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(2) N231 Pharmacology > Neurosensory III Meds (BY CLASSES) > Flashcards

Neurosensory III Meds (BY CLASSES) Flashcards

1
Q

Triptans

A

Name(s): Almotriptan (Axert), Eletriptan (Replax), Frovatriptan (Frova), Naratriptan (Amerge), Rizatriptan (Maxalt, Maxalt-MLT), Sumatriptan (Imitrex)*, Zolmitriptan (Zomig, Zomig-ZMT)*

Indication(s): Abortive (acute) therapy for migraine/cluster* HA’s

Action(s): Specific 5-HT1 receptor agonist → cranial vessel vasoconstriction with associated ↓neuropeptides → ↓migraine/cluster* HA

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2
Q

Client education for triptans

A
  • Take as soon as migraine s/s develop
    • Abortive therapy treatment - replaced ergots as 1st line treatment
  • Report chest pain
    • May result in MI
  • Common side effects - subside as the body gets used to drug
    • Flushing
    • Tingling
    • Hot sensation
  • Contraindications
    • Actual/suspected ischemic heart disease
    • Cerebrovascular ischemia
    • HTN
    • Peripheral vascular disease (PVD)
    • Pregnancy (Class C)
    • Lactation
    • Certain medications
      • SSRI’s
      • St. John’s wort
      • ergot alkaloids (within 24hrs of each other)
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3
Q

Ergot Alkaloids

A

Name(s): Ergotamine (Ergomar), Dihydroergotamine (Migranal, DHE 45), Caffeine/Ergotamine (Migergot, Cafergot)

Indication(s): Abortive (acute) therapy for migraine/cluster HA’s

Action(s): Stimulate alpha-adrenergic and serotonergic (5-HT) receptors → vasoconstriction of dilated blood vessels (carotid artery bed) → ↓migraine/cluster HA’s

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4
Q

Client education for ergot alkaloids

A
  • Take as soon as migraine s/s develop
    • Abortive therapy treatment - replaced by triptans 1st line treatment
  • Report chest pain
    • May result in MI
  • Common side effects - subside as the body gets used to drug
    • Flushing
    • Tingling
    • Hot sensation
  • Contraindications
    • Actual/suspected ischemic heart disease
    • Cerebrovascular ischemia
    • HTN
    • Peripheral vascular disease (PVD)
    • Malnutrition
    • Pregnancy (Class X)
    • Lactation
    • Certain medications
      • Triptans (within 24hrs of each other)
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5
Q

Analgesics

A

Name(s): Tramadol (Ultram)

Indication(s): Moderate to moderate-severe pain; also used to treat photophobia, and phonophobia associated with migraine HA’s

Action(s): Binds to opioid receptors, inhibiting reuptake of serotonin & norepinephrine in CNS

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6
Q

Client education for analgesics

A
  • Monitor for seizures - ↑risk with antidepressants and opioids
  • Encourage patient to turn, cough, and breathe deeply q2hrs to prevent atelectasis
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
    • Change positions slowly to minimize orthostatic hypotension
  • Known abuse potential that may result in dependency, addiction, and overdose
  • Contraindications
    • Respiratory depression
    • Known/suspected GI obstruction
    • Pregnancy (Class C)
    • Lactation
    • ETOH
      • Actively intoxicated
      • Chronic use/abuse
    • Certain medications
      • Sedatives/hypnotics
      • Centrally-acting analgesics
      • Opioids analgesics
      • Psychotropic agents
        • SSRI’s/SNRI’s
        • Benzodiazepines
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7
Q

Non-Steroidal Anti-Inflammatory Drugs (NSAID’s)

A

Name(s): Ibuprofen (Advil, Motrtin), Naproxen (Aleve, Naprosyn, Anaprox), Acetaminophen (Tylenol)*

Indication(s)​: Mild-moderate pain, fever, and inflammatory disorders; acute (abortive) therapy for mild HA’s

Action(s): Inhibits prostaglandin synthesis, thereby reducing mediators of pain, fever, and inflammation primarily in CNS

*technically a miscellaneous analgesic but has similar uses and mechanisms of action as NSAID’s

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8
Q

Client education for NSAID’s

A
  • Take with full glass of water and remain in an upright position 15-30mins after administration
    • Minimizes gastric upset
  • Assess for s/s of gastric bleeding, especially in chronic use
    • Dark, tarry stools
  • Monitor for rashes or fevers periodically during therapy
    • May cause SJS or TEN
  • Contraindications
    • Active GI bleeding
    • Cardiovascular disorders
    • Coagulation disorders
    • Pregnancy (Class B-D)
      • Acetaminophen is preferred in all trimesters
    • Lactation
    • ETOH
      • Actively intoxicated
      • Chronic use/abuse
    • Certain medications
      • Concurrent NSAID use
      • Anticoagulants
      • SSRI/SNRI’s
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9
Q

