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PHARM > Week 9 - Analgesics > Flashcards

Week 9 - Analgesics Flashcards

1
Q

Essential function of COX-1 and COX-2

A

COX 1 - protects the stomach lining and regulates platelets

COX 2 - Triggers inflammation and pain

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2
Q

First generation NSAIDs relationship to gastric ulcers

A

NSAIDS inhibit both COX1 and COX2 – inhibition COX 1 leads to loss of stomach lining protection which leads to ulcers, and inhibits blood clotting leading to more bleeding

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3
Q 
Celecoxib (Celebrex) 
Class:
Who doesn't benefit?
Contraindications (4)
Caution (4)
A

2nd generation NSAID
-Patients who take ASA for MI or stroke do NOT benefit because ASA decreases the serum level of NSAIDs
Contraindications: severe renal or hepatic disease, asthma, peptic ulcers
Caution: bleeding disorders, early pregnancy, lactation, lupus

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4
Q

Naloxone (Narcan)
Class/function:
Nursing actions

A

Class: Opioid ANTAGONIST, antidote for opioid overdose, knocks opioid off the receptor sites, and knocks endorphins off receptor sites
-Do NOT push an entire vial immediately unless the condition warrants it

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5
Q

What does pushing an entire vial of Narcan immediately lead to?

A

Pain crisis

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6
Q 
Fentanyl (Sublimaze) 
Class/function:
Comparison to Morphine 
Metabolized by
Routes
Given when
Dosage
A

Class/function: Opioid ANALGESIC, adjunct to anesthesia
Comparison to Morphine: 100x more potent, more lipid soluble (faster onset)
Metabolized by liver
Routes - IM, IV, transdermal (for continuous pain control, caution with febrile patients)
Given in open heart surgery to protect myocardium from excessive O2 demands
Dosage in mcg

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7
Q

Aspirin (ASA)
Class:
Uses (5):
Mechanism:

A

Class: 1st generation NSAID
Uses (5): analgesic, anti-inflammatory, anti-platelet, anti-pyretic, CAD and MI/embolic stroke prophylaxis
Mechanism: Inhibits prostaglandin synthesis, inhibits hypothalamic heat regulator center, blocks thromboxane A2 synthesis

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8
Q

Aspirin (ASA) Dosage

  • Antiplatelet, analgesic
  • Arthritis
A
  • Antiplatelet, analgesic: 81 mg (Baby ASA), 325-650 mg PO q4hrs PRN – max 4 g/day
  • Arthritis: ceiling of 3-5 g/day
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9
Q

Aspirin (ASA)

  • Absorption
  • Distribution
A

Absorption: 80-100%
Distribution: 59-90% protein bound
Crosses placenta

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10
Q

Aspirin (ASA)

  • Metabolism (Half life)
  • Excretion
  • Contraindications (3)
A

Metabolism: 2-3 hrs (low dose), 2-20 hrs (high dose)
Excretion: 50% urine
Contraindications: hypersensitivity to salicylates or NSAIDS, 3rd trimester, flue or virus symptoms in kids (leads to Reyes)

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11
Q 
Aspirin (ASA)
Drug interactions (4)
A
  • Increased risk of bleeding with anticoagulants
  • Increased risk of hypoglycemia with oral hypoglycemic agents
  • Increased ulcerogenic effect with glucocorticoids
  • Potentiated by caffeine
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12
Q 
Aspirin (ASA) 
Lab interactions (3)
A
  • Decreased cholesterol (advantageous)
  • Decreased K, T3, T4
  • Increased PT, bleeding time, uric acid
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13
Q

Aspirin (ASA) side effects (9)

A
  • N/V, diarrhea, stomach pain
  • Heartburn
  • Dizziness, confusion, drowsiness
  • Rash
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14
Q

Aspirin (ASA)
Caution in
Adverse reactions (10)

A

Caution in renal and hepatic disorders
Adverse reactions: tinnitus, uticaria, peptic ulcer, anaphylaxis, bronchospasm, hepatotoxicity, agranulocytosis, hemolytic anemia thrombocytopenia, luekopenia

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15
Q

Aspirin (ASA)

  • Signs of overdose/hypersensitivity (3)
  • Treatment
  • If hypersensitive, what else should you not give
  • Foods that contain salicylates
A
  • Signs of overdose/hypersensitivity (3): tinnitus, uticaria, peptic ulcer
  • Treatment: activated charcoal
  • If hypersensitive, what else should you not give: Difulnisal (NSAID derivative)
  • Foods that contain salicylates: prunes, raisins, licorice, curry powder, paprika
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16
Q

Interactions between Aspirin and anticoagulants

A

Aspirin INCREASES BLEEDING with anticoagulants

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17
Q

Acetaminophen (Tylenol)
Uses:
Mechanism:
Routes (3):

A

Uses: Analgesic, anti-pyretic
Mechanism: Inhibits prostaglandins and heat-regulatory center in hypothalamus
Routes (3): PO, IV, suppository

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18
Q 
Acetaminophen (Tylenol) 
Dosage: 
Onset: 
Half life:
Antidote to:
A

Dosage: 325-650mg q 4-6hrs
Onset: 10-30 min
Half life: 2-4 hrs
Antidote to: Acetylcystine (Mucolytic), and charcoal (within 60 min of ingestion)

19
Q

Difference between Acetaminophen and NSAIDs

A

NSAIDs have anti-inflammatory effects where as acetaminophen does not – both are antipyretic and analgesic.

