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Flashcards in palliative drugs Deck (72):
1

which drug is a Tetrahydrocannabinoids and how does it work

nabilone

antiemetic action may be d/t interaction w cannabinoid receptor sys in brain (dec nausea)

2

what is nabilone and what is it used for

o synthetic derivative of THC (major substance of marijuana).
o Treatment of nausea and vomiting associated with chemo that has not responded to other conventional antiemetics
o Stimulates appetitie and weight gain for pt w AIDS

3

would nabilone gen be the first choice antiemetic

no its used when other antiemetics arent working

4

if using to stop nausea from chemo when should nabilone be taken and how long will it last

it should be taken 1-3hrs before
can also be taken night before
or after

5

can nabilone have psychoactive effects

which age group is not nec safe with this

yes..the side effects sound like someone who has just smoked hha. there are potential for adverse psych reactions up to 72hrs after taking

also causes HoTN

undetermined if safe for kids

6

nabilone peak and duration

peak 1-3hr and duration 8-12

7

which 3 anticholinergics are we to learn

scopolamine
hyoscine butylbromide
glycopyrrolate

8

scopolamine how does it work

o MOA- blocks the binding of Ach to the cholinergic receptors in this region- correcting an imbalance between the neurotrasmitters Ach and norepi

o Potent effects on the vestibular nuclei- controls balance

9

what is the primary anticholinergic used as an antiemetic

what kind of nausea does this treat

scopolamine

o Most commonly used antiemetic for n + v and motion sickness
for prevention of motion sickness and PONV

10

scopolamine what uses beyond antiemetic

o Used as an adjunct to anesthesia to inhibit salivation and excessive resp secretions
o Produces amnesia and sedation and used for palliative control of secretions

also reduces spasms

11

what routes could you give scopolamine and which lasts longer and which is faster acting

maybe it is only the transdermal that is good for secretion control? here are the numbers that Francesca got for pharmacokinetics

transdermal lasts 72hr with onset in 4hr
while PO is only 4-6hr but has onset n 30min

o Half life: 9.5 hr
o Onset: 1-2 hr
o Peak: 6-8 hr
o Duration: 72 hr

12

what might scopolamine cause since it is antiACH

urinary retention
blurred vision
tachy
dry mouth (yay!)
drowsy

13

what is hyoscine butylbromide and what is it useful for

o Buscopan is a smooth muscle (involuntary muscle) anti-spasmodic that is effective in relieving colicky abdominal pain, caused by painful spasms in the muscles of gastro-intestinal (digestive) system or the genito-urinary system by blocking ach receptors and preventing contraction
elsewhere I found it used for resp secretions!

14

how does hyoscine butylbromide work

o MOA-blocks Ach on receptors of smooth muscle walls of Gi and urinary tract and reduces the smasms and contractions

15

when is hyoscine b not a good idea

o Should not be used if: glaucoma, muscle weakness, paralytic ileus, dilated colon, caution w elderly

16

where is scopolamine patch gen applied

behind the ear

17

if someone is using scopolamine should they drive
what about nabiione

no no

18

what kind of drug is glycopyrrolate and what is it used for

anticholinergic

o Synthetic antimuscarinic drug that blocks Ach receptor sites in the autonomic nervous system that controls the production of secretions and the concentration of free acids in the stomach

o Used preop to reduce salivation and excessive secretions in the resp and GI tract.

o Manages GI disorders when oral meds are not tolerated or rapid cholinergic effect is required eg adjunctive mgmt of PUD

19

what is a muscarinic receptor

a type of acetylcholine receptor

20

how does dose relate to glycopyrrolate function

low doses dec sweating, salivation, resp secretions eg4-10mcg/kg/dose q 3-4 or 4 times daily

intermediate doses--dec HR

lg doses dec GI and GU motility eg up to 200mcg

21

how is glycopyrrolate given routes

half life onset peak duration

IM, PO, IV

o Half life: variable
o Onset: IV: 1 min, IM: 20-40 min
o Peak: IV: 10-15 min, IM: 30-45 min
o Duration: IV: 4 hr, IM: 4-6 hr

22

what might glycopyrrolate be mixed with to be given as preanaesthetic

o Glycopyrrolate is used pre-op and can be mixed w morphine or meperidine for preanethetsic med

23

which neuroleptics were we to learn

chlorpromazine
methotrimeprazine
haloperidol

24

class of chlorpromazine

Classification
Therapeutic: antiemetics, antipsychotics
Pharmacologic: phenothiazines

25

action of chlorpromazine and therapeutic effects

Alters the effects of dopamine in the CNS. Has significant anticholinergic/alpha-adrenergic blocking activity.
Therapeutic Effects: Diminished signs/symptoms of psychosis. Relief of nausea/vomiting/ intractable hiccups.Decreased symptoms of porphyria.

