Pharmacotherapeutics Exam 1 Flashcards
1
Q
Pharmacology
A
the study of substances that interact with living systems through chemical processes
2
Q
Toxicology
A
branch of pharmacology that deals with the undesirable effects of chemicals on living systems
3
Q
Drug vs Medicine
A
Drug:
Substances which act on the body and are used for prevention, diagnosis and treatment
Medicine:
Substances that have definite form and therapeutic use for treatment
all drugs are not medicine
All medicines are drugs
4
Q
Pharmacogenetics
A
using a persons genetic makeup to help guide drugs and their doses for a particular person
5
Q
Pharmacodynamics vs Pharmacokinetics
A
Pharmacodynamics (PD)
Drug action and mechanism
Pharmacokinetics (PK)
Absorption, distribution, metabolism, excretion
6
Q
Pharmacodynamics
A
What the drug does to the body
Drug action and mechanism
the biochemical and physiological effects of drugs on the body
the mechanisms of drug action in the body
the relationship between drug concentration and drug effect.
7
Q
Pharmacokinetics
A
What the body does to the drug
Absorption, distribution, metabolism, excretion
the rate and extent to which drugs are absorbed into the body and distributed to the body tissues
the rate and pathways by which drugs are eliminated from the body by metabolism and excretion
the relationship between time and plasma drug concentration.
8
Q
Targets for drug binding
A
Receptors
Ion channels
enzymes
transporters
9
Q
factors that can affect responses to drugs
A
Drug interactions
Adherence to a drug regimen
Tolerance and resistance
Vomiting
10
Q
DEA
A
The agency which controls the distribution of drugs that may be easily abused.
11
Q
FDA
A
The leading enforcement agency at the federal level for regulations concerning drug products.
12
Q
Controlled Substances Act of 1970
A
(CSA) established by US Congress, identifies 5 groups or schedules of drugs as controlled substances and put strict guidelines on their distribution.
13
Q
Drug schedules
A
I-V
Schedule I being worst, no acceptable medical uses, high potential for abuse
Schedule V being best , low potential for abuse
14
Q
Schedule I
A
Schedule I – High potential for abuse and no accepted medical use in the US.
Heroin, some opium derivatives, and hallucinogenic substances, Marijuana?
15
Q
Schedule II
A
Schedule II – High potential for abuse and may lead to physical or psychological dependence, but also has a currently accepted medical use in the US.
Amphetamines, cocaine, methadone, and various opiates
16
Q
Schedule III
A
Schedule III – Potential for abuse is less than those in Schedules I and II and there is a currently accepted medical use in the US, but abuse may lead to moderate or low physical dependence or high psychological dependence.
Anabolic steroids , compounds that contain codeine
17
Q
Schedule IV
A
Schedule IV – Low potential for abuse relative to Schedule III and current accepted medical use in the US, but abuse may lead to limited physical dependence or psychological dependence.
Phenobarbital, sedative chloral hydrate, and some anesthetics
18
Q
Schedule V
A
Schedule V – Low potential for abuse relative to Schedule IV and current accepted medical use in the US, but abuse may lead to limited physical dependence or psychological dependence.
Limited amounts of codeine included in this group
Exempt narcotics are in this group
19
Q
Florida prescription monitoring program
A
Eforce
20
Q
When must you have a written prescrition
A
Schedule II drugs require a written prescription
Schedule III - V may be oral or written (also fax)
21
Q
How are medications assessed
A
Medications are assessed based on safety, efficacy, and cost-effectiveness
22
Q
Efficacy
A
Efficacyis the capacity to produce an effect
maximum response that can be achieved by a drug
23
Q
Effectiveness
A
Effectivenessdiffers from efficacy in that it takes into account how well a drug works in real-world use
maximum response achieves when the drug is taken exactly as prescribed
24
Q
Drug Formulary
A
Drug formulary is a list of approved drugs that a health plan or a State/Territory, often has agreed to cover, and defines the prescription drug benefit
The purpose of using a drug formulary is to provide high-quality care using the most cost-effective medications. Typically, a drug formulary is developed by experts using clinical evidence.
