UNIT 4: MEDS TO KNOW Flashcards
What class of medication is Naloxone?
Opiod antagonist; Antidote
Route of admin for Naloxone?
- IV (preferred)
- IM
- Sub q
- Inhalation
- IO
- oral
What are some warnings/precautions of naloxone?
- Acute opiod withdrawl
- R/t release of catecholamines which may precipitate acute withdrawal or unmask pain in those who regularly take opiods
- Combativeness
- Some patients may be agitated or combative when resuscitated with naloxone.
- Caution w/cardiovascular disease
- Seizures
- Opioid overdose symptom recurrence
- Recurrance of resp. and/or CNS depression is possible if the opiod involved is long-acting.
How long do you push naloxone?
Over 30 seconds as undilutaed or admin lower doses as a slow IV push.
What is the medical indication for the use of Naloxone?
For complete or partial reverasal of opioid toxicity (including resp depression) induced by natrual and synthetic opiods (methadone). It is also indicated for the diagnosis of suspected or known acute opiod overdosage
What is the MOA of naloxone?
Pure opioid antagonist that competes and displaces opiods at opioid receptor sites
What should we monitor for a patient who recieved naloxone?
- Resp status (oxygenation and ventilation)
- LOC
- HR
- BP
- Temp
- S/s of opioid withdrawal
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What are s/s of acute withdrawal in opiod-dependant patients?
- pain
- tachycardia
- hypertension
- fever/sweating
- abdominal cramps
- n/v/d
- agitation/irritability
What pharm class is Flumazenil
Benzodiazepine antagonist
What is the MOA of flumazenil?
Completely inhibits the activity at the benzodiazepine receptor site on the GABA/benzodiazepine receptor complex.
Flumazenil does not antagonize the CNS effect of drugs affecting GABA-ergic neurons by means other than the benzo receptors (ethonal, barbiturates, general anesthetics) and does not reverse the effects of opiods
What dietary considerations should we teach patients taking flumazenil?
avoid alochol for the 1st 24 hours after administration or as long as teh effects of benzos exist
What should we monitor for a patient when taking flumazenil?
- sedation, resp depression
- benzo withdrawals
monitor for at least 3 hours and until the patient is stable and resedation is unlikly.
What are some adverse reactions of flumazenil?
- Vomiting
- Cardiovascular flushing, palpitations, vasodilation
- Diaphoreisis
- Agitation
- Dizziness
- Blurred visision
- Confusion, lack of concentration
- Hiccups
What are some percautions we should keep in mind with flumazenil?
- Amnesia
- CNS depression
- Resedation
- Resp depression
- Seizures
What is the black box warning for flumazenil?
Benzo reversal may result in seizures
What pharm class is gabapentin?
Antiseizure
What should we inform patient to do when quitting gabapentin?
should be withdrawn gradually over 1 week or more to minimize the potential of increased seizure frequency or withdrawal symptoms
What are some clinical uses of gabapentin?
- Seizure prevention
- Epilepsy tx
- Neuropathic pain
- restless leg syndrome
What are some side effects of gabapentin?
- Signs of an allergic reaction: hives, itching, swelling, blistered or peeling skin, difficulty breathing
- Changes in mood or behavior
- Signs of liver abnormailities: yellowing of skin, whites of eyes, dark urine, light-colored stools, vomiting, unusal bleeding/bruising
- Signs of kidney abnormabilites: Trouble urinating, a change in how much urine is passed, blood in your urine, weight gain, swelling in legs and feet
- change in skin color, bluish color on skin, lips, nail beds
More common
1. tired
2. dizzy
3. headache
4. n/v
5. fever
6. recurring infections
7. memory loss
8. weight gain
9. eye problems
what is the clinical indication for gabapentin?
Indicated for the tx of postherpetic neuralgia in adults and for the adjunctive tc of partial onset seizure
What is the MOA of gabapentin
Inhibits the release of excitatory neurotransmitters
What are the black box warnings for Ketorolac?
- For short term (up to 5 days in adults) tx of moderatly severe acute pain requiring opioid-level analgesia and only as continuation of parenteral tx
- GI risk :bleeding
- Cardio: NSAID- thrombotic events
- Renal
- Bleeding risk
- Concomitant NSAID
What are some common reactions of torrodol?
- Headache
- nausea
- abdominal pain
- dizzy
- diahrehha
- HTN
- GI bleeding
- MI
- Stroke
What is the pharm class of ketorolac?
NSAID
What is the indication for Ketorolac?
It is indicated for short term managment of acute pain that requires the calibre of pain managment offered by opioids.
May be used post op, for spinal and soft tissue pain, RA, mentrual disorders, headaches,
What pharm class is methotrexate?
Anti-rheumatic drug (DMARD)
What are the clinical uses for methotrexate?
- Cancer
- Ectopic pregnancy
- RA
What are side effects of methotrexate?
- Diarrhea
- Dizziness
- Stomach pain
- Headache
- Nausea
What are some monitoring parameters for methotrexate?
- Dermatologic toxicity
- Hematologic tox complicaitons
- s/s of infectiong (during/after tx)
- S/s of pnumonitis (dry cough, nonproductive, fever dyspnia, hypoxemia, or pulmonary infiltrate)
- oncologic- baseline and frequent during tx: cbc with diff, platelets, cr, bun, lfts.
- For high doses monitor electrolytes at baseline and at least daily methotrexate levels, UO and ph.
