Pharm Flashcards
1
Q
We alter the function of the body to
A
prevent, diagnose, and treat
2
Q
drugs can be given for two different effects
A
local or systemic
3
Q
An example of local is
A
putting a topical steroid on eczema
4
Q
An example of systemic is
A
oral medication taken for a headache, that goes through the whole body, may have side effects not related to the headache
5
Q
NCLEX you will see
A
Generic names of medications used
6
Q
A prototype drug is
A
individual drugs that represent groups of drugs, they are often the first drug of a particular group to be developed. Example: Morphine represents opioid analgesics
7
Q
Common medication errors include:
A
wrong medication or IV fluid, incorrect does or IV rate, wrong client, route, or time, administration of known allergic medication, omission of a dose, incorrect discontinuation of medication or IV fluid
8
Q
Nurses responsibilities Regarding Drug therapy include:
A
know how to safely administer medication, know correct route of administration, know how to use effective communication between nurses and providers, know what to monitor/assess before and after drug administration, know how to educate patients about drug therapy, and advocate for them
9
Q
In administration of drugs it is important to use
A
Application of the Nursing Process: Assessment, Diagnosis, Planning, Implementation, Evaluation
10
Q
Medication Safety(10)
A
Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Documentation, Right Assessment Diagnose, Right Evaluation, Right Education, Right to Refuse
11
Q
Black box Warning is:
A
Strictest Warning by the FDA
Reasonable evidence of a serious or life threatening hazard associated with the drug
12
Q
Example of Black labeled drugs include:
A
Antidepressants: cause suicidal thoughts
Deep Provera:(injectable birth control) causes bone loss)
Fluoriquinolones (antibiotics like Cipro) cause tendon rupture
13
Q
FDA Pharmaceutical Pregnancy Categories include:
A
Categories A, B, C, D, and X. A is the least harmful, and X is the worst.
14
Q
Category A:
A
Adequate and well controlled human studies demonstrated no risk.
15
Q
Category B:
A
Animal studies demonstrate a risk, but no human studies have been performed, or animal studies demonstrate a risk, but human studies have demonstrated no risk,
16
Q
Category C:
A
Animal studies demonstrate a risk but no human studies have been performed. Potential benefits may outweigh the risks.
17
Q
Category D:
A
Human studies demonstrate a risk, potential benefits may outweigh the risks.
18
Q
Category X:
A
Animal or human studies demonstrate a risk. The risks outweigh the potential benefits.
19
Q
Oral Routes from slowest to fastest:
A
Rectal, Pills(tablets, capsules), Liquid, Subcutaneous, Intramuscular, Intravenous
20
Q
Metabolism is
A
the method by which drugs are inactivated or biotransformed by the body. (need enzymes to activate drugs) The LIVER is the main site of drug metabolism(Enzyme P450)
21
Q
First-Pass Loss Effect is when
A
a drug given via enteral route(by mouth) and has to be metabolized by liver before reaching blood, losing some to entire drug effect.
22
Q
How Receptors work:
A
In order for drugs to work,cells have recemptorsthat drug must fit into to work. Agonists fit into the cell to make the drug work, and Antagonists block cells to prevent an action.
