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Exam One Review Sheet Flashcards

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1
Q

What are other drugs in the same class as Morphine

A 
fentanyl
hydromorphone (Dilaudid)
levorphanol
meperidine (Demerol)
Methadone
oxycodone (Percodan, Percocet)
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2
Q

Morphine is considered what kind of opioid?

A

Strong Narcotic Agonist

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3
Q

fentanyl is ______ times more potent than morphine.

A

80-100%

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4
Q

Mechanism of Action of morphine

A
  • occupies mu and kappa in brain and dorsal horn of SC
  • decreased release of neurotransmitters in presynaptic space
  • Results in hyperpolarization of post synaptic dorsal horn neurons
  • Prevent transmission of nociceptor pain
  • Decreased relsear of substance P - modulates pain perception
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5
Q

Indications for morphine

A

Moderate to severe pain

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6
Q

Metabolism of morphine happens in the __________

A

Liver

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7
Q

Elimination of morphine is through the __________

A

Feces (PO)

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8
Q

Onset of morphine

A

15-30 minutes

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9
Q

Duration of morphine

A

3-7 hrs

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10
Q

Contraindications of morphine

A

Head injury patients (masks signs and symptoms)
Patients on other CNS depressants
Elderly may need dose reduction
Prostate patients due to urinary retention

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11
Q

Adverse Effects of morphine

A

CNS: Mood change, lethargy, delirium, euphoria, pupillary constriction
Respiratory: Decrease RR, Resp arrest, apnea
CV: hypotension, bradycardia, cardiac arrest, shock, coma
GI: N/V, constipation
GU: Urinary retention
Histamine: Itching and hives

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12
Q

Drug interactions with morphine

A

Hepatically cleared drugs: H2 Blockers, barbituates, warfarin
CNS depressants: ETOH

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13
Q

What type of opioid is codeine?

A

Mild Narcotic agent

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14
Q

What other drugs are in the same class as codeine?

A

hydrocodone (Vicodin)

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15
Q

Codeine is _____ as potent as morphine

A

1/6

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16
Q

Mechanism of action of codeine

A

Similar to morphine
acts on opioid receptors in CNS to prduce analgesia, euphoria, and sedation
Acts on medullary cough center to depress cough reflex
Drying effects on mucous membranes

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17
Q

Indications for codeine

A

Mild to moderate pain

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18
Q

Metabolism of codeine happens in the ________

A

Liver

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19
Q

Elimination of codeine happens in the __________

A

Kidneys

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20
Q

Onset of codeine

A

15-30 min

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21
Q

Duration of codeine

A

3-7 hours

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22
Q

Contraindications of codeine

A

Pre/post op patients who need to cough and deep breathe
CVA patients
Resp patients

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23
Q

Adverse effects of codeine

A 
Similar to morphine
Dry mouth
Drowsiness
Sedation
Depress cough reflex
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24
Q