Barbiturates

A

Name(s): Butalbital/APAP/Caffeine (FioriCET), Butalbital/ASA/Caffeine (FioriNAL)

Indication(s): Acute (abortive) therapy for tension HA’s symptom complex

Action(s): Analgesic (APAP/ASA) for pain relief, barbiturate (butalbital) for sedative effect, caffeine for vasoconstriction

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10
Q

Client education for barbiturates

A
  • Notify provider if you are allergic to acetaminophen, butalbital, or caffeine
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
    • Change positions slowly to minimize orthostatic hypotension
  • Assess for s/s of gastric bleeding, especially in chronic use
    • Dark, tarry stools
  • Monitor for rashes or fevers periodically during therapy
    • May cause SJS or TEN
  • Known abuse potential that may result in dependency, addiction, and overdose
    • Butalbital
  • Contraindications
    • Respiratory depression
    • Known/suspected GI obstruction
    • Pregnancy (Class C)
    • Lactation
    • ETOH
      • Actively intoxicated
      • Chronic use/abuse
    • Certain medications - CNS depressants
      • Sedatives/hypnotics
      • Centrally-acting analgesics
      • Opioids analgesics
      • Antidepressants
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11
Q

Anticonvulsants

A

Name(s): Gabapentin (Neurotin), Lamotrigine (Lamictal), Phenytoin (Dilantin)

Indication(s): Preventive (prophylactic) therapy for migraine HA’s

Action(s): Alters and stabilizes neuronal ion transport using a variety of mechanisms, resulting in ↑neurotransmitter levels and ↓pain impulses

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12
Q

Client education for anticonvulsants

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness*
    • Use caution while driving or activities that require alertness
    • Change positions slowly to minimize orthostatic hypotension
  • May impair judgment or motor and cognitive skills*
    • Caution patient to avoid driving and other activities requiring alertness
  • Monitor for rashes or fevers periodically during therapy**
    • May cause SJS, TEN, or NMS
  • Contraindications
    • HF
    • Ischemic heart disease
      • 2nd/3rd-degree heart block
    • Pregnancy (Class C-D)
      • Gabapentin is unclassified
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications - CNS depressants
      • Sedatives/hypnotics
      • Centrally-acting analgesics
      • Opioids analgesics
      • Antidepressants - use cautiously

* = Buproprion

** = Mirtrazapine

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13
Q

Beta-Blockers (BB’s)

A

Name(s): Propranolol (Inderal), Timolol (Blocadren)

Indication(s): Preventive (prophylactic) therapy for migraine HA’s

Action(s): Blocks stimulation of β1- and β2-adrenergic receptor sites, resulting in cerebral vasoconstriction, prevention of cortical spreading depression*, and may ↑hypothalamic activity*

* = associated with migraines

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14
Q

Client education for beta-blockers

A
  • Monitor BP and HR frequently
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
    • Change positions slowly to minimize orthostatic hypotension
  • Monitor for rashes or fevers periodically during therapy
    • May cause SJS or TEN
  • Assess routinely for fluid overload
    • s/s - peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, JVD
      • Monitor I&O’s
      • Monitor daily weights
      • Respiratory assessment
  • Do NOT discontinue medication abruptly
    • Can cause life-threatening arrhythmias, hypertension, or myocardial ischemia
  • Contraindications
    • HF
    • Pulmonary edema
    • Cardiogenic shock
    • Bradycardia
    • Pulmonary disease (especially bronchospasm) - use cautiously
      • Asthma
    • HoTN
    • DM - use cautiously
      • May mask signs of hypoglycemia
    • Pregnancy (Class C)
    • Lactation
    • ETOH - use cautiously
      • May cause HoTN
    • Grapefruit juice - AVOID
    • Certain medications
      • Concurrent antihypertensives
      • Nitrates
      • Insulins, oral antidiabetics - may alter effectiveness
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15
Q

Calcium Channel Blockers (CCB’s)

A

Name(s): Amlodipine (Norvasc), Verapamil (Calan, Verelan)

Indication(s)​: Preventive (prophylactic) therapy for migraine HA’s

Action(s): Inhibits transport of Ca2+ into myocardial and vascular smooth muscle cells, thereby preventing arterial constriction

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16
Q

Client education for CCB’s

A
  • Monitor BP and HR frequently
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
    • Change positions slowly to minimize orthostatic hypotension
  • Monitor for rashes or fevers periodically during therapy
    • May cause SJS or TEN
  • Assess routinely for fluid overload
    • s/s - peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, JVD
      • Monitor I&O’s
      • Monitor daily weights
      • Respiratory assessment
  • Do NOT discontinue medication abruptly
    • May result in anginal pain - requires gradual reduction
  • Contraindications
    • HF
    • Cardiogenic shock
    • HoTN
    • Pregnancy (Class C)
    • Lactation
    • ETOH - use cautiously
      • May cause HoTN
    • Grapefruit juice - AVOID
    • Certain medications
      • Concurrent antihypertensive - use cautiously
      • Nitrates - use cautiously
17
Q