23
Q
Non- receptor drugs
A
do not bind to a receptor to work: for example: antacids that coat the stomach
24
Q
Factors that affect Pharmacodynamics include-
A
genetics, gender, race,( P450 Liver Enzyme, muscle mass vs. ft stores), Age/weight, (Pediatric, Geriatric, kg),Disease Processes, (Pre-existing, Psychological)
25
There are many lifespan considerations when it comes to Geriatric Patients:
- Factors decrease absorption rate
- they have less gastric acid(increased PH or Alkaline)
- Slower GI motility, and slowed gastric emptying
- reduced blood flow to GI,CV, liver, and kidneys
- Reduced absorptive surface area, factors reduce distribution
- Less body water, increased body fat, decreased lean body mass
- more body fat to store("trap") lipid soluble drugs
- Less protein binding sites(more free drugs in the blood)
- reduced blood flow to Cardiovascular system
- smaller distributive volume which leads to increased concentration of the drug
26
Older adult pharmacology(factors that reduce metabolism):
-Reduced organ functions of liver, kidneys, cardiopulmonary, leading to longer half life
-decreased liver enzyme production/function
-poor circulation, less therapeutic effects
-Increased responses to enteral drugs due to reduced first-pass effects
-reduced blood flow to liver
factors that reduce elimination
-Renal insufficiency failure
-Bowel Obstruction
-Loss of Nephrons
Reduced blood flow to kidneys
27
Factors specific to Pediatric Life Span Considerations:
Immature system/Organ functions(liver, kidney, blood-brain barrier, bone and teeth growth)
- decreased gastric acid production and slower gastric emptying time
- decreased first pass medication metabolism
- Increased absorption of topical medications (greater BSA and thinner skin)
- Lower Blood Pressure(more blood flow to the liver and brain and less blood flow to the kidneys.
- Higher body water content (dilutes water soluble medications)Decreased serum-protein-binding sites(until age 1) leads to higher blood protein-binding drug level
28
Pediatric pharmacology factors:
-show greater individual variation, higher risk for medication errors.
-Dosages are usually based on weight or body surface area
-2/3 of drugs used in pediatrics have been tested on children
-Adult medication must be prepared in very small dose unit
-limited sites exist for IV medication administration
Nursing implications: Dosing per body weight/increased risk for adverse drug reaction
29
Nursing interventions for older adults:
- obtain a complete medication history
- starts the new drug therapy at the lowest possible dose
- assess/monitor
- Promote adherence by:
- providing tailored education
- choosing appropriate drug form and dosing schedule
- providing user friendly pill containers
- developing daily calendar
- Identify support system(friend,neighbor, relative)
30
Factors that reduce ability to manage medication:(in patients 65 and older):
-impaired memory or altered mental state
-vision and hearing impairment
-impaired mobility and fine motor skills
-poor adherence and low health literacy level
- reduced financial resources
-Poly-Pharmacy(taking several prescription medications and OTC meds together which can decrease organ system functions and certain medical conditions, can lead to potential toxicity
-multiple and severe illnesses
-Nonspecific symptoms of adverse Drug reactions
-Multiple providers, but inadequate supervision of long-term therapy
use many drugs with low Tl like digoxin
31
Definition of Distribution:
Drugs are carried by blood and tissue fluids to:
Action sites
Metabolism sites
Excretion sites
*depends on adequacy of blood circulation
32
Pharmacodynamics definition:
What drug does to body
| how drugs are working
33
Definition of Excretion:
```
Elimination of a medication from the body
this requires adequate function of the:
-circulatory system
-kidneys,bowel
-lungs,
-skin
```
34
Pharmacokinetics:
What the body does to the drug. ADME
| absorption, distribution, Metabolism, Elimination
35
Absorption:
Onset of drug action is determined by the rate of absorption.
*Factors that affect rate and extent of drug absorption
_Dosage form, route and administration, administration site, blood flow, GI function, the presence of food and other drugs
36
BEERS criteria:
list of potentially inappropriate medications used by the older adult-30% of hospital admissions are linked to drug reactions
37
Example of a category X medication is:
Accutane (Isotretinoin)
38
Access to drugs:
prescription: written by a licensed health care provider such as a physician, dentist, or nurse practitioner.
OTC or over the counter meds do not require a prescription
-Regulated by various laws
39
Drug Schedule 1-5 Refers to level of potential for abuse:
Schedule 1 drugs have the highest potential for abuse, and schedule 5 drugs have low potential for abuse
40
In drug development the patient is the main focus:
our goal is to help the patient overcome illness/disease and to improve quality of life.
