Pharm exam 1- prototypes

What is morphine?

A schedule 2 opioid

What therapeutic class is morphine?

Analgesic

What pharmolocigal class is morphine?

Opioid agonist

What is the MOA for morphine?

Works in the brain to inhibit pain sensation; binds to mu & kappa receptors to produce profound analgesia

What are the uses for morphine?

Moderate to severe pain that is not relieved through non opioid medications; air hunger

What are nursing considerations for morphine?

• Monitor for respiration depression, sedation, urinary retention, N/V, constipation

• Assess BP, pulse, respiration rate prior to administration and during

• Administer stool softener, if precribed, to avoid constipation or consider requesting PRN for stool softener

• Discontinue use of opioids if pain can be managed by non opioids, potential for abuse/addiction

• Requires a 2 RN sign off to waste or discard

Adverse effects: Morphine

Dysphoria, hallucinations, severe respiration depression, cardiac arrest

Side effects: Morphine

Nausea, constipation, dizziness, itching

Contraindications: Morphine

Do not consume with alcohol, patients with severe asthma, liver, or kidney impairment

Interactions: morphine

Other CNS depressants, antidepressants, St. John’s wort

Antidote: Morphine

Naloxone

What is another name for Naloxone?

Narcan

Therapeutic class: Naloxone

Reversal agent, antidote for opioids

Pharm class: Naloxone

CNS opioid receptor antagonist

MOA: Naloxone

Competes with opioids at the receptor site in the brain

Uses: Naloxone

Reversal of opioid intoxication or overdose

Nursing considerations: Naloxone

• Have drug available if administering opioids- especially PCA or continuous IV

• Administration may cause sudden withdrawal symptoms (N/V/D, diarrhea, fever, sweating, body aches, crying, irritability)

• Administration may reveal underlying pain so be ready to give pain medication

• Administer when RR goes below 10

Adverse effects: Naloxone

Rapid reversal may cause pain, increased blood pressure, hyperventilation

Side effects: Naloxone

Minimal toxicity

Contraindications: Naloxone

Hypersensitivity to naloxone

Interactions: Naloxone

None

What is methadone used for?

Treatment for opioid dependance

Therapeutic class: methadone

Opioid analgesic

Pharm class: methadone

Long- acting opioid agonsit

MOA: methadone

Works in the brain to desensitize multiple pain receptors, blocks cravings and euphoria often caused by heroin, morphine, hydrocodone, and oxycodone

Uses: methadone

To treat opioid use disorder or to facilitate medical withdrawal, sometimes used for chronic pain management

Nursing considerations: methadone

• May be used to facilitate opioid withdrawl after an ICU stay

• Same monitoring as morphine, can cause respiratory depression

• Usually given as a taper off over time

• Watch for withdrawl symptoms, may need to slow taper

What is the generic name for aspirin?

ASA, bayer

Therapeutic class: aspirin

Analgesic, anti-inflammatory, anti-pyretic

Pharm class: aspirin

NSAID, salicylate, non-selective COX inhibitor

MOA: aspirin

inhibits synthesis of prostaglandins for pain and inflamm; vasodialates and sweating

Uses: aspirin

Mild→ moderate pain, treatment of inflammation, may prevent stroke and heart attack

Nursing considerations: aspirin

• GI irritation (take with food or enteric coated)

• Use in caution with bleeding disorders especially patients with chronic alcohol abuse. Monitor the signs and symptoms of bleeding

• Do not use with other drugs that increases the risk of bleeding (warafrin, heparin, clopidogrel)

• Monitor hepatic and renal function

• May lead to steven johnsons syndrome, cause laryngeal edema, anaphylaxis

• DO not use in kids- leads to reyes

Adverse effects: aspirin

GI discomfort and bleeding

Contraindications: aspirin

patient with anticoagulation therapy

Interactions: aspirin

Many, check with anticoagulation therapy

Antidote: aspirin

Activated charcoal, gastric lavage

What is the generic name of Ibuprofen?

Advil, Motrin,

Therapeutic class: Ibuprofen

Analgesic, anti-inflammatory, anti-pyretic

Pharm class: Ibuprofen

NSAID, Non-selective COX inhibitor

MOA: Ibuprofen

inhibits the conversion of archadonic acid to cyclooxegenase (COX), which inhibits production of prostoglandins

Are prostoglandins all bad?

NO- COX 1= protective; COX 2= inflammatory

Uses: Ibuprofen

Mild→ moderate pain, treatment of fever, treatment of inflammation

Nursing considerations: Ibuprofen

• May cause/exacerbate GI bleeding due to COX 1 inhibition. May cause/exacerbate peptic ulcers- patients with ulcers should avoid

• Monitor for bleeding

• Observe for elicit S/S of Gi distress (N/V/ heartburn, epigastric pain)

• Monitor hepatic and renal function

• Has cross sensitivity with aspirin in terms of allergy/anaphylaxis- patients with aspirin allergy should not take ib

Adverse effects: Ibuprofen

Rare, kidney injury, GI bleed

Side effects: Ibuprofen

Mild nasuea, heartburn

Interactions: Ibuprofen

Drugs for anticoagulation, diuretics, other NSAIDS, ginkgo, ginger

What is the generic name for acetaminophen?

Tylenol

Therapeutic class: acetaminophen

Analgesic, anti-pyretic

is acetaminophen a anti-inflam?

