ATI Pharmacology FINAL (pain and nervous system)

god help us all

pathophysiology

study of diseases. Physiology of altered health.

pathology

study of structural and functional changes in cells, tissues, organs, and systems that cause or are caused by disease 

etiology

cause of disease

sign

objective manifestation detected by the examiner (ex vital signs)

symptoms

subjective complaint by the affected person (ex nausea)

Pharmacokinetics

how meds travel through the body

first pass effect

• Inactivation of some medications on their first pass through the liver

  • Requires a nonenteral route: sublingual, IV

primary site of elimination

kidneys

Medications with a high TI have a wide or narrow safety margin

wide

Medications with a low TI have a wide or narrow safety margin

narrow

agonist

Bind to or mimic the receptor activity that endogenous compounds regulate (ex morphine)

antagonist

Block the usual receptor activity that endogenous compounds regulate or the receptor activity of other medications (ex narcan)

2 important drug-food interactions

• Tyramine-rich foods with MAOIs

  • Hypertensive crisis

• Vitamin K with warfarin

  • Bleeding/clotting events

cytochrome p450 inducers

carbamazepine, barbiturates, phenytoin, rifampin, griseofulvin, st johns wort, modanafil, cyclophosphamide

cytochrome p450 inhibitors

amiodarone, cimetidine, fluoroquinolones, clairthromycin, azole antifungals,grapefruit juice, isonizaid, ritonavir

signs of inflammation

• Rubor

  • Redness

• Tumor

  • Swelling

• Calor

  • Heat

• Dolor

  • Pain

• Functio Laesa

  • Loss of function

2 types of leukocytes that participate in the acute inflammatory response

• • Granulocytes

    • Neutrophils, eosinophils, basophils

  • Monocytes

    • Largest of the leukocytes

First-Generation NSAIDs MOA

COX 1-2 inhibitors

what medications are first gen NSAIDs (there are 4)

Ibuprofen, Naproxen, Diclofenac, Ketorolac

first gen NSAIDS therepeutic uses

Inflammation suppression, analgesia (mild-to-moderate), fever reduction

first gen NSAIDs complications

• GI discomfort: dyspepsia, abdominal pain, heartburn, nausea

• Impaired kidney function: decreased urine output, weight gain from fluid retention, increased BUN/creatinine

first gen NSAIDS contraindications/precautions

• Hypersensitivity reactions

• Pregnancy (D)

• Peptic ulcer disease

• Bleeding disorders

first gen NSAIDs interactions

• Anticoagulants

• Glucocorticoids

• EtOH

• OTC medications

acetominophen therepeutic uses

Analgesia, antipyretic effects, preferred to NSAIDs for children suspected on having a viral infection

why give children acetominophen instead of other NSAIDs?

prevent reyes syndrome

acetominophen complications

Acute toxicity: liver damage with NVD, sweating, abdominal pain

acetominophen contraindications/precautions

• Pregnancy (B)

• Hypersensitivity reactions

• Liver disease

• EtOH

acetominophen interactions

• EtOH

• Anticoagulants

• Acetylcysteine

Morphine thereptuic uses

• Relief of moderate to severe pain, sedation

Morphine complications

• Respiratory depression

• Constipation

• Orthostatic hypotension

• Urinary retention

• Cough suppression

• Sedation

• NV

• Opioid toxicity triad: coma, respiratory depression, pinpoint pupils

Morphine contraindications/precautions

• Caution in pregnancy

• Premature infants

• Respiratory conditions

• GI conditions with constipation

• Hepatic/renal disease

Morphine interactions

• CNS depressants

• Anticholinergic agents

• Antihypertensives

Nalaxone therepeutic uses

Reversal of effects of opioids

nalaxone complications

• Tachycardia and tachypnea 

• Abstinence syndrome

  • hypertension, vomiting, and tremors

• ventricular arrythmias

nalaxone contraindications/precautions

• Pregnancy

• Opioid dependency

  • people may be aggressive when taken out of euphoria

nalaxone interactions

• Opioid agonists

first gen NSAIDs client instructions

take the medication with food, milk, or 8 ounces of water to minimize gastrointestinal effects.

Salicylism

is the name for aspirin toxicity.

tinnitus, unwarranted sweating, headache, and dizziness and some signs

a client on aspirin should report

Instruct the client to report manifestations of bleeding, such as bruising, petechiae, and coffee-ground emesis.

antagonist for acetominophen

aceytylcystine

clients taking acetominophen should report

any abdominal discomfort, nausea, vomiting, diaphoresis, or diarrhea, as this could indicate a possible overdose.

narcan nursing interventions

closely monitor for dangerous elevations in clients’ blood pressure, in addition to other vital signs such as respiratory rate, heart rate, heart rhythm, oxygen saturation, and level of consciousness for manifestations of opioid withdrawal for clients who are opioid dependent.

