CNS and Pain- Pharm

Hydrocortisone

Short-acting glucocorticoid

Prednisone

Intermediate glucocorticoid

Dexamethasone

Long-acting glucocorticoid

Methylprednisolone (Solu-Medrol)

Intermediate acting glucocorticoid

Glucocorticoids

Given for Addison’s disease, autoimmune disorders, and inflammation

*Give with food, give in morning, will cause osteoporosis, taper off, may cause cataracts

Fludrocortisone

Mineralocorticoid acting like aldosterone

*Promotes sodium and water retention

Mineralocorticoids

Treat adrenal insufficiency and orthostatic hypotension

Acetylsalicylic Acid (Aspirin/ Salicylate)

NSAID blocking COX enzymes

*Do not give to children

Ibuprofen (Motrin)

NSAID blocking COX enzymes

*Has the most anti-inflammatory effects

Naproxen

NSAID blocking COX enzymes

Ketorolac

NSAID blocking COX enzymes

*Short term use only since it can cause kidney damage

Celecoxib (Celebrex)

NSAID blocking COX-2 enzymes (fewer GI effects)

NSAIDs

GI upset, heartburn, ulcerations, GI bleeds, bleeding tendencies, ren dysfunction, increase risk of thromboembolic events (except for ASA)

Salicylism (too much aspirin)

Classic sign= tinnitus

swelling of eyes, face, lips, tongue or throat

wheezing, difficulty breathing, fast heartbeat, cool, clammy skin, hives, rash, bloody stool, bloody vomit

Reye’s syndrome (children)

N/V, confusion, seizure

Acetaminophen

Effects limited to CNS and will cause liver damage

*No GI effects, anticoagulation effects or anti-inflammatory effects

*Acetylcysteine is the antidote

Opioid Drugs

Stimulate Mu, Kappa, and Delta receptors causing pain relief, euphoria, sedation, physical dependence, decreased respirations, and psychosis

Fentanyl

Very very strong opioid

Meperidine (Demerol)

Discontinued as it causes seizures

Methadone

treats heroin addiction by mimicking effects expect the euphoric feeling

Morphine Sulfate

Common Opiod

BBWs: Never use ER in opioid naive pts, monitor addiction, monitor respiratory depression, accidental exposure to children can be fatal, neonatal withdrawal

Codeine

Weak Opioid

*5-10% of Caucasians lack the enzyme to metabolize codeine to morphine

Hydro-morphone (Dilaudid)

Good opioid if renal issues are present

Opiates

Present in opium from seedpod of Papaver somniferum

*Morphine, Codeine

Opioids

Semisynthetic- derived from an opiate

Synthetic- synthesized to have a function similar to natural opiates

Opiod Agonist/ Antagonists

Less abuse potential, similar pain-relieving effect

*May cause respiratory depression, sedation, constipation, psychosis, W/D

Buprenorphine (Buprenex)

IV/IM Opiod Agonist/ Antagonists

Buprenorphine/ Naloxone (Suboxone)

SL Opiod Agonist/ Antagonists

Naloxone

Opioid Antagonist- treats opioid overdose

*No effect on non-opioids

Naltrexone (Revia)

Treats alcohol dependence

Ergotamine, Cafergot (PO)

Antimigraine medication causing blood vessel constriction

*BBW: Peripheral ischemia, do not give to pregnant women

Sumatriptan (PO, SQ), Rizatriptan (ODT), Zolmitriptan (Nasal Spray)

Antimigraine medication which increases serotonin

*Best if given at first sign of migraine

*Do not take with antidepressants

Serotonin Syndrome

Change in LOC, seizures, fever, sweating