Flashcards in 24. Pharmacology: Part II (Narcotics-Non narcotics) Deck (120):
Gold standard of narcotics
Narcotics are derived from what type of plant?
Poppy plant : Papaver somniferum
Narcotics are also known as (3Os)
3 receptors of narcotics
Drugs with morphine-like properties that acts in CNS
Opioid receptors (mu kappa delta) nakikita sa: Limbic system (emotion center)
* Narcotics = controls pain and reaction to pain
: (because inaalter ung limbic system)
🔺Hippocampus - memory center
🔺Amygdala - resp for fear,anger, arousal; (almond shape)
🔺substantia nigra - dopamine production
🔺basal ganglia - voluntary motor movts
Most common side effect of narcotics
- (Area Postrema)
Part of nervous system that controls
📌 action of narcotics???
Solitary nuclei - gag,cough reflex..
📌 Narcotics suppresses cough reflex
Narcotics that suppresses Cough reflex
"anti tussive" (Dextromethorphan)
Drug taken to inhibit gastric motility
BQ: "gate" in gate control theory
Substantia gelatinosa of Rolando
Most accepted theory for pain;
- painful stimulus: gate opens
- non painful: gates closes
Gate control theory
BQ: What are the endogenous opioids produced by our body?
BQ: Narcotic agents blocks pain in the "peripheral" nervous system. True/False?
False - blocks pain in CNS!
BQ: What is the combination of Diphenoxylate and Atropine
Induces gastric motility
Therapeutic effects of Narcotics:
BQ: what kind of drug is Guaifenesin?
Most common side effect of narcotics
BQ: drug that puts patient in "trans like state"
Adverse effect of narcotics which is opposite of euphoria
Most serious side effect of narcotics
BQ: Morphine Triad (due to overdose)
Miosis (pupillary constriction:pinpoint)
BQ: What are the components of Neuroleptic analgesia? (Anesthetic technique that puts px in stage 1 anesthesia)
1. neuroleptic agents/antipsychotics
- Butyrophenones : (induces hallucinations)
3. Nitrous oxide (optional)
BQ: What is the drug that causes "dissociative" anesthesia? / "trans like state"
- conscious mind separated from body
- "trans like state"
BQ: What type of drugs are contraindicated to glaucoma
Ano nakikita ng patient na may glaucoma?
BQ: type of NARCOTIC drug contraindicated to glaucoma?
Meperidine (may slight anticholinergic effect)
BQ: Drug contraindicated to glaucoma
choices: one of "DiTriBeAM" bec it has slight anticholinergic
Is Diphenhydramine contraindicated to glaucoma? Yes. (All DiTriBeAM sa boards)
Drug used for severe orofacial pain
- "prodrug" : converted to morphine
- common na ginagamit sa dental: bec low drug dependence
Acetaminophen is similar with what drug in ph
Acetaminophen : Paracetamol
Tylenol ~~~~~~~ Biogesic
Other term for acetaminophen
Oxycodone + Acetaminophen = what brand name?
What is the route of administration of morphine and meperidine
More potent than morphine
BQ: strip name of drugs
- "Big H"
- "Brown sugar"
Strip name of cocaine
"Poor man's cocaine"
Dental disease assoc with Methamphetamine HCl
- Meth = enhances sympathetic nervous system
- Saliva during symp = ⬇️ = Xerostomia ➡️ Caries and Perio dse = METH MOUTH!!!