25
Guideline vs protocol
A guideline is defined as "a statement or other indication of policy or procedure by which to determine a course of action."
In contrast, a protocol is "a precise and detailed plan for the study of a biomedical problem or for a regimen or therapy.”
26
Therapeutic index=
the ratio that compares the blood concentration at which a drug becomes toxic and the blood concentration at which the drug is effective
27
Pharmacodynamic-
activity of the drug at the site of action is directly or indirectly altered
28
Antagonism-
opposes the drugs action
29
Addition/summation-
opposes the drugs action adds to the drugs action
30
Synergism/potentiation-
enhances the action of the drug
31
a change in behavior caused by biochemical
Addiction: changes in the brain after continuous substance abuse
32
Dependence:
stopping would cause withdrawal (physical/mental symptoms)
33
Tolerance:
a state in which an organism no longer responds to a drug & a higher dose is required to achieve the same effect
34
Number 1 abused prescription drug
Alprazolam (Xanax) Number #1
35
FDA MedWatch
Prescribers are encouraged to voluntarily report any adverse effects by approved drugs.
Monitoring system
36
Recalls Class 1
Class I – strong likelihood that the product will cause serious adverse effects or death
37
Recalls Class 2
Class II – product may cause temporary but reversible adverse effects, little likelihood of serious adverse effect
38
Recalls Class 3
Class III– the product is not likely to cause adverse effects
39
Recalls
Action to remove a drug from the market and are voluntary on the part of manufacturer
3 classes
40
Drug regulatory authorities often have other important functions including:
Pharmacovigilance.
Regulating clinical trials.
Regulating herbal and homeopathic medicines.
Inspecting and maintaining standards of drug development and manufacture
41
Other offices of FDA
Center for Drug Evaluation and Research (CDER)
Center for Biologic Evaluation and Research (CBER)
Center for Devices and Radiological Health (CDRH)
Center for Food Safety and Applied Nutrition (CFSAN)
Center for Veterinary medicine (CVM)
42
Exclusivity
Exclusivity refers to exclusive marketing rights granted by the FDA upon approval and was designed to promote a balance between new drug innovation and generic drug competition.
Patents and exclusivity may or may not run concurrently and may or may not cover the same aspects of the drug product.
43
Patent / exclusivity Times
The terms also vary because a patent runs 20 years from filing (subject to extension) while exclusivity is granted according to the type of drug, usually between 6 months and 7 years.
Must demonstrate equivalence with FDA approval
Over 50% of all meds are generic.
44
Who can prescribe
Under the CSA, only licensed medical practitioners are authorized to prescribe controlled substances listed in Schedules II-V to patients.
45
Open vs closed formularies
“Open” formularies list drugs favored by the organization and serve an educational role. Typically there are no incentives to prescribe from the list.
“Closed” formularies are lists of drugs that are available for coverage by the organization. Coverage for medications not on the list may be available only if the physician believes that the drug is clearly preferable and obtains a waiver.
46
What can't A PA prescribe in FLorida
In State of Florida:
\
Prescribing physician assistants are able to prescribe any medication except those specifically prohibited by the Formulary Committee of the PA council and the Boards of Medicine.
47
Primary vs secondary caregiver
Primary (gatekeeper)
GP, faily physician, PCP, urgent care, ED
Secondary:
Specialists
48
Clinical testing phases
Phase 1-3 testing
| Phase 4 marketing
49
How are drugs classified
```
Body system (cardiology)
Therapeutic use (channel blocker)
site action (cellular site)
molecular structure (steroid, alkaloid(
Legal (schedule 1-5)
```
50
Medication reconciliation (MR)
The process of comparing a patient's medication orders to all of the medications that the patient has been taking.
This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.