- Chest xray- RA
The MOA of methotrexate
Methotraxate has more than one MOA. To get rid of cancerous cells, it acts as a folate antagonist that works by targeting an enzyme dihydrofolate reductase- an enzyme necessary for folic acid production. Folic acid is a necessary compound for nucleotide synthesis. Therefore its inhibition stops nucleotide formation. Methotraxate rargets actively dividing cells. Therefore, it is effective agaist cancer cells.
In inflammatory conditions, such as psoriasis and RA, methotrexate acts with a different MOA, giver intermittently once a week. It works by inhibiting enzymes involved in purine metabolism, leading to the accumulation of adenosine and its release from cells
Adenosine works by acting on cell surface receptors, suppressing the expression of adhesion molecules on tcells and neutrophils, eventually inhibiting their accumlation in inflammed tissue. Moreover, it lowers the release of cytokines from inflammatory cells. In this way methotrexate acts as an anti-inflammatory drug
What should we teach patients about methotrexate?
- Has a toxic effect on rapidly dividing tissues, esp. bone marrow. It can cause bone marrow tox, hepat tox, and PNEUMONITIS. to monitor for its toxcities, frequent blood counts and liver function testing should be done. Before the first prescription, a chest xray should also be done.
- Should be avoided in patients with renal impairment
- Avoid NSAIDS- like acetaminophen and asprin
- Report new onset symptoms like: blood disorders, mouth ulcers, sore throat, bruising… Liver tox: n/v/abdominal discomfort and dark urine, REsp: SOB
What is the black box warning for Lorazepam?
- Risks from concomitant use with opioids (injeciton,oral)- may cause profound sedation, resp depression, coma and death.
- The use of benzos including lorazepam, exposes users to risk of abuse, misuse and addiction which can lead to overdose and death.
- Dependance and withdrawal reactions.
What pharm class is lorazepam?
Antiseizure, benzos
How should we discontinue lorazepam?
Unless safety concerns require a more rapid withdrawal, gradually taper to detect remerging symptoms in patients receiving therapy more than 4 weeks or as appropriate.
What is the MOA of lorazepam?
Binds to benzodiazepine receptors on the postsynaptic GABA-a Ligand-gated choloride channel neuron at several sites within the central nervous system.
It is used to tx symptoms of anxiety, panic attacks and help calm you before procedures. It can help tx seizures and some sleep problems/
What are side effects of lorazepam?
- Feeling lightheaded, sleepy,or having blurred eyesight or change in thinking clearly
- dry mouth and blurred vision
- feeling tired or weak
- change in balance
what are s/s of overdose for lorazapam?
- Agitation
- changes in patterns and rhythms of speech
- confusion
- excitement
- increased sweating
- loss of strength and energy
- shakiness and unsteady walk
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what drug class is levofloxacin?
Fluroquinolone antibiotics used to tx different types of bacterial infections.
What is the MOA of levofloxacin?
Inhibit bacterial topoisomerase (DNA gyrase)–> stop bacterial DNA replication–> bacterial cell death
What are clinical indications for the use of levofloxacin
Infections caused by both gram negative and postive bacteria
1. Bacterial conjuntivites
2. Bacterial pneumonia
3. TB
4. GI infections
5. UTI
6. Gential infections (gonorrhea)
Route(s) of adminstration for levofloxacin
PO and IV
What are side effects of of levofloxacin
- Headache, restlessness, dizziness, confusion, depression, nightmares, insomnia, seizures
- GI distrubances: Abdominal cramp, n/v/d,
- Skin rash,
- blurred vision
- Tinnitus
- Chest pain, palpitations, qt prolongation
7.
What is the BBW for levofloxacin?
- Boxed warning: Myasthenia gravis (tendonitis and tendon rupture)
What do we need to assess for a pt talking levofloxacin?
- Vitals
- Injection site reactions
- CBC, ESR, Renal and liver function tests, Culture and sensitivity
How will we know that levofloxacin was effective?
- Absence of infection
- normal vitals
- decreased pain
What is our patient education for levoflaxacin?
- Purpose: eliminate bacteria causing infeciton
- take with full glass of water with or without food
- Take either 2 hours before or 6 hours after dailry products, mineral supplements or antacids
- Stay hydrated recommend. 2000 ml daily
- Complete entire course
- minimize sun exposure, wear sun screan
- Report tendon pain
- Abdominal cramping severe or bloody diahrrnhea report
- Mental status changes: anxiety, agitation, nightmares.
What pharm calss is haloperidol?
1st gen antipsychotic
What is the MOA of haldol
- D2 blockage in the mesolimbic pathway
2
What are clinical indications of haldol
- Schizophrenia
- Psychosis
- Acute mania
- Delirum
- Bipolor disorders
- OCD
What are side effects of haldol?
- EPS
- Dystonia (hours-days)
- Akathisia, pseudoparkinsonism (days-months)
- Tardive dyskensia (months- years)
- NMS (typical > atypical)
- Anticolinergic side effects
- dry mouth, blurred vision, urinary retention, constipation
- Orthostatic hypotension
- QT prolongation
- Sedation
- Metabolic syndrome
What are contraindications and cautions of haldol
- QT prolongation
- CNA depression
- Alcohol
- BBW- increased risk of death in elderly clients with dementia
- Clozapine
What assessments and monitoring do we do for haldol?
- Mental and vehavior status
- LOC
- weight
- vitals- assess for orthostatic hypotension
- Labortory: CBC, electrolytes, glucose, lipid profile, hepatic and renal funciton
- current meds
- Side effects