41
The generic drug name is assigned in the United States, the name indicates the:
drug group and is often hard to pronounce.
| Amoxicillin belongs to the penicillin group
42
the brand name or trade name is developed by the company requesting approval for the drug and identifies it as the exclusive property of that company. :
Brand name is come up with by people trying to market the drug and make name more memorable like flomax (prostate med)
43
An ideal drug is effective, safe, and
selective
| *Goal of drug therapy is Maximum benefit with minimum harm
44
therapeutic Index:
ratio between the dosage of a drug that causes a lethal effect and the dosage that causes a therapeutic effect.
45
Half Life:
This is the period of time required for the concentration or amount of drug in the body to be reduced by one-half.
46
Activity means:
How well the drug candidate binds to its target and generates the desired biological response
47
metabolic Profile toxicity:
whether or not any toxic effects are produced by the drug candidate or its byproducts when the body's enzymes break it down
48
Half -life:
How long the drug stays in its active form in the body
49
Oral-Bioavailability:
How much drug candidate reaches the appropriate tissues in its active form when given orally
50
Solubility:
Affects how well the drug candidates can be absorbed by the body if taken orally
51
the most important properties of an ideal drug are:
effectiveness, safety, and selectivity
52
If a drug is not effective:
it should not be used
53
Drugs have both:
benefits and risks
54
There is no such thing as a wholly selective drug:
All drugs can cause side effects
55
The objective of drug therapy is to:
provide maximum benefit with minimum harm.
56
Because all patients are unique, drug therapy:
must be tailored to each individual
57
Nursing responsibilities with regard to drugs extends far beyond the
Rights of Drug Administration
58
You are the patients last:
line of defense against medication errors
59
Your knowledge of pharmacology has a wide variety of practical applications in
patient care and patient education
60
application of the nursing process in drug therapy us directed at:
individualizing treatment which is critical to achieving therapeutic objective.
61
The goal of pre administration assessment is to gather data needed for:
1) evaluation of therapeutic and adverse effects. 2) identification if high-risk patients, and 3) assessment of the patients capacity for self-care
62
The analysis and diagnosis phase of treatment is directed at:
1). judging the appropriateness of the prescribed therapy 2)identifying potential health problems treatment might cause and 3) characterizing the patient's capacity for self-care
63
Pre administration assessment:
therapeutic goal, baseline data, identifying high risk patients
64
implementation:Administration
Routes, Administration
65
Implementations: Measures to enhance therapeutic Effects:
```
Ongoing Evaluations and Interventions:
Summary of monitoring
Evaluating Therapeutic effects
minimizing adverse effects
minimizing adverse interactions
managing toxicity
```
66
Amphetamine adverse effect:
CNS stimulation, Nursing Diagnosis: Disturbed sleeping pattern related to drug-induced CNS excitation
67
Aspirin adverse effect:
Gastric Erosion: Related Nursing Diagnosis: Pain related to aspirin induced gastric erosion
68
Atropine: adverse effect:
urinary retention: Urinary retention related to drug therapy
69
Bethanachol: adverse effect
stimulation of GI smooth muscle: Bowel incontinence related to drug induced increase in bowel motility
70
Cyclophosphamide: adverse effect:
Reduction of white blood cell counts: Risk for infection related to drug induced neutropenia
71
Digoxin: adverse effect:
dysrhythmias: inaffective tissue perfusion related to drug-induced cardiac dysrhythmias
72
Furosemide: adverse effect:
Excessive Urine Production: Deficient fluid volume related to drug induced diuresis
73
Gentamicin: adverse effect:
damage to the eight cranial nerve: disturbed sensory perception: hearing impairment related to drug therapy
74
Glucocorticoids: adverse effect:
thinning of the skin: impaired skin integrity related to drug therapy.
75
Haloperidol: adverse effect:
involuntary movements: low self-esteem due to drug-induced involuntary movements
76
Propanolol: adverse effect:
Bradycardia: Decreased cardiac output related to drug-induced bradycardia
77
Warfarin: adverse effect:
bleeding: Risk of injury related to drug induced bleeding
78
Pharmacokinetics consists of four basic processes:
absorption, distribution, metabolism, and excretion
79
Pharmacokinetic processes determine the:
concentration of a drug at its sites of action, and thereby determine the intensity and time course of responses.