51
```
Medication reconciliation (MR)
5 Steps
```
(1) develop a list of current medications
(2) develop a list of medications to be prescribed
(3) compare the medications on the two lists
(4) make clinical decisions based on the comparison
(5) communicate the new list to appropriate caregivers and to the patient
52
High risk medications list
A PINCH
```
Anti infectives
Potassium (electrolytes)
Insulin
Narcotics (sedatives)
Chemotherapeutic drugs
Heparin (anticoagulants)
```
53
JCO
| Do not use abbreviation list
```
U (unit)
IU (International Unit)
QD / QOD (every day)
Trailing zero (xxx.0mg)
MS, MSO4, MsSO4 (Morphine/mag sulfate)
```
Write out words
54
Osteoarthritis medications
NSAIDS
Capsacin
Duloxetine
Intraarticular glucocorticoids
55
Osteoarthritis, when to use capsacin
Topical capsaicin is an option when one or a few joints are involved and other interventions are ineffective or contraindicated; however, its use may be limited by common local side effects.
56
Cox 2 selective NSAIDS Drugs
Celebrex
57
Semi-selective NSAIDS Drugs
```
Meloxicam
diclofenac
etodolac
indomethacin
prioxicam
nabumetome
sulindac
```
58
non-selective NSAIDS Drugs
Ibprophen
| Naproxen
59
Irreversible non-selective NSAIDS Drugs
Asprin
60
What drug types should RA patients initially be started on
DMARDS
Shown better outcomes than NSAIDS & steroids
61
What test should you get if you are taking hydroxychloroquine
Eye exam
62
What test should you get if you are taking a biologic agent or Janus kinase (JAK) inhibitor
TB test
63
What tst should all patients get prior to intiating DMARD treatment
HEP B, HEP C screening
64
RA patients with flares
Patients with RA flares should be treated as patients with sustained disease activity and should have modifications of their baseline drug therapies
65
DMARD Types
```
TNF Inhibitors
Newer TNF inhibitors
B cell Agent
T cell action
IL 6 Inhibitor
```
66
Why DMARDS over other drugs
NSAIDS offer only symptomatic relief
They have no effect on bone or cartilage
Inflammation is maximal at an early age
If given early DMARDS can stabalize joint function near normal
67
Osteomyelitis antibiotic Unknown Pathogen:
Vanc
| Ceph (3rd or 4th gen)
68
Osteomyelitis antibiotic for Staph (non MRSA)
```
Nafcillin
Oxacillin
Cefazolin
Flucloxacillin
Ceftriaxone
```
69
MRSA Drug
Osteomyelitis
Vanc
| Alt - daptomycin
70
Gram negative pathogen drug
Osteomyelitis
```
cipro
levaquin
Ceph
Ertapenem
Meropenem
```
71
Enterococci drug
Osteomyelitis
Ampicillin
Aqueous Cyrstalline Penecillin G
Vanc
Combo: ampicillin plus Ceftriaxone
72
Streptococci Drug
Osteomyelitis
Ampicillin
Aqueous Cyrstalline Penecillin G
Ceftriaxone
Vanc
73
Cutibacterium Drug
Osteomyelitis
Aqueous Cyrstalline Penecillin G
| Ceftriaxone
74
Septic arthritis pathogen
Septic arthritis is usually monomicrobial.
Staphylococcus aureus (including methicillin-resistant S. aureus) is the most common cause of septic arthritis in adults
75
Acute Bacterial arthritis managment
Management of acute bacterial arthritis consists of joint drainage and antibiotic therapy.
76
Septic arthritis Drugs
Clindamycin (600mg TID)
Sulfa (2 DS tabs BID) or (4mg/kg per dose)
Doxy (100mg BID)
77
Three main therapeutic options for management of osteonecrosis
supportive care,
joint-preserving procedures (eg, core decompression and its variants, bone grafting),
total hip arthroplasty when advanced collapse has occurred.