NO

Pharm class: acetaminophen

Para-aminophenal derivative

MOA: acetaminophen

Inhibits synthesis of prostaglandins in the brain; dilates peripheral blood vessels to enable sweating and dissipation of heat

Uses: acetaminophen

Fever, mild→ moderate pain (often used in combo with an opioid), treatment of fever

Nursing considerations: acetaminophen

• Hepatoxic- ensure the correct dosing. do not use in pts with hepatic insufficiency or those who drink more than 3 drinks a day

• Ensure correct dose, admins as recommended and do not exceed dose of 3,000 mg/day for adults- peds based on weight

Adverse effects: acetaminophen

Skin reactions or blisters indicate steven johnsons, severs liver injury, anaphylaxis

Side effects: acetaminophen

Minimal at therapeutic dose

Contraindications: acetaminophen

Chronic alcohol consumption

Interactions: acetaminophen

Can cause toxic levels of warafarin, risk for bleeding

Antidote: acetaminophen

IV N-acetylcysteinel (acetadote)

What is the generic name for sumatriptan?

Imitrex

Therapeutic class: sumatriptan

Antimigrane drug

Pharm class: sumatriptan

Triptan, serotonin (S-HT) receptor drug, vasoconstrictor of intracranial arteries

MOA: sumatriptan

Causes vasoconstriction of cranial arteries

Uses: sumatriptan

Migraine headache treatment

Side effects: sumatriptan

Some pts experience “triptan rush”- sense of tingling, soreness, tenderness of scalp/face/neck- transient warm sensation, injection site reactions

Nursing considerations: sumatriptan

• Not preventative, can only work once a headache has started

• May cause mild sedative effects

• Not pregnancy safe

Contraindications: sumatriptan

Do not use in pts with angina or history of myocardial infarction, acute kidney injury, or hepatic impairment

Interactions: sumatriptan

With other triptans or ergot alkaloids, ginkgo, St. John’s Wort

What is the generic name for prednisone?

Deltasone, pediapred

Therapeutic class: prednisone

Anti-inflammatory

Pharm class: prednisone

Corticosteroid- steroid

MOA: prednisone

Decreases inflammation and depresses immune system

Uses: prednisone

To treat allergic disorders, skin conditions, inflammation disorders, acute bronchospasm in asthma, antineoplastic in acute anemia

Nursing considerations: prednisone

• When taking for more than 10 days must taper off

• May cause cushings syndorme

• Causes GI distress ( take w/ food) , can lead to peptic ulcer formation- may need to be on a GI protective drug

Adverse effects: prednisone

Long-term therapy can cause Cushing syndrome, gastric ulcers

Contraindications: prednisone

Active infection

Interactions: prednisone

Azole antifungal drugs, patients with diabetes may need to increase insuling, decreases effect of vaccines, St. Johns wort

Therapeutic class: Penicillin G

Antibacterial

Pharm class: Penicillin G

Cell wall inhibitor, natural penicillin

MOA: Penicillin G

Bactericidal- used for gram positive organisms, effective against that dont produce beta-lactamase and are susceptible to S and S testing

What is a beta-lactam ring

Part of penicilin G and cefazolin that is responsible for antibacterial activity (what is attacked in resistant microbes)

Uses: Penicillin G

Strep- throat, ear infection, UTI

Admin: Penicillin G

IV, IM (Penicillin and amoxicillin oral)

Adverse effects: Penicillin G

• Allergy such as rash, pruritus and fever; N/V/D

• Allergy to penicillin increases risk for allergy to other drugs in the same class (Cephalosporiins)

• Best given on an empty stomach

Contraindications: Penicillin G

• Hypersensitivity to drug in penicillin class, caution with severe renal disease

• Observe for electrolyte imbalance if given with spironolactone, ACE, ARBS, (most PCNs are sodium or potassium)

• Often given in combo with other chemical and drugs to help fight resistance

• Used for ear, nose, throat, and lower resp infections and UTIs

Interactions: Penicillin G

Safe to take when pregnant- can decrease effectiveness of BC

What is the generic name for Cefazolin?

Ancef

Therapeutic class: Cefazolin

Antibacterial

Pharm class: Cefazolin

Cell wall inhibitor; first gen cephalosporin

MOA: Cefazolin

Bacteriacidal; inhibits cell wall synthesis

Uses: Cefazolin

For active respiratory infections, UTI, genital infections, endocarditis, prophylactic prior to surgery; uses a beta-lactam ring

Adverse effects: Cefazolin

• Allergic reaction like penicillin

• Can cause proliferation of C. Diff, or other super infections of prolonged use

• Many generations of this drug (most have cef in the name)

Contraindications: Cefazolin

• DO NOT use in pts with PCN allergy due to cross reactions

• Most given IV, delays food absorption

Cautions: Cefazolin

Administration in pts with renal or GI diseases taking diuretics

Interactions: Cefazolin

Nephrotoxic drugs can increase risk for nephrotoxicity

Therapeutic class: Ciprofloxacin (Cipro)

Antibacterial

Pharm class: Ciprofloxacin

Fluoroquinolone, bacterial DNA synthesis inhibitor

MOA: Ciprofloxacin

2nd generation fluoroquinolone, inhibits DNA gyrase affecting replication and repair (most widely prescribed in this class)

Uses: Ciprofloxacin

Gram-negative bacteria, UTI, Sinisitus, pneumonia infectious diarrhea

Adverse effects: Ciprofloxacin

GI effects, V/D/N, dont take with antiacids or mineral supplements