new pharm cards

Aspirin class

COX-1/2 inhibitor; irreversible

Aspirin uses

Pain, fever, inflammation; prevent MI/stroke

Aspirin major risks

Salicylate poisoning; GI bleed; ulcer

Aspirin interactions

Anticoagulants; glucocorticoids; morphine

Morphine class

Prototype for opioids

Morphine receptors

Mu & kappa

Morphine effects

Peripheral vasodilation → orthostatic hypotension; constipation; sedation

Morphine black box

Respiratory depression

Morphine serious risks

Cardiac arrest

Morphine contraindications

Gallbladder; asthma; GI; kidney/liver impairment

Morphine avoid with

CNS depressants; hypotensive meds; kava; valerian; St John's wort; alcohol

Ibuprofen class

COX-1/2 inhibitor

Ibuprofen bleeding risk

Less bleeding risk than aspirin

Ibuprofen cardiovascular effect

No decreased risk of MI/stroke

Ibuprofen major risks

GI bleed; peptic ulcer disease

Ibuprofen uses

Mild/moderate fever & pain relief

Ibuprofen avoid with

Anticoagulants; aspirin; alcohol; 4Gs

Fentanyl

More potent opioid

Fentanyl receptors

Mu

Fentanyl major risk

Profound respiratory depression

Fentanyl other effects

Orthostatic hypotension; laryngo/bronchospasm; apnea

Fentanyl patches

Wear gloves for patches

Fentanyl precautions

Keep intubation equipment nearby; monitor

Fentanyl risks

High risk of dependence; toxicity

Celecoxib

class: COX-2 inhibitor

Celecoxib use

More chronic pain; less refills

Celecoxib cardiovascular risk

Increased MI/stroke risk

Celecoxib contraindications

Ischemic heart disease; peripheral artery disease; heart failure

Celecoxib allergy concern

Sulfa allergy

Celecoxib interactions

Warfarin; oral antiplatelets; lithium; ACE; fluconazole

Hydromorphone Binds

Mu, delta, kappa

Hydromorphone major risk

Respiratory depression

Hydromorphone effects

Euphoric; sedation; restless; N/V; low BP; severe constipation; hallucination

Hydromorphone contraindications

Ileus; sulfite allergy

Hydromorphone potency

Heavy hitting drug

Acetaminophen class

COX-1/2 inhibitor; central acting (CNS)

Acetaminophen anti-inflammatory effect

No anti-inflammatory

Acetaminophen IV

Expensive IV

Acetaminophen maximum dose

Limit 4,000 mg

Acetaminophen black box

Hepatotoxicity and SJS

Acetaminophen avoid

Herbals with liver toxicity risk; anticoagulants; alcohol

Acetaminophen monitoring

AST & ALT

Acetaminophen overdose treatment

N-acetylcysteine

Naloxone class

Opioid antagonist

Naloxone receptors

Blocks opioid activity at Mu & kappa

Naloxone uses

Reverse symptoms of addiction, toxicity, and overdose

Naloxone indication

Give if RR <10

Naloxone pregnancy

Crosses placenta

Naloxone effects after reversal

↑ BP; tremors; N/V; loss of analgesia; hyperventilation; drowsiness

Prednisone class

Corticosteroid/glucocorticoid

Prednisone mechanism

Inhibits prostaglandin

Prednisone use

Decrease inflammation; 4-10 day treatment

Prednisone administration

Take with food; don't chew

Prednisone discontinuation

Taper off

Prednisone risks

Fetal harm; insomnia; Cushing's; osteoporosis

Prednisone avoid with

Azole; statin; insulin; vaccine; aloe; buckthorne; licorice; St John's wort

Methadone

Opioid withdrawal treatment; not a cure

Methadone properties

Properties like morphine but slower

Methadone cardiac risk

Prolongs QT interval; torsades de pointes

Methadone contraindications

Lung disease; head injury; brain tumor; seizure; gallbladder; pancreas; thyroid issues

Methadone pregnancy

Safe in pregnancy

Allopurinol class

Xanthine oxidase inhibitor

Allopurinol use

Gout

Allopurinol risks

Bone marrow depression; severe skin rash; uric acid crystals

Allopurinol avoid with

Oral hypoglycemics; warfarin; thiazide; ACE; ampicillin; alcohol

Triptan class

Serotonin agonist

Triptan mechanism

Constriction of intracranial vessels

Triptan use

Migraine

Ergot alkaloids

Interact with adrenergic, dopaminergic, and serotonin receptors

Ergot alkaloids action

Vasoconstrictors

Ergot alkaloids use

Terminate ongoing migraines

Baclofen class

GABA-B receptor agonist

Baclofen uses

Multiple sclerosis; spinal injury; cerebral palsy

Baclofen effect

Skeletal muscle relaxant

Diazepam

class: GABA-enhancing drug

Diazepam mechanism

Enhances GABA throughout CNS

Diazepam use

Acute spasticity

Diazepam effect

Skeletal muscle relaxant

Benzodiazepines class

GABA agonists

Benzodiazepines uses

Anxiety & insomnia

Benzodiazepines precautions

CNS depression; elderly; respiratory dysfunction; liver dysfunction; renal dysfunction

Benzodiazepines IV

Watch IV administration

Benzodiazepines pregnancy

Contraindicated; cleft lip

Benzodiazepines other contraindications

Suicide risk; narrow glaucoma

Benzodiazepines effects

Dizziness; drowsiness; sedation; lethargy; respiratory depression

Benzodiazepines paradoxical effects

Hyperexcited; muscle spasticity; paradoxical insomnia; euphoria; anxiety; rage

Nonbenzodiazepines Used

for anxiety and sleep

Nonbenzodiazepines PRN

Not PRN

Nonbenzodiazepines onset

Slow onset

Nonbenzodiazepines sleep effect

Fall asleep faster; improve quality/length of sleep

Nonbenzodiazepines sleep behaviors

Sleep-related behaviors: walking; eating; driving

Nonbenzodiazepines discontinuation

Taper off; rebound insomnia

Nonbenzodiazepines CNS effect

Not CNS depressant

Nonbenzodiazepines abuse potential

No abuse/tolerance potential

SSRIs class

Selective serotonin reuptake inhibitors; prototype sertraline

SSRIs mechanism

Block reuptake of serotonin

SSRIs use

Treat depression

SSRIs major risk

Serotonin syndrome

SSRIs pregnancy

Pregnancy risk