78
Fibromyalgia treatment
Aimed at reducing the major symptoms
including chronic widespread pain, fatigue, insomnia, and cognitive dysfunction
May respond to non pharmacological measures
Psych factors, Cognitive behavior therapy
If meds are needed
amitriptyline, duloxetine, milnacipran, pregabalin
cyclobenzaprine is an alternative to amitriptyline
79
Fibromyalgia patients with severe sleep issues
pregabalin taken at bedtime
Gabapentin is an acceptable alternative for patients for whom cost or regulatory constraints limit the availability of pregabalin
80
Fibromyalgia Meds
amitriptyline, duloxetine, milnacipran, pregabalin
amitriptyline for sleep
cyclobenzaprine is an alternative to amitriptyline
81
Muscle relaxants approved for spaticity
baclofen
dantrolene
tizanidine
82
Muscle relaxants approved for muscle spasms
```
carisoprodol
chlorzoxazone
cyclobenzaprine
metaxalone
methocarbamol
orphenadrine
```
83
Differneces between Antispasmodic and antispastic agents
anti-spasmodics
Block nerves from signaling brain
Injury, trauma
Anti-spastics
Act on skeletal muscle, blocks nerves at spinal cord
MS, Stroke, CP, infection, spinal injury
84
Treatment for gout flares
Oral steroids, NSAIDS, or colchicine
Treatment depends on factors such as age, comorbidities, other medications etc.
Aspirin is not used for the treatment of gout flares because of the paradoxical effects of salicylates
85
NSAIDS for gout
Naproxen 500mg BID
or
indomethacin 50mg TID
86
In gout patients who are unable to take oral medications and/or who have only one or two actively inflamed joints
(and in whom infection has been excluded)
suggest arthrocentesis and intraarticular injection of glucocorticoids. We prefer triamcinolone acetonide
87
Gout patients on anti coags
low dose colchicine
88
Long term chronic gout treatment
improvement in patient physical function and health-related quality of life
Allopurinal
89
When should uricosuric agents be avoided (chronic gout)
Uricosuric agents should be avoided in patients with urolithiasis and risk of uric acid nephropathy.
90
Gout prophylaxis
colchicine
91
Pseudogout Joint injection
Injections into large joints, including the knees and shoulders, use triamcinolone acetonide mixed with 1 or 2 mL of 1% lidocaine.
92
Acute pseudogout not treated with injection
```
NSAID (naproxen 500BID)
or
Colchicine (1.2mg / 06.mg)
or
Oral prednisone (30-50 mg tapered)
```
93
JRA
NSAID for nondisabling symptoms
no Aspirin (Reyes Syndrome)
94
JIA
No cure for JIA
NSAIDS, Steroids (oral/injection), DMARDS, biologic agents
all help with.....
Decrease inflammation, pain, swelling
Make it easier for children to stay active
prevent damage to joints
increase quality of life
95
First step for osteopenia/osteoporosis
Lifestyle modification
smokin, vitamin D, calcium, exercise, fall prevention,alcohol
1200mg calcium 800mg Vitamin D
96
osteopenia/osteoporosis first line meds
Bisphosphonates (oral)
97
osteopenia/osteoporosis anabolic agent
teriparatide
98
IV bisphosphonate for osteopenia/osteoporosis
Zoledronic acid is the only IV bisphosphonate that has demonstrated efficacy for fracture prevention
99
Polyarteritis nososa MIld disease meds
Inital dose of prednisone
100
Polyarteritis nososa Mod/severe disease meds
glucocorticoids and cyclophosphamide combined
101
Polymyalgia rheumatica (PMR)
In all patients with PMR
initial treatment with prednisone.