Drug interactions with codeine

A

Other CNS depressants

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25
True or false: Codeine is safer for brain injury patients than morphine
True: Doesn't depress the CNS as much or mask s/s of brain injury
26
What kind of opioid is pentazocine (Talwin)?
Narcotic Agonist
27
What other drugs are in the same class as pentazocine (Talwin)?
buprenophine (Bupranex) butorphanol (Stadol) nalbuphine (Nubain)
28
Mechanism of action of pentazocine (Talwin)
Mixed opioid effects Agonist at some receptors and antagonist at other receptors Get opioid effect without over doing it.
29
Indications for pentazocine (Talwin)
Moderate to severe pain
30
pentazocine (Talwin) is metabolized in the ________
Liver
31
pentazocine (Talwin) is eliminated through the _____
Kidneys
32
Onset of pentazocine (Talwin)
15-30 min
33
Duration of pentazocine (Talwin)
3-7 hours
34
Contraindications of pentazocine (Talwin)
Resp depression patients
35
Adverse effects of pentazocine (Talwin)
``` Withdrawl effects in unknown addicts Resp depression Circulatory depression N/V Dizziness Lightheadedness Euphoria ```
36
Drug interactions with pentazocine (Talwin)
Other CNS depressants
37
True or false: pentazocine (Talwin) is used in patients with hx of addiction
True
38
Street name for pentazocine (Talwin)
T's and blues
39
naloxone (Narcan) is what kind of opioid?
Opioid Antagonist
40
What other drugs are in the same class as naxolone (Narcan)?
naltrexone (Revia)
41
Mechanism of Action of naloxone (Narcan)
High affinity for opioid receptor but produce no effect | OPIOID OD ANTIDOTE
42
Indications for naloxone (Narcan)
Opioid antidote
43
naloxone (Narcan) onset
When given IV 2-5 minutes
44
naloxone (Narcan) duration
Short half life
45
naloxone (Narcan) adverse effects
HTN, N/V, Sweating, Tachy, tremors
46
Narcan has a short half life therefore....
drug may wear off before narcotic and require multiple doses
47
With Narcan, Assess and monitor __________
Vital signs frequently
48
True or false: With Narcan have resuscitation equiptment near by
True
49
Prototype for Salicylates
Aspirin
50
Other drugs in the same class as Aspirin
diflunisal | salsalate
51
Mechanism of action of aspirin
Non-selective COX inhibitor - anti-pyretic (hypothalamus) - anti-inflammatory (inhibits prostaglandin synthesis) - analgesic (inhibits COX 2 and decrease prostaglandins which sensitize pain receptors - antiplatelet (irrevesible inhibition prostaglandin = decrease platelet aggregation
52
Indications for aspirin
Fever (adults only) Pain Inflammation Arthritis
53
Absorption of Aspirin
30 minutes Mostly absorbs in the small intestines Suppositories absorb slower
54
Distribution of aspirin
Highly protein bound Onset = 30 min Inflammatory response takes weeks T 1/2 = 1.5 to 50 hours
55
Aspirin is metabolized in the __________
Liver
56
Aspirin is excreted through the _________
Kidneys
57
Contraindications of Aspirin are:
Peptic ulcers or other bleeding disorders Anti-coagulation treatment Gout (increase uric acid, renal or liver patients) Kids with fever or flu sx = Reye's Syndrome Smokers and ETOH patients = decreased gastric mucosa = increase GI bleed
58
Adverse effects of aspirin
``` GI: ulcers, bleeding Sedation, confusion Rash, fever Tachy Acute bronchospasm Renal impairement, Na & H20 ret. HA, dizziness Tinnitus ```
59
Aspirin drug interactions
Anticoagulants and antiplatelets = increase bleeding | Metabolism of digoxin, phenytoin, cyclosporine, fluconazole
60
Pregnancy category for Aspirin
1st and 2nd Trimester = C | 3rd trimester = D
61
Aspirin Hypersensitivty
Tinnitus Vertigo Bronchospasm
62
Aspirin Toxicity
Salicylism -Occurs with long term or high dose tx S&S: HA, Tinnitus, GI Distress, Resp stim (Increase CO2 loss = alkalosis), drowsiness, confusion
63
Aspirin Poisoning
``` Life threatening, Adult 20-25 g Peds 4 g S/S same as toxicity but occur quicker No antidote Tx with gastric suctioning (NG), charcoal to induce vomiting & life support ```
64
Drug prototype of Prostaglandin Synthetase inhibitors
Ibuprofen (Advil, Motrin)
65
Other drugs in the same class as ibuprofen (Advil, Mortim)
``` Propionic acids -fenoprofen -naproxen (Aleve) -fetoprofen Acetic Acids -indomethacin (Indocin) -ketorolac (Toradol) ```
66
Mechanism of Action of ibuprofen
Non-selective COX inhibitor SAME AS ASPIRIN Anti-pyretic (Hypothalamus) Anti-inflammatory (Inhibits prostaglandin synthesis) Analgesic (Inhibits COX 2 and decrease prostaglandins which sensitize pain receptors) Anti-platelets (irreversible inhibition prostaglandin = decrease platelet aggregation
67
Indications for ibuprofen
Same as aspirin | Fever, Pain, Inflammation, Arthritis
68
Absorption of ibuprofen
``` Mostly GI Slower with food Analgesic and anti-pyretic effects with in 2-4 hours Anti-inflammatory = days to weeks Highly protein bound ```
69
Distribution of ibuprofen
Highly protein bound Onset = 30 min Inflammatory response takes weeks T 1/2 = 1.5-50 hours
70
Metabolism of ibuprofen
Liver
71
Excretion of ibuprofen
Kidneys
72
Contraindications of Ibuprofen
Ulcer or bleeding disorder Heart pts (Increase risk MI/CVA) HTN pts Renal Patients
73
Adverse effects of ibuprofen
GI: Ulcers, bleeding HTN Decreased renal blood flow = renal toxicity Vision change
74
Drug prototype for selective COX 2 inhibitor
celecoxib (Celebrex (Rx)
75
Mechanism of Action of celecoxib (Celebrex)
Selective COX 2 inhibitor | Inhibits prostaglandin synthesis
76
Indications for celecoxib (Celebrex)
Arthritis | Dysmenorrhea
77
Absorption of celecoxib (Celebrex)
1-2 weeks for anti-inflam response
78
celecoxib (Celebrex) is metabolized in the ________
Liver
79
celecoxib (Celebrex) is excreted through the ____
Feces
80
Drug interations with celecoxib (Celebrex)
Ace inhibitors | Coumadin = Increase INR
81
Pregnancy category or celecoxib (Celebrex)
1st and 2nd trimester: C | 3rd trimester: D
82
Drug prototype for Para-aminophenol derivatives
Acetaminophen (Tylenol)
83
Mechanism of Action of acetaminophen (Tylenol)
Reversible COX inhibitor in periphery anti-pyretic (hypothalamus) Inhibits action of chemical that causes vasodilation and sweating Pain: unk. MOA ON ANTI-INFLAM EFFECT OR PLATELET AGGREGATION INHIBITION Does not decrease kidney function Does not change gastric mucosa (ok for GI ulcer pts.
84
Indications for acetaminophen
Fever Mild to mod pain PEDS PG women
85
Absorption of acetaminophen
Rapid and completely absorbed orally
86
Distribution of acetaminophen
Onset: 30 min Peak: 1-2 hrs Duration: 4 hours
87
Metabolism of acetaminophen
Liver (Hard on the liver)
88
Excretion of acetaminophen
Kidneys
89
Contraindications of acetaminophen
Liver pts Viral hepatitis ETOH pts (Will increase hepatotoxicity) Anemia (will exacerbate anemia
90
Adverse effects of acetaminophen
RARE | Rash, Uticaria, Nausea, Fever, Neutropenia (CA pt), Thrombocytopenia, Jaundice
91
Pregnancy category for acetaminophen
Ok for PG and lactating women
92
Acetaminophen toxicity
Signs and Symptoms: Anorexia, N/V, Pallor, Abd Discomfort (RUQ), Jaundice (Later stage)
93
Acetaminophen Overdose
Can be fatal Partially metabolized into a toxic metabolite that body converts to a non-toxic form with glutathione In OD, GLUTATHIONE is quickly depleted Accum of toxic metabolite occurs = liver damage
94
Acetaminophen Poisoning
ACETYLCYSTEINE is the antidote | Activated charcoal also used to induce vomiting

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