80
To move around the body, drugs must cross membranes by either:
passing through he pores, undergoing transport, or penetrating the membrane directly
81
P-glycoprotein(found in the liver, kidney, placenta, intestine, and brain capillaries)can:
transport a variety of drugs out of cells.
82
TO cross membranes, most drugs must dissolve directly into the lipid bilayer of the membrane, so lipid-soluble drugs can cross membranes easily, whereas: drugs that are
polar or ionized cannot
83
Acidic drugs ionize in basic(alkaline) media, whereas:
basic drugs ionize in acidic media
84
Absorption is defined as:
the movement of a drug from its site of administration into the blood
85
Absorption is enhanced by:
rapid drug dissolution, high lipid solubility of the drug, a large surface area for absorption, and high blood flow at the site of administration
86
Intravenous administration has several advantages:
rapid onset, precise control over the amount of drug entering the blood, suitability for use with large volumes of fluid, and suitability for irritant drugs
87
Schedule 1 drugs:
high potential for abuse, no current medical use in US.
| Heroin, LSD
88
Schedule 2 drugs:
High potential for abuse:accepted use in U.S.
abuse may lead to severe psychological and physical dependence. Examples include:dilaudid, methadone, demerol, oxycodon, oxycontin, percocet, fentanyl
89
Schedule 3 drugs:
potential for abuse less than 1 and 2: moderate or low physical dependence or high psychological dependence:
example: vicodin, codeine
90
Schedule 4 drugs:
Lower potential for abuse, minimal physical or psychological dependence, examples: Xanax, Clonopin
91
Schedule 5 drugs:
Even lower risk of abuse, examples: Robitussin AC, Phenergan with Codeine.
92
What is Pain?
the 5th vital sign, warning sign, sensory perception of injury.
93
Acute pain:
result of injury, trauma, spasm, ischemia
94
Chronic pain:
duration of three months or greater, associated with depression, irritability, decreased appetite, and disturbed sleep
95
Pain is subjective:
The patient is the only one who knows what they are experiencing. Pain scales help us quantify pain-but are highly variable. Pain perception is based on own experience:age/culture/ect.
96
Underreporting of pain often happens because of:
fear of addiction, don't want to be a bother, don't want to be considered week, afraid of side effects or death
97
Our job as healthcare providers is to:
believe the patient, educate about misperceptions and care for them.
98
Over reporting pain can occur because:
Patients think if they o not give a high number they won't get any pain medication. And addiction and medication seeking
99
General guidelines for treating pain control:
treat the causes, Administer medications routinely(ATC), instead of PRN.
100
Medication administration for pain, start with the least invasive route:
try oral medications first
101
Begin with a low dose:
titrate carefully until comfort is achieved(go slow)
102
More pain control guidelines:
Reassess and adjust dose frequently(every 15-30 minutes), Maximize pain relief while minimizing medication side effects, realize total relief is not realistic, and advise that physical dependence is not addiction
103
Types of Analgesia include:
non-opioid, opioid, adjuvant and other
104
Mild pain:
should be treated with a non-opioid or Adjuvant
| such as aspirin, acetaminophen, NSAIDS
105
Moderate pain:
opioid, non-opioid, adjuvant
| such as codeine, hydrocodone, oxycodone
106
severe pain:
should be treated with opioid, non-opioid, Adjuvant
| such as morphine, hydromorphone
107
Non-opioid medications:
non-addicting, antipyretic effects(fever reducing), work well alone for mild pain, when combined with opioids it enhances analgesic effect
108
acetaminophen(tylenol) indications and Adverse effects:
Indications: minor aches and pains, fever
| Adverse effects:can cause liver injury from overdose
109
ibuprofen(advil,motrin):
Indications: mild to moderate pain, arthritis, menstrual pain, fever
Adverse effects: gastrointestinal upset, bleeding
110
aspirin(ASA):
Indications:headache, mild pain, inflammation, fever, in low doses suppresses platelet aggregation(prevent heart attack)
Adverse effects: gastrointestinal upset, bleeding, renal impairment with excessive use
111
Ketoratac (Toradol):
Indications: moderate to severe pain, short term use only
| Adverse effects: gastrointestinal upset, bleeding, renal impairment
112
celecoxib(celebrex):
indications: arthritis, acute pain, menstrual pain
| adverse indications:gastrointestinal upset, abdominal pain, possible cardiovascular effects
113
Acetaminophen(APAP)
```
Action: Thought to slow productions of prostaglandins in CNS.
