palliative drugs Flashcards
which drug is a Tetrahydrocannabinoids and how does it work
nabilone
antiemetic action may be d/t interaction w cannabinoid receptor sys in brain (dec nausea)
what is nabilone and what is it used for
o synthetic derivative of THC (major substance of marijuana).
o Treatment of nausea and vomiting associated with chemo that has not responded to other conventional antiemetics
o Stimulates appetitie and weight gain for pt w AIDS
would nabilone gen be the first choice antiemetic
no its used when other antiemetics arent working
if using to stop nausea from chemo when should nabilone be taken and how long will it last
it should be taken 1-3hrs before
can also be taken night before
or after
can nabilone have psychoactive effects
which age group is not nec safe with this
yes..the side effects sound like someone who has just smoked hha. there are potential for adverse psych reactions up to 72hrs after taking
also causes HoTN
undetermined if safe for kids
nabilone peak and duration
peak 1-3hr and duration 8-12
which 3 anticholinergics are we to learn
scopolamine
hyoscine butylbromide
glycopyrrolate
scopolamine how does it work
o MOA- blocks the binding of Ach to the cholinergic receptors in this region- correcting an imbalance between the neurotrasmitters Ach and norepi
o Potent effects on the vestibular nuclei- controls balance
what is the primary anticholinergic used as an antiemetic
what kind of nausea does this treat
scopolamine
o Most commonly used antiemetic for n + v and motion sickness
for prevention of motion sickness and PONV
scopolamine what uses beyond antiemetic
o Used as an adjunct to anesthesia to inhibit salivation and excessive resp secretions
o Produces amnesia and sedation and used for palliative control of secretions
also reduces spasms
what routes could you give scopolamine and which lasts longer and which is faster acting
maybe it is only the transdermal that is good for secretion control? here are the numbers that Francesca got for pharmacokinetics
transdermal lasts 72hr with onset in 4hr
while PO is only 4-6hr but has onset n 30min
o Half life: 9.5 hr
o Onset: 1-2 hr
o Peak: 6-8 hr
o Duration: 72 hr
what might scopolamine cause since it is antiACH
urinary retention blurred vision tachy dry mouth (yay!) drowsy
what is hyoscine butylbromide and what is it useful for
o Buscopan is a smooth muscle (involuntary muscle) anti-spasmodic that is effective in relieving colicky abdominal pain, caused by painful spasms in the muscles of gastro-intestinal (digestive) system or the genito-urinary system by blocking ach receptors and preventing contraction
elsewhere I found it used for resp secretions!
how does hyoscine butylbromide work
o MOA-blocks Ach on receptors of smooth muscle walls of Gi and urinary tract and reduces the smasms and contractions
when is hyoscine b not a good idea
o Should not be used if: glaucoma, muscle weakness, paralytic ileus, dilated colon, caution w elderly
where is scopolamine patch gen applied
behind the ear
if someone is using scopolamine should they drive
what about nabiione
no no
what kind of drug is glycopyrrolate and what is it used for
anticholinergic
o Synthetic antimuscarinic drug that blocks Ach receptor sites in the autonomic nervous system that controls the production of secretions and the concentration of free acids in the stomach
o Used preop to reduce salivation and excessive secretions in the resp and GI tract.
o Manages GI disorders when oral meds are not tolerated or rapid cholinergic effect is required eg adjunctive mgmt of PUD
what is a muscarinic receptor
a type of acetylcholine receptor
how does dose relate to glycopyrrolate function
low doses dec sweating, salivation, resp secretions eg4-10mcg/kg/dose q 3-4 or 4 times daily
intermediate doses–dec HR
lg doses dec GI and GU motility eg up to 200mcg
how is glycopyrrolate given routes
half life onset peak duration
IM, PO, IV
o Half life: variable
o Onset: IV: 1 min, IM: 20-40 min
o Peak: IV: 10-15 min, IM: 30-45 min
o Duration: IV: 4 hr, IM: 4-6 hr
what might glycopyrrolate be mixed with to be given as preanaesthetic
o Glycopyrrolate is used pre-op and can be mixed w morphine or meperidine for preanethetsic med
which neuroleptics were we to learn
chlorpromazine
methotrimeprazine
haloperidol
class of chlorpromazine
Classification
Therapeutic: antiemetics, antipsychotics
Pharmacologic: phenothiazines
action of chlorpromazine and therapeutic effects
Alters the effects of dopamine in the CNS. Has significant anticholinergic/alpha-adrenergic blocking activity.