The symptomatic response to glucocorticoid treatment is typically rapid
102
Polymiositis
for inflammatory myopathy associated with significant muscle weakness
We typically begin prednisone
We suggest initiating a glucocorticoid-sparing agent at the same time glucocorticoids are begun. The first-line glucocorticoid-sparing agents are azathioprine and methotrexate
103
Reactive arthritis (reiter syndrome)
Rare disease even in rheumatology
arthritis coexisting with infection
Pathogens are Chlamydia and trachomatis
104
Reactive arthritis (reiter syndrome) treatment
NSAIDS (not DMARDS)
(naproxen 500mg bid)
(diclofenac 50 mg TID)
(indomethacin 50mg TID)
if no response, then intraarticular glucocorticoids
105
Sjogren syndrome
All patients benefit from nonpharmacologic and preventive interventions
smiking, diet, meds, imms, pregenancy counseling
106
SLE (lupus) therapy goals
ensure long-term survival,
achieve the lowest possible disease activity,
prevent organ damage,
minimize drug toxicity,
improve quality of life,
educate patients about their role in disease management
107
SLE (lupus) nonpharm interventions
```
sun protection
diet
nutrition
exercise
smoking
imms
treatment of comorbidities
avoiding certain meds
pregnancy counseling
```
108
SLE (lupus) meds
hydroxychloroquine or chloroquine
with or without
nonsteroidal antiinflammatory drugs (NSAIDs),
and/or
short-term use of low-dose glucocorticoids
109
MOA of SLE drug Hydroxychloroquine
Hydroxychloroquine (antimalarial)
| inhibts chemotaxis of eosinophils and locomotion of neutrophils, impairs complement antibody reactions
110
MOA of SLE drug ibprofen
Advil
inhibits inflammatory reactions and pain by decreasing prostoglandin synthesis
111
MOA of SLE drug Naproxen
Aleve
inhibits inflammatory rxn and pain by decreasing cyclooxygenase
this results in prostoglandin synthesis
112
MOA of SLE drug DMARDS
Immunomodulators
Cyclophosphamide
113
Raynauds meds
-dipines (amlodipine, nifedipine etc)
Calcium channel blockers
White - no blood flow
blue - no oxygen
red - blood flow returns
114
Which of the below medication best treats Raynaud’s phenomenon?
Lisinopril
Nifedipine
Clonidine
Metoprolol
Nifedipine
115
What is the MOA for the drug Salagen?
Anticholinergic
TNF modulator
Histamine 2 blocker
Cholinergic
Cholinergic
116
Which of the below contraindication is a contraindication for the drug, denosumab (Prolia)?
Pregnancy
QT Interval prolongation
Hepatic dysfunction
Renal dysfunction
Pregnancy
117
Which of the below contraindication is not a contraindication for the drug, Probenecid?
Acute gouty attack
Uric acid kidney stones
Concomitant salicylates
Pregnancy
Pregnancy
118
Which of the following is the MOA for allupurinol?
Xanthine oxidase inhibitor
TNF Modulator
Folic acid antagonist
COX-2 inhibitor
Xanthine oxidase inhibitor
119
Which of the following is not a 1st-line medication for osteoarthritis?
Naproxen
Oxycodone
Duloxetine
capsaicin
Oxycodone
120
What the precise mechanism of action for the drug Celebrex?
Semiselective for COX
Selective for COX-2
Nonselective to COX-2
Selective for COX-1
Selective for COX-2
121
Acute vs chronic pain
Acute -
cause generally known
short duration of pain
usually self limiting
Chronic-
Cause often unknown
pain persists
outcome is often pain control
122
Nociceptive pain
Pain due to actual tissue injuries such as burns, bruises or sprains
123
Neuropathic pain
Peripheral neuropathic pain as the case post-herpetic neuralgia or diabetic neuropathy
Central neuropathic pain - cerebral vascular accident sequella
124
Psychogenic pain
Pain caused by psychologic factors such as headaches or abdominal pain caused by emotional, psychological, or behavioral factors
125
Breakthrough pain
Rapid onset
severe
self limiting
types: incident, spontaneous/idiopathic, end of dose failure
126
Incident pain
A type of breakthrough pain
Induced by activiteis like moving, walking, coughin, talking, turning in bed
127
Glutamate
main excitatory neurotransmitter in the nervous system
leading role in pain transmission
role inchronic pain
128
Substance P
Neurons release substance P
It then stimulates mast cells and blood vessels
129
Nerve Growth Factor
makes a protein called nerve growth factor beta (NGFβ)
important in the development and survival of nerve cells
especially those that transmit pain, temperature, and touch sensations (sensory neurons).