NO anti-inflammatory effects
Reduces fever
decreases opioid requirements
safe in children and the elderly
metabolized almost completely by the liver
Causes liver toxicity in high doses
Max dose: 4gm/day(if no liver disease)
Many recommend max dose of 2600 mg
#1 cause of liver failure in the U.S.
Antidote:Acetylcysteine (Mucomyst)
```
114
NSAIDS:
Mode of action is to prevent COX enzymes from releasing prostaglandins that cause pain, fever, and inflammation
Efficacy is similar amongst NSAIDS
They can however have difference in potency, time of onset, and duration of action
115
Prostaglandin effects by COX enzymes:
COX-1(Positive): Cox-2(Negative)
kidney-vasodilation site of injury-inflammation
platelet-aggregation Brain-pain sensation, fever
stomach-protect mucosa
116
side effects from NSAIDS:
gastric irritation/ulcers, kidney function/renal failure, bleeding-decreases platelet aggregation which can be positive or negative
117
Ibuprofen(motrin):
Initial choice for acute pain due to cost and safety
anti-inflammatory
antipyretic(reduces fever)
good for arthritis
hard on kidneys in large doses
Can cause GI irritation and u must watch for GI bleeding
Hemoptysis(bloody sputum)
for GI safety do not administer more than 1200mg/day
118
Cox 2 inhibitors
Selectively inhibit cyclooxyrgenase-2
-less GI irritation, less platelet effects, CV risks?
Celecoxib (Celebrex)
used for patients with low cardiovascular risk who require NSAID therapy and are at increased risk for GI toxicity
119
Aspirin(ASA)
Effective like acetaminophen for acute pain at similar doses
Worse side effect profile however than acetaminophen
Anti-inflammatory
Antipyretic
analgesic
anti-platelet
should administer with food to decrease GI upset burn, bleeding and tinnitus(ringing in the ears)
120
Overuse of aspirin in children can cause:
Rene Syndrome: Which is an extremely serious pathological condition associated with swelling of the liver and brain
121
Opioids:
-originally derived from poppies
-body possesses endogenous opioids:enkephalins/endorphins
-Opiate receptors include:
mu-primary site for opioids
delta
kappa
sigma
122
morphine:
Indications:moderate to severe pain
| Adverse effects: sedation, respiratory depression,nausea, vomiting
123
butorphanol(Stadol):
Indications:moderate to severe pain
| Adverse effects: sedation, respiratory effects
124
codeine:
Indications: cough, mild to moderate pain
| Adverse Effects: sedation, respiratory depression, nausea, vomiting
125
hydrocodone(vicadin):
indications: moderate pain
| Adverse effects: sedation, respiratory depression, nausea, vomiting
126
hydromorphone (dilaudid):
Indications: severe pain
| Adverse effects:sedation, respiratory depression, nausea, vomiting
127
fentanyl: (usually patches?)