Therapeutic Effects: Diminished signs/symptoms of psychosis. Relief of nausea/vomiting/ intractable hiccups.Decreased symptoms of porphyria.
indications of chlorpromazine
o Second-line treatment for schizophrenia and psychoses after failure with atypical antipsychotics. Hyperexcitable, combative behavior in children. Nausea and vomiting. Intractable hiccups. Preoperative sedation. Acute intermittent porphyria. Unlabeled Use: Vascular headache. Bipolar disorder.
chlorpromazine pharmacokinetics and metb where?
highly metb in liver and GI mucosa Half life: 30 hr Onset: (PO) 30-60 min Peak: unknown Duration: 4-6 hr (Po) 4-8 hr (IM) unknown for IV
chlorpromazine side effects
neurloletpic malignant syndrome, sedation, blurred vision, hypotentsion, constipation, dry mouth, dry eyes, agranulocytosis, etc
what to assess for chlorpromazine
o mental status
o weight
o positive and negsymp of schiz
o monitor BP, pulse, resp
o fluids, bowels
o onset of akathisiaabd extrapyramidal side effects
o Monitor for tardive dyskinesia (uncontrolled rhythmicmovement of mouth, face, and extremities; lipsmacking or puckering; puffing of cheeks; uncontrolledchewing; rapid or worm-like movements oftongue, excessive eye blinking). Report these symptomsimmediately; may be irreversible.
ending for phenothiazines
azine
methotrimeprazine action and class
- Antipsychotic, nonopioid analgesic. Phenothiazine
* Action: sedation. Therapeutic effect=dec in severity of pain
methotrimeprazine indiccations
• Indications: mgmt of psychotic disturbances, mgmt of conditions assoc w anxiety or tension. As analgesic and adjunct in pain d/t cancer, zona, trigeminal neuralgia, intercostals neuralgia, phantom limb pain and muscular discomforts. Used as preop sedative, antiemetic
SE of methotrimeprazinE
• SE: NMS, seizures, amnesia, drowsiness, ortho HoTN, bradycardia, constipation, hyperglycemia, blood dyscrasias
METHOTRIMEPRAZINE PHARMAOKINETICS
- IM for analgesia onset unknown and peak 20-40mins. Duration 8hrs.
- PO (blood levels) peak 20-40min and lasts 8hrs
- Looks like its given IV to peds in palliative care
WHAT TO ASSESS METHOTRIMEPRAZINE
• pain before and 30min after. BP freq after injection (often syncope etc occurs 10min-12hr after admin. Keep them supine 6-12hr after injection. Wt and BMI throughout therapy. EPS. NMS. Hyperprolactinemia, BG
how does methotrimeprazine affect resps (resp depression?)
how does it affect CNS
• potentiates action of other CNS depressants but can be given in conjunction w modified doses of opioid analgesics for mgmt of severe pain. This med doesn’t significantly depress resp status and can be useful when pulm reserves are low
class of haloperidol and its action
- T: antipsychotic P: butryophones
* Action: alters effects of dopamine in CNS also has anticholinergic and alpha adrenergic blocking activity
indications of haloperidol
• Normally given for psychosis..Indications: acute and chronic psychotic disorders eg SCH, manic, drug induced psychoses, aggressive or agitated…Off label use N/V from sx or chemotherapy
SE haloperidol
• SE: seizures, extrapyramidal rxn, HoTN, resp depressionblurred vision, constipation, dry mouth, agranulocytosis, neuroleptic malignant syndrome
what is onset and peak of haloperidol PO
• p.kinetics onset Po is 2hrs. Peak is 2-6
what to assess before giving haloperiodl
Assess: mental status, nausea and vomiting, bp and pulse, bowel fx, I/O, wt, EPS
Implement: give w water/food
what kind of drug is midazolam
benzo
what effects does midazolam have and how does it work
• Action: Acts at many levels of the CNS to produce generalized CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter. Therapeutic Effects: Short-term sedation. Postoperative amnesia
basically anxiolytic, sedative (and preprocedural sedative), amnesia, balanced anesthesia, sleep induction, muscle relaxation
how can midazolam be given and how quickly could it act
• Routes: Intranasal (fastest onset 5min and peaks at 10min). IM onset 15min and peak 30-60). IV 1.5-5min onset and peak rapid (for most uses it is IV)
SE of midazolam
• SE: excess sedation, drowsiness, arrhythmia, apnea, laryngospasm, resp depression, cardiac arrest, phlebitis, nausea, vomiting
assessments to do before midazolam
• Level of sedation and LOC throughout and for 2-6hr after admin. If giving IV monitor BP, pulse, resps continuously
what should you have on hand if giving lg doses of midazolam or using it for sedation
- Have 02 and resuscitative equipment nearby.
