PHARM EXAM 2 Flashcards

Question

Special info for Fentanyl

Answer 1

- rapid IV injection or large doses can lead to muscle rigidity - topical patches Duragesic used for long acting pain relief is used every 72 hours BUT only give this to someone who has been on opioids and has some degree of tolerance; also never give on a heated area - Lozenge on stick (Actiq) and buccal tablets (Fentora)

Answer 2

- similar to morphine - Central action on perception of pain [in the brain]. Primary site is sensory cortex. Also alters attitudes by psychological, sedative, and hypnotic effects.

Answer 3

-benzodiazepine -acts on the limbic, hypothalamic regions to cause CNS depression, and skeletal muscle relaxation -also prevents seizure activity (probably potentiates GABA)

Answer 4

1. Respiratory depression/arrest 2. Decreased alertness 3. Amnesia 4. Hypotension 5. Tachycardia 6. Laryngospasm 7. Muscle tremors BLACK BOX WARNING

Answer 5

1. produces an anterograde amnesia effect and decreases anxiety 2. has a prolonged post anesthetic recovery compared to barbs 3. other Benzos- diazepam (Valium), lorazepam (Ativan)

Answer 6

1. Mepivacaine (Carbocaine)-short duration 2. Lidocaine (Xylocaine) 3. Long acting Bupivocaine Marcaine

Answer 7

1. loss of all sensation occurs, but pain fibers affected first 2. If it becomes systemic, can have serious reaction--especially heart and brain 3. VASOCONSTRICTORS must be used to decrease systemic absorption 4. Topical example= Benzocaine

Answer 8

non-depolarizing (competitive) neuromuscular blocking agent

Answer 9

Prevents acetylcholine from acting by occupying cholinergic receptor sites. Competitive antagonist. - Jumps on ACH receptor site – attracted to same receptor site - Stays there so ACH cannot bind so muscle cannot contract

Answer 10

1) tachycardia 2) muscle weakness 3) salivation 4) HTN

Answer 11

by administering anticholinesterase like Neostigmine (allows for accumulation of Ach, or a newer agent called sugammadex -this will lead to muscle contraction

Answer 12

depolarizing neuromuscular blocking agent that looks like Ach to the body except it gives an extended depolarization and does not allow for repolarization

Answer 13

Repolarization of end-plate does not occur after discharge. Resembles acetylcholine - but produces more prolonged depolarization of motor endplates--partially due to slower inactivation by cholinesterase. - Causes twitchy contraction throughout body and doesn’t allow for a second one b/c no repolarization  causes the person to be paralyzed

Answer 14

- Muscle weakness, bronchospasm, apnea, bradycardia, hypotension, arrhythmias, increased salivation, *postop muscle pain*, hyperthermia. However, has low level toxicity.

Answer 15

Post op muscle pain

Answer 16

- Central action on perception of pain [in the brain]. Primary site is sensory cortex. Also alters attitudes by psychological, sedative, and hypnotic effects. - opioid agonist

Answer 17

1) analgesia 2) drowsiness 3) changes in mood 4) euphoria (+) or negative 5) mental clouding

Answer 18

1) Miosis- constricted pupils 2) Depresses brain stem, decreases response to CO2 3) Post-medualla-chemoreceptor trigger zone (CTZ) is directly stimulated--> makes people nauseous and vomit

Answer 19

- the very young, - those w underlying respiratory disease - elderly

Answer 20

while patient is laying supine, there is no major effects on BP, pulse rate and rhythm but it DILATES THE VESSELS leading to POSTURAL HYPOTENSION - we also don't give morphine if they have a head injury because it also dilates the cerebral vessels which may further increase ICP - most opioids provoke the release of histamine which may be the cause of hypotension

Answer 21

CONSTIPATION 1) decreases motility 2) decreases secretions

Answer 22

URINARY RETENTION a. ureter-- INCREASES tone and amplitude of contractions of ureters, especially lower 1/3 b. bladder-- INCREASES tone leading to urgency. Increases tone of sphincter leading to retention INCREASE tone of contractions makes you feel like you have to urine but  tone of sphincter will not allow you to urinate c. uterus--prolongs labor; male-decreases libido d. bronchial--large doses lead to bronchoconstriction

Answer 23

therapeutic doses cause cutaneous blood vessels to dilate--leading to flushed and warm face, neck and upper thorax. (may be due to release of histamines--also reason for pruritus and sweating.)

Answer 24

1) Antipyretic 2) Anti-inflammatory 3) Analgesia 4) Anti-coagulation/Anti platelet 5) GI- local irritation and also stimulation of vomiting center in the brain

Answer 25

1) Topical NSAIDs should be considered before oral NSAIDs for knee and hand osteoarthritis pain (Voltaren) 2) Therapeutic response usually occurs in 2 weeks for chronic disease. 3. Give with food to reduce GI symptoms. 4. ALL NSAIDs except salsalate and celecoxib can interfere with platelet function and prolong bleeding time. This effect is reversible (unlike aspirin). 5. Contraindicated in patients with a history of aspirin-induced bronchospasm, or those with symptoms of asthma, rhinitis, nasal polyps, angioedema, urticaria 6. If any visual difficulties with the drug should have a complete eye exam and stop drug. 7. New drug – Caldolor – IV ibuprofen (rarely used)

Answer 26

``` Class effect – “potential increased risk for cardiovascular events” Can increase risk of thrombotic events, MI, CVA, and heart failure – especially with higher doses, longer use, or in patients with CV disease or risk factors for CV disease • Entire class of NSAIDs  risk of CV disease (MI, stroke, etc.) ```

Answer 27

* Affect protein synthesis in the bacteria – NOT cell walls * Either bactericidal or bacteriostatic * Used for serious infections  usually gram (-) organisms * Monitor peak and trough levels closely! – coordinate w/ lab values

Answer 28

• Probably the most extensively-used antimicrobials worldwide o Each generation has better improvements • Generic name = “ – Cef” or “ – Ceph” • Often used as an alternative to penicillins (especially in penicillin-allergic individuals) o Fewer people are allergic to cephalosporins

Answer 29

o One of the first major class of anti-infective agents o Work by interfering w/ proper bacterial cell wall formation o Allow cells to take up water – increases osmotic pressure, then they can rupture  Make faulty cell well when organism is forming then water can leak in and organism can burst o GI side effects most common, but group also causes allergic and anaphylactic reactions o Generic names = end in “ –cillin”

Answer 30

Immunosupressant, Anti Inflammatory Action: works by inhibiting cell proliferation by interfering with synthesis of DNA and RNA -affects purine metabolism

Answer 31

used to prevent organ transplant rejection but in many parts of the world it is used as an inflammatory still due to it's immunosupression

Answer 32

1) Bone marrow suppression 2) Jaundice 3) Hemorrhagic cystitis 4) N/V, anorexia 5) increased risk of infection 6) Cancers/ neoplasms bc of the immunosuppression