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