26

indications of chlorpromazine

o Second-line treatment for schizophrenia and psychoses after failure with atypical antipsychotics. Hyperexcitable, combative behavior in children. Nausea and vomiting. Intractable hiccups. Preoperative sedation. Acute intermittent porphyria. Unlabeled Use: Vascular headache. Bipolar disorder.

27

chlorpromazine pharmacokinetics and metb where?

highly metb in liver and GI mucosa
Half life: 30 hr
Onset: (PO) 30-60 min
Peak: unknown
Duration: 4-6 hr (Po) 4-8 hr (IM) unknown for IV

28

chlorpromazine side effects

neurloletpic malignant syndrome, sedation, blurred vision, hypotentsion, constipation, dry mouth, dry eyes, agranulocytosis, etc

29

what to assess for chlorpromazine

o mental status
o weight
o positive and negsymp of schiz
o monitor BP, pulse, resp
o fluids, bowels
o onset of akathisiaabd extrapyramidal side effects
o Monitor for tardive dyskinesia (uncontrolled rhythmicmovement of mouth, face, and extremities; lipsmacking or puckering; puffing of cheeks; uncontrolledchewing; rapid or worm-like movements oftongue, excessive eye blinking). Report these symptomsimmediately; may be irreversible.

30

ending for phenothiazines

azine

31

methotrimeprazine action and class

• Antipsychotic, nonopioid analgesic. Phenothiazine
• Action: sedation. Therapeutic effect=dec in severity of pain

32

methotrimeprazine indiccations

• Indications: mgmt of psychotic disturbances, mgmt of conditions assoc w anxiety or tension. As analgesic and adjunct in pain d/t cancer, zona, trigeminal neuralgia, intercostals neuralgia, phantom limb pain and muscular discomforts. Used as preop sedative, antiemetic

33

SE of methotrimeprazinE

• SE: NMS, seizures, amnesia, drowsiness, ortho HoTN, bradycardia, constipation, hyperglycemia, blood dyscrasias

34

METHOTRIMEPRAZINE PHARMAOKINETICS

• IM for analgesia onset unknown and peak 20-40mins. Duration 8hrs.
• PO (blood levels) peak 20-40min and lasts 8hrs
• Looks like its given IV to peds in palliative care

35

WHAT TO ASSESS METHOTRIMEPRAZINE

• pain before and 30min after. BP freq after injection (often syncope etc occurs 10min-12hr after admin. Keep them supine 6-12hr after injection. Wt and BMI throughout therapy. EPS. NMS. Hyperprolactinemia, BG

36

how does methotrimeprazine affect resps (resp depression?)
how does it affect CNS

• potentiates action of other CNS depressants but can be given in conjunction w modified doses of opioid analgesics for mgmt of severe pain. This med doesn’t significantly depress resp status and can be useful when pulm reserves are low

37

class of haloperidol and its action

• T: antipsychotic P: butryophones
• Action: alters effects of dopamine in CNS also has anticholinergic and alpha adrenergic blocking activity

38

indications of haloperidol

• Normally given for psychosis..Indications: acute and chronic psychotic disorders eg SCH, manic, drug induced psychoses, aggressive or agitated…Off label use N/V from sx or chemotherapy

39

SE haloperidol

• SE: seizures, extrapyramidal rxn, HoTN, resp depressionblurred vision, constipation, dry mouth, agranulocytosis, neuroleptic malignant syndrome

40

what is onset and peak of haloperidol PO

• p.kinetics onset Po is 2hrs. Peak is 2-6

41

what to assess before giving haloperiodl

Assess: mental status, nausea and vomiting, bp and pulse, bowel fx, I/O, wt, EPS
Implement: give w water/food

42

what kind of drug is midazolam

benzo

43

what effects does midazolam have and how does it work

• Action: Acts at many levels of the CNS to produce generalized CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter. Therapeutic Effects: Short-term sedation. Postoperative amnesia

basically anxiolytic, sedative (and preprocedural sedative), amnesia, balanced anesthesia, sleep induction, muscle relaxation



44

how can midazolam be given and how quickly could it act

• Routes: Intranasal (fastest onset 5min and peaks at 10min). IM onset 15min and peak 30-60). IV 1.5-5min onset and peak rapid (for most uses it is IV)

45

SE of midazolam

• SE: excess sedation, drowsiness, arrhythmia, apnea, laryngospasm, resp depression, cardiac arrest, phlebitis, nausea, vomiting

46

assessments to do before midazolam

• Level of sedation and LOC throughout and for 2-6hr after admin. If giving IV monitor BP, pulse, resps continuously

47

what should you have on hand if giving lg doses of midazolam or using it for sedation

• Have 02 and resuscitative equipment nearby.
• Antidote

48

what is the antidote to benzos

flumazenil

49

what level of pain is morphine indicated for

is it good for round the clock pain

what specific type of pain is it the drug of choice to treat

Relief of moderate to severe, acute, or chronic pain. Mgmt of moderate to severe chronic pain in pts requiring use of continuous around the clock opioid analgesic for an extended period (extended or sustained release) Drug of choice for pain due to MI.