Strip name of "MJ" / "Weed" / "Blunt"
Marijuana (Cannabis sativa)
BQ: Drug that shouldnt be combined with MAO-Inhibitors
BQ: Narcotic antagonists
("naltrexone" : pag wala sa choices ung naloxone)
BQ: Give 4 drugs that are associated with respiratory depression and dependence
BQ: "non schedules narcotic" (no prescription needed)
BQ: Drugs with different classification
BQ: Some narcotics(depressant) that are metabolized to a CNS stimulant by the LIVER
Meperidine (Demerol) ➡️ "nor"meperidine
Propoxyphene (Darvon) ➡️ "nor"propoxyphene
BQ: Study SCHEDULE II drugs : HIGH potential for abuse or dependence
1. Hydromorphone (Dilaudid)
2. methadone (Dolophine)
3. Meperidine (Demerol)
4. Oxycodone (percocet)
5. fentanyl (sublimaze, duragesic)
BQ: Impaired control over taking the drug
(Pag nasa isip mo ung drug)
Continued administration of the drug is required to prevent unpleasant "withdrawal syndromes" ✅ (Ex. Alcoholic, smokers)
- "hinahanap ng body mo yung drug"
BQ: Increasingly large dose of narcotics are required to produce the same degree of analgesia (Ex. Caffeine)
BQ: Opioid withdrawal: Life threatening or not?
Not life threatening
Most common drug assoc with withdrawal symptoms
Alcohol (life threatening)
4 na kailangan para makapag induce ng General anesthesia = which results to COMA
Stage na delikado or critical sa patient
- dapat maging stage 3 na agad
- uses FAST ACTING / Ultrashort
End of stage 1 and start of stage 2
Desirable stage during GA
Guerin's stages of General Anesthesia
Stage 1 - Amnesia and analgesia
Stage 2 - Excitement and Delirium
Stage 3 - Surgical anesthesia
Stage 4 - Medullary Paralysis
Inhalational drugs used in GA
Short acting hypnotic agent
Used for dissociative anesthesia
Ketamine (trans like state)
Blocks pain mainly in the PERIPHERAL NERVOUS SYSTEM
- Doesn't have CNS depression effects
- Doesn't act in Opioid receptors
Non narcotic analgesics
Non narcotic analgesics
General pharmacological effects of Non narcotics
Mild to mod pain
Controls fever / antipyretic
Non narcotic analgesics block what enzyme resulting to decrease prostaglandin production
BQ: Prostaglandins produced in CNS causes:
Fever and pain
BQ: Prostaglandins produced in PNS causes:
Enzyme that breaksdown PHOSPHOLIPID BILAYER during tissue damage
Breakdown of Phospholipid bilayer by Phospholipase A2 results to production of what chemical?
Once arachidonic acid goes to the RESPIRATORY SYSTEM, It will bind to what enzyme?
Arachidonic acid + Lipooxygenase =
Production of LEUKOTRIENES
Binding site of Leukotrienes
Leukotriene-Receptor sa Lungs
Binding of Leukotrienes to Leukotriene-receptor sa lungs = it will result to?
- main reason kaya nagkaka-ASTHMA
Drug that inhibits "lipooxygenase pathway"
✅ It creates a barrier = so that Leukotrienes can't bind to the receptors.
✅ prevents Bronchoconstriction
Leukotriene receptor blocker
BQ: Example of a "Leukotriene receptor blocker" that prevents ASTHMA
If yung Arachidonic acid nakarating sa CNS - it will meet what enzyme?
COX2 in CNS converts AA into:
Prostaglandins: (pain and fever)
COX1 in PNS converts AA into:
Thromboxane A2 (platelets: blot clotting)
- protects stomach
- Inc renal blood flow
Prostaglandin that protects stomach and increases renal blood flow is derived from?
AA + "COX1" in PNS
COX2 in PNS converts AA into:
- inflammation (vasodilation=inc blood flow)
Enzyme responsible pag nagkakaroon ng WOUND
COX2 of PNS
(Converts AA into Prostaglandins and Prostacyclins = pain and inflammation)
Produced mainly by platelets: Helps in blood clotting
BQ: What are the 3 end products of cyclooxygenase pathway?
BQ: An Exception: CENTRALLY ACTING Non-narcotic analgesic
(*non narcotic=PNS acting*)
Acetaminophen inhibits what enzyme?
Cyclooxygenase (COX2 in CNS)
-inhibits pain and fever
Is acetaminophen/paracetamol an NSAID?
No. Not an NSAID!
- bec it doesnt have an anti inflammatory effect/ doesnt control swelling
Centrally acting analgesics
Peripherally acting analgesics
NSAIDS acts on CNS/PNS???