130
Pain assessment tools
Universal (1-10)
Verbal descriptor (no pain/ severe pain)
Wong baker (faces
Activity tolerance (No pain/can be ignored/bedrest required)
131
S/S of pain
```
Dilated pupils
diaphoresis
Pallor
vasoconstriction
elevated resp
elevated HR
elevated BP
elevated BGL
```
132
Drugs that can mask pain
SSRIs and SNRIs
133
Narcotic vs opioid
Narcotic-
Produce sleep, or stupor while also relieving pain
Opioid-
any synthetic compound that has opiate like qualities but is not derived from opium
134
Narcotic
Produce sleep, or stupor while also relieving pain
135
Opioid
any synthetic compound that has opiate like qualities but is not derived from opium
136
Narco
Numbness (Greek)
137
Opiate
A compund derived from the opium plant
138
Opioid pathways
Peripheral sensitization
Descening modulation
Central sensitization
139
Opioid Receptor Mu
```
Analgesia
miosis
Respiratory depression
euphoria
physical dependence
suppression of opiate withdrawl
```
140
Opioids
semi-synthetic
vs synthetic
```
Semi- synthetic
substituted derivatives of morphine and codeine
hydromorphone
oxymorphone
levorphanol
oxycodone
hydrocodone
```
```
Synthetics
Non morphians
Meperidine
Fentanyl
Sufentanil
Alfentanil
Remifentanil
```
141
Opioids
| semi-synthetic
Substituted derivatives of morphine and codeine
```
hydromorphone
oxymorphone
levorphanol
oxycodone
hydrocodone
```
142
Opioids
| synthetic
Non morphians
```
Meperidine
Fentanyl
Sufentanil
Alfentanil
Remifentanil
```
143
Non opioid analgesics
```
Acetaminophen (tylenol/paracetamol)
Aspirin (ASA)
Ibprofen (motrin)
Tramadol (ultram) (***opioid agonist but non opioid)
Ketorolac (toradol)
```
144
Types of pain antidepressants can treat
Neuropathic
fibromyalgia
nociceptive
145
Med for Postherpetic neuralgia
Gabapentin
| Lyrica (pregabalin)
146
Med for Diabetic neuropathy
```
Carbamazepine
phenytoin
gabapentin
lamtrigine
Lyrica (pregabalin)
```
147
Topical treatments
Lidocain and capsaicin are topical & local
Lidocaine blocks nerves from feeling pain
Capsaicin depletes local neurons of substance P which is needed for nociceptive pain signals
148
How does lidocaine block pain
Lidocaine blocks nerves from feeling pain
149
How does capsaicin block pain
Capsaicin depletes local neurons of substance P which is needed for nociceptive pain signals
reversibly deplets sensory nerve endings of substance P and by reducing the density os the epidermal nerve fibers
150
MOA of Lidocaine
Alters depolarization in neurons by blocking the fast voltage gated sodium channels in the cell membrane
With sufficient blockade, the membrane of the presynaptic neuron will not depolarize and so fail to trasnmit action potential, leasding to anaesthetic effects
151
MOA of capsaicin
reversibly deplets sensory nerve endings of substance P and by reducing the density os the epidermal nerve fibers
152
Long acting vs Ultralong acting drugs
Long acting
Morphine, oxycontin
Ultralong acting
methadone
153
Pain assessment
A thorough pain assessment is vital to the initial evaluation of a patient and must be performed to guide treatment decisions
154
opioid naive
Naïve implies that the patient is not already taking opioids
“Opioid tolerant” implies patients are chronically receiving opioids on a daily basis.
Opioid naïve implies patients are not chronically receiving opioids on a daily basis.