20
Q 
Ibuprofen (Motrin, Advil)
Class: 
Uses: 
Adult Dosage: 
Child Dosage:
A

Class: 1st generation NSAID, propionic acid derivative
Uses: Anti-inflammatory, analgesic, anti-pyretic
Adult Dosage: 200-800 mg PO tid/qid; max below 3.2g/day
Child Dosage: based on age and weight

21
Q 
Ibuprofen (Motrin, Advil)
Absorption: 
Half Life:
Excretion: 
Contraindications (3) 
Caution (4)
A

Absorption: PO is well distributed
Half Life: 2-4 hrs
Excretion: Urine and Bile (NSAIDs THINK KIDNEY)
Contraindications (3): severe renal or hepatic disease, asthma, peptic ulcers
Caution (4): bleeding disorders, early pregnancy, lactation, lupus

22
Q 
Ibuprofen (Motrin, Advil) 
Drug interactions (4)
A
  • INCREASED BLEEDING with anticoagulants
  • INCREASED effects WITH phenytoin, sulfonamides, warfarin
  • DECREASED EFFECT with Aspirin (do NOT take WITH aspirin)
  • Increases severe side effects of lithium
23
Q

Ibuprofen (Motrin, Advil)
Side effects (12)
Adverse (6)

A

Side Effects:

  • N/V, diarrhea, anorexia
  • Rash, edema, purpura
  • Fatigue, dizziness, lightheadedness, confusion
  • Anxiety, tinnitus

Adverse: GI bleed, heart disease, life threatening blood dyscrasias, dysrthythmias, nephrotoxicity, anaphylaxis

24
Q

Morphine Sulfate
Class:
Uses:
Mechanism:

A

Class: Opioid analgesic
Uses: Severe pain, pain/anxiety in MI, small doses for dyspnea
Mechanism: CNS depression depressed pain impulses

25
Q

Gold standard for analgesic effectiveness

A

Morphine

26
Q

Drug of choice for pulmonary edema

A

Morphine b/c it decreases preload

27
Q

Morphine
Distribution (PB, implications):
Half life:
Excretion:

A

Distribution (PB, implications): PB 30%, can cross placenta, excreted in breast milk
Half life: 1.5 - 2 hrs
Excretion: 90% in urine (adjust for renal patients)

28
Q 
Morphine Dosage (PO)
Adults:
Break through dose:
Sustained release: 
Duration of IR, SR:
A

Adults: 10-30 mg q 4 hrs PRN (limit on 24 hr amount)
Break through dose: q2hrs PRN
Sustained release: 15-30 mg q12hrs on the dot (titrate up PRN)
Duration of IR - 3-5 hrs
Duration of SR - 8-12 hrs

29
Q 
Morphine Dosage (SC/IM)
Adults: 
Onset:
Peak SC:
Peak IM:
A

Adults: 2.5-15 mg q 2-6 hrs PRN
Onset: 15-30 min
Peak SC: 50-90 min
Peak IM: 30-60 min

30
Q 
Morphine Dosage (IV) 
Adults: 
Inject over how long?
Onset:
Peak:
Duration:
Absorption:
A 
Adults: 2.5-15 mg q 2-6 hrs PRN
Inject over 5 min, can be diluted  
Onset: rapid 
Peak: 20 min 
Duration: 3-5 hrs
Absorption: rapid
31
Q

Morphine Contraindications (6)

A
  • Asthma + respiratory depression
  • Increased ICP
  • Shock
  • Hypotension
  • Ileus
  • Sleep apnea
32
Q

Morphine Caution (7)

A
  • Respiratory disease, renal disease, hepatic disease
  • MI
  • Elderly
  • Infants, children
33
Q

Morphine Drug interactions (2)

A
  • INCREASED EFFECTS with alcohol, sedatives, hypnotics, antipsychotics, muscle relaxants
  • INCREASED SEDATION with kava kava, valerian, St. Johns wort
34
Q

Morphine Lab interactions

A

Morphine INCREASES AST, ALT

35
Q

Morphine side effects (17)

A
  • Anorexia, N/V, constipation
  • Urinary retention
  • Drowsiness, confusion, sedation, hallucinations
  • Dizziness, blurred vision
  • Rash, pruritis, hives, itching at IV site
  • Bradycardia, flushing
  • Euphoria
36
Q

Morphine Adverse reactions (4)

A

Hypotension, uticaria, life threatening ICP, seizures

37
Q 
Nalbuphine (Nabuain) 
Class:
Uses: 
Side effects:
Adverse reactions (3):
A

Class: Narcotic Agonist-Antagonist prototype
Uses: moderate to severe pain, labor pain
Side effects: fewer than opioid agonists
Adverse reactions (3): bradycardia, tachycardia, hypo/hypertension

38
Q

What could Nalbuphine (Nabuain) produce?

A

Withdrawal symptoms

39
Q

Frequent narcotic use or dependence is NOT meant for…

A

Chronic or cancer pain

40
Q

Aspirin (ASA) and NSAID interaction

A

Aspirin decreases serum levels of NSAIDs

41
Q

What should you NOT take NSAIDs with?

A

Aspirin

42
Q

Relationship between NSAID and anticoagulants

A

INCREASED BLEEDING

43
Q

Allopurinol (Zylorpim)
Class:
Mechanism:
Uses:

A

Class: Anti-gout, uric acid inhibitor
Mechanism: Inhibits production of uric acid to prevent precipitation of gout attack or prophylaxis
Uses: Renal impairment, unresponsive to uricosurics

44
Q

Allopurinol (Zyloprpim)

Implications (5)

A
  • Avoid purine foods (fermented foods), caffeine, alcohol
  • Avoid large doses of vitamin C (risk for kidney stones)
  • Annual eye exams
  • INCREASE FLUID INTAKE to prevent kidney failure because it promotes diuresis and alkalinzation of urine
  • Take acetaminophen instead of aspirin

PHARM (11 decks)

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