Nsaids - PNS
NSAIDS inhibits what enzymes?
Cox1 and Cox2 in PNS
Toxic effects of NSAIDS
- "reduces formation of blood clot" (TXA2)
- "gastric irritation/ulcers" (removes prostaglandins that protects stomach)
- "kidney damage" (removes prostaglandins na nagiincrease ng renal blood flow)
Therapeutic effects of NSAIDS
(-inhibits prostaglandins and prostacyclins)
Aspirin is an active or inactive drug?
Inactive / "prodrug"
- converted to SALICYLATES
Peripherally acting drug
BQ: Side effect of aspirin pag binigay sa child with viral infection
(Viral inf presents "fever": Aspirin has mild effects on CNS kaya mej anti pyretic dati!now anticoagulant na!)
Is Aspirin sometimes classified as "NSAID"?
Yes: Aspirin = NSAID ✅
(Has mild anti inflammatory effect)
BQ: MOA of aspirin? Why is ASPIRIN used as a "blood thinner" or "anticoagulant"?
Aspirin "IRREVERSIBLY blocks COX1"
(*Platelets uses COX1 to produce TXA2*)
ASPIRIN kahit wala na sa body: causes platelets to be permanently damaged or non functional=hindi na makakaproduce ng TxA2 which is resp for blot clotting = Kaya ginagamit sya as anticoagulant but lasts only until 10 days (lifespan ng platelets)
* Unlike sa NSAIDS: Once na nawala NSAID sa body (after 4hrs): platelets will restore cox1 = can produce TXA2 again
BQ: How many days prior to surgery must the patient stop taking Aspirin?
7 days (stop!)
NSAIDS that selectively blocks COX 2
*Cox2 lang iniinhibit therefore:
Cox1❌: No adverse effects: gastric irritation, renal damage, inc bleeding tendency
Drug examples of Cox2-inhibitors
BQ: which of the ffg drugs na wag ibibigay sa patient prior to surgery?
NSAID (ung nasa choices)
*specifically: Aspirin dapat: but aspirin is considered a NSAID*
(Nsaids like mefenamic acid ok lang ibigay before surgery)
Only non narcotic analgesic WITHOUT anti inflammatory effects
- no anti inflammatory effect bec: Centrally acting
- anti pyretic and analgesic only
3 drugs that are HEPATOTOXIC ("Hart")
"Overdose of aspirin"
Toxic effects of ASPIRIN:
✅gastric irritation: ❌cox1:prostaglandins
✅renal damage: ❌cox1:prostaglandins
✅prevents clotting: ❌cox1:txa2
✅Reye's syndrome - if aspirin is given to a child with viral infection
Aspirin and other NSAIDS can enhance the effects of
Warfarin(Coumadin) and Coumarin
*wag icocombine: anticoagulant + anticoagulant = BLEEDING!!!!!
BQ: Drug used to treat Salicylism?
BQ: What is the parent drug that is converted to acetaminophen?
BQ: Excessive doses of these 2 drugs can lead to "Narcotic-like" adverse effects
BQ: Drug interaction of PNS acting and CNS acting Non-narcotic analgesics
Pns + Cns non-narcotic analgesic are SYNERGISTIC!!! (1+1=>2)
Example: Ibuprofen(nsaid:pns) + Paracetamol(cns) = Alaxan
Non scheduled drug: dont need prescription
NSAID + another NSAID cannot be combined ❌
⬆️⬆️ Toxic effects!!!!
✅ Nsaid + Paracetamol = Synergistic
Brand name of Ibuprofen
Alaxan, medicol, midol
Generic name of flanax
Examples of NSAIDS:
Toxic effects of COX2-inhibitors
Can lead to heart attack or stroke or any cardiac disease
Wall of bv is made up of Prostacyclin and TxA2
Cox2-inhibitors inhibits Prostacyclins; Magdodominate TxA2⬆️=constricted BV dahil lumalapot yung blood: ⬆️obstruction
Ideally: Cox2-inhibitors are taken maximum of how many days
Maximum of 7 days