Medications Flashcards
(19 cards)
What is morphine?
Is used for pain relief. Also Morphine reduces breathlessness and respiratory effort.
Is used for the relief of moderate to severe pain such as after an injury, or operation or pain caused by a terminal illness such as cancer. It is usually used when other milder painkillers such as paracetamol or non-steroidal anti-inflammatories (NSAIDs) don’t work well enough.
Adverse events vs side effects
Adverse events are unintended pharmacologic effects that occur when a medication is administered correctly while a side effect is a secondary unwanted effect that occurs due to drug therapy.
Another name for Sevredol?
Morphine
What are the contra-indications of morphine?
Raised intracranial pressure (respiratory depression may be poorly tolerated and further increase intracranial pressure); acute head injury (interferes with pupillary responses useful for neurological assessment); comatose patients (unless in terminal care); risk of paralytic ileus
What are contra-indications?
Anything (including a symptom or medical condition) that is a reason for a person to not receive a particular treatment or procedure because it may be harmful.
Cautions of morphine
Impaired respiratory function (e.g. obstructive sleep apnoea, asthma, COPD); neurological disorders; uncorrected endocrine abnormalities (hypothyroidism and adrenocortical insufficiency); obstructive bowel disorders; prostatic hypertrophy; myasthenia gravis; hypotension or shock
Morphine adverse effects
Respiratory depression is the most serious adverse effect.
Other adverse effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, dyspepsia, biliary spasm, bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dizziness, confusion, drowsiness, sleep disturbances, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing due to histamine release, rash, urticaria, pruritus; less commonly ureteric or paralytic ileus, bronchospasm, hypothermia, raised liver enzymes, syndrome of inappropriate antidiuretic hormone secretion (SIADH), anaphylaxis, seizures; with long-term use hypogonadism, adrenal insufficiency, opioid-induced hyperalgesia; with large doses muscle rigidity, hypotension, myoclonus
Routes of morphine
Oral
Intravenous
Intramuscular injection
Subcutaneous injection
What is fentanyl?
Treating severe pain, typically advanced cancer pain
How does fentanyl work?
Bind to opiate receptors in the brain and spinal cord resulting in inhibition of the ascending pain pathways thus altering the perception and response to pain.
Fentanyl contra-indications
Acute respiratory depression; when there is a risk of paralytic ileus; conditions associated with raised intracranial pressure and in head injury
Fentanyl cautions
Impaired respiratory function (avoid in chronic obstructive pulmonary disease); asthma; hypotension; urethral stenosis; shock; myasthenia gravis; prostatic hypertrophy; obstructive or inflammatory bowel disorders; diseases of the biliary tract; convulsive disorders; impaired consciousness; cerebral tumour; reduced dose is recommended in elderly or debilitated patients; hypothyroidism and adrenocortical insufficiency; caution advised in patients with a history of drug dependence; avoid abrupt withdrawal after long-term treatment; diabetes mellitus
Serotonin syndrome
Transdermal
Fentanyl adverse effects
nausea and vomiting (particularly in initial stages), constipation, abdominal pain, dyspepsia, diarrhoea, gastro-oesophageal reflux disease, biliary spasm, dry mouth, stomatitis, anorexia, hypertension, vasodilation, bradycardia, tachycardia, palpitation, oedema, postural hypotension, dyspnoea, aesthenia, myoclonus, anxiety, tremor, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, appetite changes, rhinitis, pharyngitis, paraesthesia, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, pruritus; larger doses may produce muscle rigidity, hypotension, and respiratory depression
Patches also application-site reactions
Nasal spray also epistaxis, rhinorrhoea, nasal discomfort
Route to give fentanyl
Subcutaneous infusion Transdermal Intravenous injection Intramuscular injection Intranasal Subcutaneous injection
What is warfarin?
Warfarin is an anticoagulant. It is used to treat and prevent clots in your blood.
prevention and treatment of venous thrombosis and pulmonary embolism; prevention of stroke following myocardial infarction in patients with increased embolic risk; prevention of thromboembolism in atrial fibrillation; prevention of thromboembolism in patients with prosthetic heart valves
Warfarin contra-indications
Haemorrhagic stroke; significant bleeding or bleeding risk
Warfarin cautions
conditions in which risk of bleeding is increased, e.g. history of gastro-intestinal bleeding, peptic ulcer, recent surgery, recent ischaemic stroke, threatened abortion; hyperthyroidism or hypothyroidism (changes in thyroid hormone status or thyroid therapy can influence response to anticoagulation); postpartum (delay warfarin until risk of haemorrhage is low—usually 5–7 days after delivery); uncontrolled hypertension; spinal or epidural anaesthesia; lumbar puncture; concomitant use of drugs that increase risk of bleeding; avoid cranberry juice; calciphylaxis
Warfarin adverse effects
haemorrhage—see notes, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, priapism (see Drug-induced priapism (Long-lasting Erections) Prescriber Update, September 2014), pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency), calciphylaxis
How is warfarin give
Orally