Selective Serotonin Reuptake Inhibitors (SSRI’s)

A

Name(s): Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil)

Indication(s): Preventive (prophylactic) therapy for migraine HA’s

Action(s): Selectively inhibits the reuptake of serotonin in CNS, thereby increasing serotonin, dopamine, and norepinephrine

18
Q

Client education for SSRI’s

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
  • Assess for serotonin syndrome - especially when taking other SSRI’s/SNRI’s/Triptans
    • Mental changes - agitation, hallucinations, coma
    • Autonomic instability - tachycardia, labile BP, hyperthermia
    • Neuromuscular abberations - hyperreflexia, incoordination
    • GI symptoms - N/V/D
  • Contraindications
    • History of seizures - use cautiously
    • History of mania - use cautiously
    • Angle-closure glaucoma (including risk of)
    • Pregnancy (Class C-D)
    • Lactation
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications
      • CNS depressants
        • Sedatives/hypnotics
        • Antihistamines
        • Opioids analgesics
      • Concurrent antidepressants
        • MAO’s - AVOID
        • Tricyclics
        • SNRI’s - use cautiously
      • St. John’s wort
19
Q

Serotonin-Norepinephrine Reuptake Inhibitor (SNRI’s)

A

Name(s): Venlafaxine (Effexor)

Indication(s): Preventive (prophylactic) therapy for migraine

Action(s): Inhibits serotonin and norepinephrine reuptake in CNS, thereby increasing serotonin, dopamine, and norepinephrine

20
Q

Client education for SNRI’s

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
  • Assess for serotonin syndrome - especially when taking other SSRI’s/SNRI’s/Triptans
    • Mental changes - agitation, hallucinations, coma
    • Autonomic instability - tachycardia, labile BP, hyperthermia
    • Neuromuscular abberations - hyperreflexia, incoordination
    • GI symptoms - N/V/D
  • Contraindications
    • History of seizures - use cautiously
    • History of mania - use cautiously
    • Pregnancy (Class C-D)
    • Lactation
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications
      • CNS depressants
        • Sedatives/hypnotics
        • Antihistamines
        • Opioids analgesics
      • Concurrent antidepressants
        • MAO’s - AVOID
        • Tricyclics - use cautiously
        • SSRI’s - use cautiously
      • St. John’s wort
21
Q

Tricyclics (TCA’s)

A

Name(s): Amitriptyline (Elavil), Imipramine (Tofranil)

Indication(s): Preventive (prophylactic) therapy for migraine/tension HA’s

Action(s): Potentiates the effect of serotonin and norepinephrine in CNS, thereby increasing serotonin and norepinephrine

22
Q

Client education for TCA’s

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness, drowsiness, or blurred vision
    • Use caution while driving or activities that require alertness
  • Caution client to wear sunscreen and protective clothing
    • Prevention of photosensitivity reactions
  • Assess for serotonin syndrome - especially when taking other SSRI’s/SNRI’s/Triptans
    • Mental changes - agitation, hallucinations, coma
    • Autonomic instability - tachycardia, labile BP, hyperthermia
    • Neuromuscular abberations - hyperreflexia, incoordination
    • GI symptoms - N/V/D
  • Contraindications
    • Angle-closure glaucoma
    • History of recent MI
    • History of HF
    • Pregnancy (Class C)
    • Lactation
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications
      • CNS depressants
        • Sedatives/hypnotics
        • Antihistamines
        • Opioids analgesics
      • Concurrent antidepressants
        • MAO’s - AVOID
        • SSRI’s - use cautiously
        • SNRI’s - use cautiously
      • St. John’s wort
23
Q

Amyotrophic Lateral Sclerosis (ALS) Agents

A

Name(s): Riluzole (Rilutek)

Indication(s): Amyotrophic lateral sclerosis (ALS)

Action: Slows progression of ALS; may be related to inhibition of glutamate release, inactivation of Na+ channels, or interference with neurotransmitter binding at receptor sites

24
Q

Client education for ALS agents

A
  • Take on an empty stomach 1hr before or 2hrs after meals
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
  • During therapy, assess for s/s of:
    • Liver injury
      • Unexplained N/V
      • Abdominal pain
      • Fatigue
      • Anorexia
      • Jaundice
      • Dark urine
    • Interstitial lung disease
      • Dry cough
      • Difficult or labored breathing)
  • Monitor for febrile illnesses and notify provider
  • Contraindications
    • ETOH
    • Females - use cautiously
    • Certain medications
      • St. John’s wort

(2) N231 Pharmacology (6 decks)

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