* Antidote
what is the antidote to benzos
flumazenil
what level of pain is morphine indicated for
is it good for round the clock pain
what specific type of pain is it the drug of choice to treat
Relief of moderate to severe, acute, or chronic pain. Mgmt of moderate to severe chronic pain in pts requiring use of continuous around the clock opioid analgesic for an extended period (extended or sustained release) Drug of choice for pain due to MI.
what lung condition can morphine be used for
weird…
pulm edema
t or f morphine can only be given IV, subcut, PO
f it can be intrathoracic, epidural, IM PO subcut, rectal, IV
peak and duration of morphine when given PO
peak 60min
duration 4-5hr
onset of morphine given subcut and peak
onset 20min
peak 50-90
SE of morphine
• SE: Sedation, decreased B/P (including orthostatic hypotension), diaphoresis, facial flushing, constipation, dizziness, drowsiness, nausea, vomiting. Major concern is resp depression
assessments for morphine
- Pain before and 1hr after (PO, IM, subcut) and 20min after IV.
- LOC and sedation, resps, bowel fx
- If taking SR/ER they might need breakthrough pain meds in addition
what to use when changing routes and giving morphine
• Use equianalgesic chart for when changing routes
antidote to morphine
what to give with it to help dec pain
- Give naloxone if OD
- Coadministration with nonopioid analgesics helps dec pain
- Give w food/milk
should fentanyl be used in an opioid naive pt
how much morphine must you be taking to be considered opioid tolerant
no. the high dose can be lethal to someone not opioid tolerant!
> 60mg oral morphine a day or 8mg dilaudid/day
indications for fentanyl
• Mainly for pain eg breakthrough pain, CA pain in chronic opioid therapy. Parenteral: Indicated for analgesic supplement to gen anesthesia for balanced anesthesia. Perop and intraop analgesia. Unlabeled as part of PCA.
are doses of sublingual/buccal/fentanyl transmucosal equivalent
NO
your pt is receiving scopolamine, glycopyrrolate
and theyre about to get fentanyl by sublingual route what might you want them to do before you giv the fentanyl
they might have dry mouth from the meds and they need to drink something BEFORE the fentanyl (if they have dry mouth)
precautions fentanyl
• Precautions: don’t use in opioid naïve. Wary of hypoventilation, bradyarrythmias, hepatic or renal impairment, inc ICP or alt LOC
SE of fentanyl
• SE: dizziness, drowsiness, resp depression, nausea, V, HoTN, constipation, dependence, pnea, laryngospasm
assessments fentanyl
- pain before and 15 min after (or depending on route). Resp assessment, BP, pulse all before and periodically during. If resp <10 assess sedation—may need to stim pt to prevent hypoventilation,
- Hx of opioid use. Last dose. What other CNS depressants are they on. LOC/sedation
fentanyl IV onset peak duration
Sublingual
IV
On-1-2
p-3-5
duration-0.5-1
sublingual
on in 30
p-30-60
dur-2-4hr
should you use transdermal fentanyl for short term pain control
why?
no
it can last up to 72hrs while the patch is still on so its best for those who need continuous opioid analgesic
which meds can be used for secretions
scopolamine
glycopyrrolate
hyoscine butylbromide
anticholinergics
your pt is having a bowel or bladder spasm what can you use
what similar drug would help to slow GI motility
hyoscine butylbromide (specifically mentioned to help w GI/GU stuff)
glycopyrolate can slow GI motility at lg dose
you want to dec secretions and treat nausea what to use
scopolamine
your pt is still in pain, nauseous and you are worried they are about to get bradypneic what med should you give
nabilone wont dec their resps
it is a nonopioid analgesic
it is an antiemetic (used after the other antiemetics have been tried)
your pt is nauseous and is psychotic what could you use
what would be better if they had PONV or chemo induced N V. is this drug more or less sedating
what would be best if they had pain as well as needing sedating, nauseous
chlorpromazine (good for N V, it is second line Tx for psychosis after failure w atypical antipsychotics. SE of sedation)
haloperidol is less sedating and is for PONV and chemo induced
methotrimeprazine
what meds can be used to control nausea
methotrimeprazine (preopNV)
haloperidol (NV from sx or chemo)
nabilone (from chemo or unresponsive to other antiemetics)
scopolamine (motion sickness and prevent PONV)
chlorpromazine