Indications: severe pain
| Adverse effects: sedation, respiratory depression
128
Common side effects of opioids:
Respiratory depression:
- pay attention to timing of IV administration
- watch carefully for overdose
- Can cause constipation
- nausea/vomiting
- tolerance usually develops
- uticaria/pruritus(Hives/Itching)(Due to histamine release)
- Sedation(tolerance usually develops)
129
Morphine(Duramorph):
-Gold standard of opioid therapy
-relief of severe pain in hospital(most commonly)
Relieves dyspnea of acute left ventricular failure and pulmonary edema and pain of MI
130
MORPHINE mnemonic:
Miosis(pin point pupil), Orthostatic Hypotension, Respiratory Depression, Physical dependency, Histamine Release, Increased ICP(intercranial pressure),Nausea, Euphoria, Sedation
131
Nursing considerations for when administering meds like morphine:
-Baseline respiratory rate
-assess pupils
-constipation
-Risk for falls in elderly population
-several opiate combinations contain acetaminophen
like percocet(oxycodone/acetaminophen)
132
If a patient is having an opioid overdose, one of the main medications you can administer is
Naloxone(Narcan)
133
Naloxone(Narcan) is an
opioid antagonist
You would want to administer this to your patient if respirations were less than 9 BPM
-Naloxone knocks opioids out of opiate receptors
-GIve Naloxone(Narcan) slowly(unless major emergency)(too much morphine given)
-this med is now being used in both hospital and pre-hospital settings
134
Pentazocine(TAlwin):
Agonist-Antagonist Opioid
- Antagonist at Mu receptor
- Agonist at Kappa receptor
- Respiratory depression is limited
- Little to no euphoria
- less likely to become addicted
- can initiate withdrawal in opioid dependent patients
- Because of Mu antagonism
135
Advent pain medications are:
drugs that are primarily for treating conditions other than pain, but may have analgesic effects
136
Anticonvulsants: carbamazepine(tegretol), clonazepam(Klonopin), gabapentin(Neurontin):
used for chronic neuropathic pain. They require trials to determine the best choice with the fewest adverse effects. Requires monitoring of blood levels and titration.
137
Antidepressants: duloxetine(cymbalta), and amitriptyline(Elavil):
used for chronic neuropathic pain, May require trials to determine the best choice with the fewest adverse effects
138
Corticosteroids: dexamethasone(Decadron), prednisone:
used for anti-inflammatory effect
| Cannot be given simultaneously with NSAIDS
139
When treating pain in pediatric patients:
- Acetaminophen is the drug of choice
- use caution with concentration
- Careful dosing based on weight
- IBuprofen also OK
- alternate between acetaminophen and ibuprofen for fever or pain
- Opioids in kids are not well studied
140
Treating pain in the older adult:
-American Geriatric Society
-Acetaminophen should be initial consideration unless contraindicated
-CAUTION with NSAIDS
-CAUTION with narcotics(more likely to cause side effects)
-Older adults may be afraid of addiction
(Always educate)
_BEERS CRITERIA- list of meds older adults should avoid
141
Medications that have anti-inflammatory properties:
NSAIDS like ibuprofen(motrin), Celecoxib(Celebrex), ASA(Aspirin)....they WORK AT SITE
***Other analgesic medications work on CNS to change perception of pain
142
Corticosteroids: like Methylprednisone, Dexamethasone, and prednisone:
stop, control, or reduce the inflammatory response(local and systemic), in any part of the body, by suppressing the immune system.
143
Corticosteroids:
There is a slow internal and external deterioration of the body with use of them especially long-term, but the trade off is that the steroid in a chronic or autoimmune disorder will usually keep the body alive longer than if the inflammatory process was left unchecked.
144
Glucocorticoids for inflammation(corticosteroids):
are nearly identical to steroids produced by the adrenal cortex.
-Administered in morning(before 9 am) to mimic burst of glucocorticoids naturally released by adrenal glands each morning. This dosing prevents adrenal insufficiency.