50

what lung condition can morphine be used for

weird...

pulm edema

51

t or f morphine can only be given IV, subcut, PO

f it can be intrathoracic, epidural, IM PO subcut, rectal, IV

52

peak and duration of morphine when given PO

peak 60min
duration 4-5hr

53

onset of morphine given subcut and peak

onset 20min

peak 50-90

54

SE of morphine

• SE: Sedation, decreased B/P (including orthostatic hypotension), diaphoresis, facial flushing, constipation, dizziness, drowsiness, nausea, vomiting. Major concern is resp depression

55

assessments for morphine

• Pain before and 1hr after (PO, IM, subcut) and 20min after IV.
• LOC and sedation, resps, bowel fx
• If taking SR/ER they might need breakthrough pain meds in addition

56

what to use when changing routes and giving morphine

• Use equianalgesic chart for when changing routes

57

antidote to morphine
what to give with it to help dec pain

• Give naloxone if OD
• Coadministration with nonopioid analgesics helps dec pain
• Give w food/milk

58

should fentanyl be used in an opioid naive pt

how much morphine must you be taking to be considered opioid tolerant

no. the high dose can be lethal to someone not opioid tolerant!

>60mg oral morphine a day or 8mg dilaudid/day

59

indications for fentanyl

• Mainly for pain eg breakthrough pain, CA pain in chronic opioid therapy. Parenteral: Indicated for analgesic supplement to gen anesthesia for balanced anesthesia. Perop and intraop analgesia. Unlabeled as part of PCA.

60

are doses of sublingual/buccal/fentanyl transmucosal equivalent

NO

61

your pt is receiving scopolamine, glycopyrrolate

and theyre about to get fentanyl by sublingual route what might you want them to do before you giv the fentanyl

they might have dry mouth from the meds and they need to drink something BEFORE the fentanyl (if they have dry mouth)

62

precautions fentanyl

• Precautions: don’t use in opioid naïve. Wary of hypoventilation, bradyarrythmias, hepatic or renal impairment, inc ICP or alt LOC

63

SE of fentanyl

• SE: dizziness, drowsiness, resp depression, nausea, V, HoTN, constipation, dependence, pnea, laryngospasm

64

assessments fentanyl

• pain before and 15 min after (or depending on route). Resp assessment, BP, pulse all before and periodically during. If resp <10 assess sedation—may need to stim pt to prevent hypoventilation,
• Hx of opioid use. Last dose. What other CNS depressants are they on. LOC/sedation

65

fentanyl IV onset peak duration

Sublingual

IV
On-1-2
p-3-5
duration-0.5-1

sublingual
on in 30
p-30-60
dur-2-4hr

66

should you use transdermal fentanyl for short term pain control
why?

no
it can last up to 72hrs while the patch is still on so its best for those who need continuous opioid analgesic

67

which meds can be used for secretions

scopolamine
glycopyrrolate
hyoscine butylbromide

anticholinergics

68

your pt is having a bowel or bladder spasm what can you use

what similar drug would help to slow GI motility

hyoscine butylbromide (specifically mentioned to help w GI/GU stuff)

glycopyrolate can slow GI motility at lg dose

69

you want to dec secretions and treat nausea what to use

scopolamine

70

your pt is still in pain, nauseous and you are worried they are about to get bradypneic what med should you give

nabilone wont dec their resps
it is a nonopioid analgesic
it is an antiemetic (used after the other antiemetics have been tried)

71

your pt is nauseous and is psychotic what could you use

what would be better if they had PONV or chemo induced N V. is this drug more or less sedating

what would be best if they had pain as well as needing sedating, nauseous

chlorpromazine (good for N V, it is second line Tx for psychosis after failure w atypical antipsychotics. SE of sedation)

haloperidol is less sedating and is for PONV and chemo induced

methotrimeprazine

72

what meds can be used to control nausea

methotrimeprazine (preopNV)

haloperidol (NV from sx or chemo)

nabilone (from chemo or unresponsive to other antiemetics)

scopolamine (motion sickness and prevent PONV)
chlorpromazine