Some states “Opioid naïve” means a patient who has not used opioids for more than seven consecutive days during the previous 30 days
155
How can dosing be done
incrementally or through titration
156
Cross tolerance
the development of tolerance to the effects of pharmacologically related drugs, particularly those that act on the same receptor site
157
equianalgesia
“approximately equal analgesia,”
is used when referring to the doses of various opioid analgesics that are estimated to provide the same pain relief
158
Nociceptive first line treatment
NSAIDS
159
Neuropathic first line treatment
Anti-depressants (TCA's, SNRI)
or
anti-epileptic drugs
160
Central sensitization first line treatment
Anti-depressants (TCA's, SNRI)
or
anti-epileptic drugs
161
Neuropathic pain
| 1st, 2nd, 3rd line
1st: Antiepileptic, antidepressnts
2nd: capsaicin, lidocaine patch, tramadol
3rd: botulinum toxin, strong opioids
162
Partial agonsit
buprenorphine
| Subutex
163
opioid antagonists
Naloxone (Narcan)
| Naltrexone (Revia)
164
Naloxone (Narcan)
vs
Naltrexone (Revia)
Naloxone (Narcan)
reduces the effects of oan opiate or overdose
Naltrexone (Revia)
used to help treat addicts and alcoholics who are trying to quit
165
Opioid misuse
use in any way not directed by a prescriber
166
Diversion
when the legal supply chain of prescription analgesic drugs is broken, and drugs are transferred from a licit to an illicit channel of distribution or use
167
Abuse
regularly uses drugs
vulnerable to drug problems
neglecting responsibilities
do not exhibit dependence symptoms
168
Addiction
ABCDE
```
In ability to ABSTAIN
Impairment in BEHAVIOR control
CRAVING or increase hunger for drug
DIMINISHED recognishion of problems with behavior
A dysfunctional EMOTIONAL resonse
```
169
Toxicity
Overdose
An overdose occurs when too much opioid fits in too many receptors slowing and then stopping breahting
170
Withdrawal
following cessation of opiates, alcohol or benzos
within 2 to 4 days with methadone and 8 to 10 hours after meperidine
include excessive lacrimation, sweating, piloerection, rhinorrhea, repeated yawning, myalgia, nasal congestion, diarrhea and abdominal cramps.
symptoms usually peak between 36 to 48 hours and gradually subside in 72 hours.
chronic drug addicts, the symptoms may last for 7 to 14 days
severe withdrawal cases, one may use clonidine
171
Marijuana Schedule
Schedule 1
| most opioids are schedule II
172
Chemicals of marijuana
TetrahyrdoCannabidol (THC)
Psychoactive compound
Cannabidol (CBD)
no psychoactive properties
173
States marijuana is legal
33 states allow medical marijuana
11 states allow recreational marijuana
174
General vs local
General
Synaptic block
Local
Conduction block
175
5 types of local anaesthesia
```
Topical
infiltraion
Nerve Block
Spinal
Epidural
```
176
Amides vs esters
Amides have 2 i's in name
i.e. Bupivacaine
Esters have 1 i in name
i.e. Tetracaine
177
Nitrous oxide MOA
Antagonism of NDMA receptors in CNS
178
What to do when opioids are required
Check E force database
| also should check for any controlled substance
179
If an opioid use disorder is identified
ensure patient has immediate access to effective addiction treatment including initiation of medication for opioid use disorder
(ie, methadone, buprenorphine, naltrexone).
180
Mild Pain treatments
NOT opioids
Tylenol
NSAIDS
Cox 2
181
Moderate Pain treatments
Oxycodone 3-4 tabs of 5mg QD
hydrocodone 3-4 tabs of 5mg QD
hydromorphone 3-4 tabs of 2mg QD
Tramadol- avoid prescribing due to unreliable analgesia
can be used if others are unavailable for use
(3-4 50mg tabs QD)
For older frail adults, lower opioid doses
2.5mg QD
182
Severe Pain treatments
Oxycodone 4-6 tabs of 5mg QD
hydrocodone 4-6 tabs of 5mg QD
hydromorphone 4-6 tabs of 2mg QD
183
7 steps of prescription
```
Precribers info
Patient Info
Recipe (Rx)
Signatur (Sig)
Dispensing instructions (Disp)
Number of refills
Prescribers signature
```