145
Glucocorticoids:
when given in low doses, physiological effects are modulation of glucose metabolism in adrenocortical insufficiency.
when given in high doses they suppress inflammation
-Like NSAIDS, steroids reduce inflammation but are hard on the stomach
-however glucocorticoids are a safer choice than NSAIDS for people with kidney disease because they do not cause kidney problems
146
Glucocorticoids can cause
adrenal insufficiency with prolonged administration
Withdrawal can also occur: to avoid you should:
-taper dosage over 7 days
-switch from multiple doses to single doses
-taper dosage to 50% of physiologic values
-monitor for signs of insufficiency
147
GOUT:
is a recurrent inflammatory disorder, it is seen mainly in men
-It causes hyperuricemia-uric acid level greater than 7mg/dl in men or 6mg/dl in women
-uric acid crystals are deposited in joints
-EPisodes of severe joint pain(typically in large toe)
-Causes:
>excessive production of uric acid
>impaired renal excretion of uric acid
148
For short term to relieve symptoms of attack we should use:
NSAIDS because they are the first-line offense
Glucocorticoids can also be used.
These meds are good for infrequent flare-ups(fewer than 3/per year)
149
For long term(3+ times a year) to lower blood levels of uric acid, we would use:
uricosuric drugs
150
NSAIDS are the agent of first choice for acute gouty arthritis because:
they are better tolerated and more predictable than colchicine.
Relief should occur within 24 hours, and swelling should subside over the next few days.
151
Adverse effects of NSAIDS include:
GI ulceration, decreased renal function, fluid retention, increased risk of cardiovascular events.
152
Glucocorticoids like prednisone are:
highly effective in relieving pain, they are also useful for patients who are hypersensitive to , are unresponsive to, or have medical contraindicate the use of NSAIDS.
Avoid glucocorticoids in patients prone to hyperglycemia
153
Colchicine(COLCRYS):
Is an anti-inflammatory agent, is no longer the first-line drug.
It is reserved for patients who are unresponsive to or intolerant of safer agents
IT is not effective against other anti-inflammatory disorders:
treats acute gouty attack, reduces incidences of attack, and aborts impending attack.
154
Adverse Effects of of Colchicine:
gastrointestinal, myelosuppression, myopathy
Drug interactions: statins,PGP inhibitors, Inhibitors of CYP3A4
Precautions and contraindications: older adults, debilitated patients, patients with cardiac, renal, hepatic, and GI disease
Pregnant patients
155
Drug therapy for hyperuricemia:
goals of therapy are to:
- promote dissolution of urate crystals
- prevent new crystal formation
- prevent disease progression
- Reduce frequency of acute attacks
- improve quality of life
156
Drugs used in therapy for Hyperuricemia:
| *Because these drugs have no analgesic or anti-inflammatory actions, they are not useful in an acute gouty attack.
```
Allopurinol
-Inhibits uric acid formation
Febuxostat
-inhibits uric acid formation
Probenecid
-Increased uric acid excretion
Pegloticase
-Converts uric acid to allantoin, a compound readily excreted by the kidney
```
157
Allopurinol:
- Reduces blood levels of uric acid
- Often used to treat tophaceous gout or hyperuricemia due to chemotherapy
- It is the current drug of choice for chronic tophaceous gout
- It prevents new typhus formation and causes regression of tophi that have already formed.
- It allows joint function to improve
- Reversal of hyperuricemia also decreases risk of nephropathy from deposition of urate crystals in the kidneys.
158
Allopurinol works by:
Mechanism of action: it inhibits xanthine oxidase(OX), which is an enzyme required for uric acid formation.
159
Allopurinols adverse effects include:
- It is actually generally well tolerated.
