (stop drug and complete and eye exam)
CLASS EFFECT: inc. risk for CV events
Ibuprofen (Motrin, Advil)
COX-2 inhibitor
Causes renal toxicity and fluid retention
Fewer GI ulcers than older NSAIDs
CONTRAINDICATED IN SULFA ALLERGY
Celecoxib (Celebrex)
NSAID; inhibits prostaglandin synthesis
Sedation, HTN, ULCERATIONS
Decreased platelet adhesion; HYPERKALEMIA
Short-term pain management
Many drug interactions
Ketorolac (Toradol)
Anti-inflammatory, TNF blocker
Increased risk of infection
Rare CNS disorders; Some Hematologic disorders
Expensive
Assess for POTENTIAL INFECTION (CXR & Tb skin test) prior to starting drug
Etanercept (Enbrel)
Antimalarial; mechanism unknown for anti-inflammatory properties (possible suppression of antigen formation)
Bone marrow depression, dermatitis alopecia, ocular issues (progression stops if drug is D/Cd)
Take with food or milk
Eye exam every year if high risk
Hydroxychloroquine (Plaquenil)
Immunosuppressive, anti-inflammatory
Inhibits responses of cells like lymphocytes and macrophages
Bone marrow depression, alopecia, hemorrhagic cystitis
Increased incidence of infection & neoplasm
Used for ORGAN TRANSPLANTS to decrease rejection
Azathioprine (Imuran)
Anti-gout; interrupts purine degradation before uric acid is formed
Rashes, bone marrow depression, reversible hepatotoxicity
Use care with anticoagulants
Interferes with hepatic function
HIGH FLUID INTAKE NECESSARY
Allopurinol (Zyloprim)
Anti-gout; mechanism unknown, possibly inhibits inflammatory response to uric acid crystals
Prolonged: bone marrow depression, AGRANULOCYTOSIS, peripheral neuritis, aplastic anemia
Acute: loss of F&E; shock
Colchicine (Colcrys)
BACTERICIDAL; interferes with CELL WALL synthesis; Gram +
Anaphylactic reactions
Blocked by bacterial penicillinase
TAKE ON EMPTY STOMACH
Penicillin
BACTERICIDAL; structurally r/t penicillin; inhibit CELL WALL synthesis
Allergic reaction, phlebitis, superinfection, bone marrow depression
Mild hepatotoxicity, sometimes kidney damage
Bleeding tendencies
PARTIAL CROSS ALLERGY POSSIBLE
Use as alternative to penicillin
Cephalosporins
BACTERICIDAL; inhibit PROTEIN SYNTHESIS; Gram -; Narrow spectrum
Auditory, vestibular, renal fxn (proteinuria)
Neuromuscular blockade –> respiratory paralysis
OTOTOXICITY (elderly & preemies)
Caution with renal insufficiency
Neomycin is not absorbed at all (only topical or instillation)
Aminoglycosides (gentamycin, neomycin)
BACTERIOSTATIC (bactericidal at higher doses); inhibit PROTEIN SYNTHESIS; Broad spectrum
Relatively non-toxic, anaphylaxis, nephropathy, CHILD TOOTH MOTTLING
Should NOT be taken with food (ESP. DAIRY); NO ANTACIDS
Contraindicated in renal dysfunction
Tetracyclines (doxycycline)
Macrolide antimicrobial; usu. BACTERIOSTATIC (can be bactericidal); inhibits PROTEIN SYNTHESIS
One of the SAFEST antibiotics
Cholestatic hepatitis, superinfection of the bowel, thrombophlebitis
USED FOR RESPIRATORY AND SKIN INFECTIONS
Inhibits liver enzymes, and increases drug concentration
Azithromycin and clarithromycin cause less nausea
Erythromycin (Ery-tab)
Fluoroquinolone antimicrobial; BACTERICIDAL, Gram + & Gram -, prolonged post-antibiotic effect
Generally well-tolerated
CARTILAGE TOXICITY & neuropathy
Used to reduce anthrax
NOT FOR KIDS <18 years old
Ciprofloxacin, Levofloxacin (Cipro, Levaquin)
Amebicide, anaerobic antimicrobial
Kills trophozoites, impairs nL DNA repair
Metallic taste, insomnia, vertigo, paresthesia
URINE REDDISH-BROWN; ANTABUSE EFFECT
Treats trichomoniasis
Metronidazole (Flagyl)
BACTERIOSTATIC, inhibits metabolism of folic acid
GU EFFECTS (crystalluria, hematuria, obstruction)
Contact dermatitis & SEVERE hypersensitivity
DRUG OF CHOICE FOR UTI
Keep urine dilute!
Decreases bowel flora and leads to Vit K deficiency (bleeding tendencies!)
Sulfonamides
Antituberculosis; inhibits production of mycolic acid; BACTERICIDAL in active case, BACTERIOSTATIC in resting phase
Neurotoxicity, hepatic dysfunction, vitamin B6 dysfunction
Alone for prophylaxis, in combo for active treatment
Isoniazid (INH)
Macrocyclic antibiotic, BACTERICIDAL, inhibits RNA SYNTHESIS
No SE in great frequency BUT LIVER DAMAGE AND JAUNDICE IN ALCOHOLICS
Orange/Red color in body fluids
Inducer of microsomal system increases drug metabolism (dec. 1/2 lives)
Also for leprosy, Legionnaires disease
Rifampin (Rifadin)
Antimicrobial/antifungal; Causes cell to leak essential components –> cell death
LARGE # of SEs: chills (RIGORS), thrombocytopenia, HIGHLY NEPHROTOXIC, leads to HYPERKALEMIA
Occasionally hepatotoxic
Premedicate pt to avoid ADRs
Incompatible with most drugs
Amphotericin B (Fungizone)
Antiviral/Anti-herpes; inhibits viral replication
Amnesia, phlebitis, hypotension, nephrotoxicity, irritation & burning
Decreased duration and severity of herpes episode
Acyclovir (Zovirax)
Anti-HIV; Inhibits replication of HIV
Depression of formed elements in blood
SEVERE HEADACHE & myalgia
ANEMIA that requires multiple transfusions
Combination therapy is recommended
Zidovudine (Retrovir)
Anti-HIV, Protease Inhibitor; inhibits function of HIV proteins and enzymes
Virus remains immature and non-infectious
Hyperglycemia, new onset DM
Pancytopenia, thrombocytopenia
Agents that inhibits P450 (grapefruit juice) inc. levels
Agents that induce P450 (rifampin, St. John’s Wort) dec. levels
Saquinivir (Fortovase)