- RARE but potentially fatal hypersensitivity syndrome
- initial therapy may elicit an acute gouty attack
160
Drugs for Rheumatoid Arthritis(Autoimmune inflammatory disease) Treatment:
- nondrug measures
- Relieve symptoms,
- Maintain joint function
- Mininimize systemic involvement
- Delay progression of disease
161
Classes of antiarthritic drugs:
* *NSAIDS
- Nonsteroidal anti-inflammatory drugs
* *DMARDS
- disease modifying antirheumatic drugs(traditional DMARDS, non-biological and biological DMARDS
* *Glucocorticoids(adrenal corticosteroids)
162
Drug selection for rheumatoid arthritis:
| NSAIDS
Nonsteroidal anti-inflammatory drugs
*First generation NSAIDS inhibit COX-1 and COX-2
*Second generation NSAIDS(coxibs):selectively inhibit COX-2(Celecoxib)
Long term use risk of GI ulceration and bleeding
163
Drug selection for Rheumatoid arthritis:
| Glucocorticoids
Glucocorticoids
-use oral glucocorticoids when symptoms are generalized
-can use intra-articular injections(one or two joints are effected)
-adverse effects
examples prednisone and prednisolone
164
Drug selection for Rheumatoid arthritis:
| DMARDs:
DMARD 1
-Methotrexate(Rheumatrex) is the most rapid acting DMARD, and is administered once a week
Therapeutic effects last from three to six weeks
*Advise clients that it can however take up to five months!
Adverse Effects include:
-Hepatic Fibrosis
-Bone Marrow suppression
-GI ulceration
-Pneumonitis
165
Drug selection for Rheumatoid Arthritis:
| DMARDS 2 are used in moderate to Severe RA
DMARDS2 are major Biologic DMARDS like Entanercept
They are tumor necrosis Factor inhibitors
-suppress immune function
-pose risk for serious infection
-work by neutralizing TNF
166
Adverse effects of Biologic DMARDS (2):
-serious infections, severe allergic reactions, heart failure, hematologic disorders, liver injury, Central Nervous System(CNS)demyelinating disorders
167
Headaches are triggered by a variety of stimuli:
stress, fatigue, acute illness, and sensitivity to alcohol
* Mild episodes are relieved by over the counter drugs(for example, aspirin, acetaminophen)
* Severe headaches-migraine, cluster, tension-type
168
Sinus headaches:
pain is usually behind the forehead and or cheekbones
169
cluster headaches:
pain is in and around one eye.
170
Tension headaches:
pain is like a hand squeezing the head
171
Migraine:
pain, nausea, and visual changes are typical of classic form
172
Migraine and cluster headaches have:
no identifiable cause
173
Identifiable underlying causes of headache include:
Severe hypertension, hyperthyroidism, tumor, infection, and disorders of the eye, nose, sinuses, and throat
174
Pathophysiology of Migraine headaches:
- Neurovascular disorder that involves the dilation and inflammation of intracranial blood vessels
- Vasodilaiton leads to pain
- Neurons of the trigeminal vascular system
- Calcitonin gene-related peptide(CGRP)
- Serotonin(5-hydroxytryptamine[5-HT])
175
Treatment of Migraines includes:
aborting an ongoing attack, nonspecific analgesics*aspirin like drugs and opioid analgesics like butorphanol, meperidine. Migraine specific drugs like serotonin receptor agonists, Ergot alkaloids
and trying to prevent attacks from occurring
176
Serotonin Receptor Agonist: Sumatriptan(Imitrex)
Mechanism of action is it binds to receptors on intracranial blood vessels and causes vasoconstriction
- diminishes perivascular inflammation
- Therapeutic use
- aborting an ongoing migraine attack to relieve headache and associated symptoms
- Pharmocokinetics
* oral and intranasal administration
177
Adverse effects of Sumatriptan:
- chest symptoms
- transient "heavy arms" or chest pressure experienced by 50% of users
- coronary vasospasm
- rare angina as a result of vasospasm
- Teratogenosis
- vertigo,malaise,fatigue, and tingling sensations
- very bad taste when taken in intranasal form
178
Serotonin Receptor Agonists drug interactions:
- Ergot alkaloids, sumatriptan, and other triptans(all cause vasoconstriction)
* *Preparations dosage and administration:oral or nasal spray
179
Sumatriptan is used in treatment of:
migraines and cluster headaches and tension headaches.
Treatments of headache include: rest, relaxation, stress reduction, acetaminophen, ASA, NSAIDS
For sinus headaches:
treat underlying infection, acetaminophen, aspirin(ASA), NSAIDS