Adjuvant Agent: Gabapentin drug class

anticonvulsant

what is an adjuvent agent?

An adjuvant agent is a substance that's used in addition to a primary treatment to enhance its effectiveness or provide additional benefits

gabapentin therepeutic uses

Neuropathic pain, neuralgia

gabapentin complications

• Bone marrow suppression

• NVD, C

• Drowsiness

• Rash

gabapentin contraindications/precautions

pregnancy

gabapentin interactions

CNS depressants

Sumatriptan drug class

Serotonin Receptor Agonist

sumatriptan therepeutic uses

• Abortive therapy for migraine

sumatriptian complications

• Chest pressure: heavy arms, chest tightness

• Coronary artery vasospasm/angina

• Dizziness/vertigo

sumatriptan contraindications/precautions

• Pregnancy: risk vs. reward

• Liver failure

• Ischemic heart disease, MI history, uncontrolled hypertension, cardiovascular disease

sumatriptan interactions

• Monoamine Oxidase Inhibitors (MAOIs)

• Concurrent use of triptans

• Selective Serotonin Reuptake Inhibitors (SSRIs)

sumatriptan nursing interventiosn

• tell clients they may report a feeling of heaviness

• Due to the risk of vasospasm of the coronary arteries, monitor vital signs closely after the first dose.

sumatriptian client instructions

IMMEDIETLY report pressure or tightness in the chest or heaviness in the back, jaw, or throat that does not resolve spontaneously.

And if CNS manifestations such as tingling and vertigo occur after taking the medication, they should report this to the provider during their next visit.

myathstasia gravis

• Believed to be caused by sensitized helper T cells and an antibody-directed attack on the ACh receptors in the NMJ resulting in impaired signal transmission

Neostigmine drug class

Reversible Cholinesterase Inhibitors:

neostigmine therepeutic uses

• Myasthenia gravis, reversal of depolarizing NM blocking agents

neostigmine complications

• Excessive muscarinic stimulation: increased GI motility/secretions, diaphoresis, increased salivation, bradycardia, urinary urgency

  • Cholinergic crisis leading to bronchospasm and cardiac arrest

neostigmine contraindications/precautions

• Pregnancy/lactation safety not established

• Obstruction of GI and renal systems

• Seizure disorders, hyperthyroidism, PUD, asthma, bradycardia, hypotension

neostigmine interactions

• Atropine

• NM blockers: succinylcholine

parkinsons disease manifestations

• Rhythmic tremors of hands, feet, neck, face, lips, tongue, jaw

• Rigidity

• Bradykinesia (slowness of movement)

  • Shuffled gait

• Difficulties expressing emotion

• Difficulty managing secretions

• Cognitive decline

Levodopa/Carbidopa drug class

Dopaminergic Agents

Levodopa/Carbidopa therepeutic uses

parkinsons disease

Levodopa/Carbidopa complications

• NV (nausea vomiting)

• Drowsiness

• Dyskinesias: tics, tremors, head bobbing

• Orthostatic hypotension

• Tachycardia, palpitations

• Psychosis

Levodopa/Carbidopa contraindications/precautions

• Cardiovascular disorders

Levodopa/Carbidopa interactions

• Pyridoxine (Vit. B₆)

• Antipsychotics

• MAOIs/TCAs

levodopa/carbadopa client instructions

• take with food if necessary

• avoid high-protein foods because they decrease the absorption of levodopa/carbidopa.

• Warn clients that their urine and sweat may darken, but this is not a side effect that should cause concern.

• Discuss the potential for orthostatic hypotension with clients

which medications are glucocorticoids (there are 4)

• Prednisone (oral)

• Beclomethasone (inhaled)

• Budesonide (inhaled)

• Hydrocortisone (intravenous)

(Glucocorticoids are a type of corticosteroid btw)

prednisone drug class

corticosteroid

prednisone therepeutic uses

• Acute inflammation during MS exacerbation

prednisone complications

• Hyperglycemia

• Fluid and electrolytes disturbances: sodium retention, potassium deficits, fluid retention

• Osteoporosis

• Adrenal suppression

• Peptic ulcers, GI discomforts

• Infection

prednisone contraindications/precautions

• DM

• Osteoporosis 

• Endocrine disorders

• GI disorders

• Immunocompromised/infections

prednisone interactions

• Oral antidiabetic agents

• NSAIDs, acetaminophen, EtOH

• Potassium-wasting agents: diuretics

• Immunizations

• Oral contraceptives, estrogens

prednisone nursing interventions

taper when d/c dose

prednisone client education

observe for manifestations of infection that may not include fever or inflammation, because these body responses are suppressed by corticosteroid therapy.

diazepam drug class

Centrally-Acting Antispasmodics: benzodiazepine

diazepam therepeutic uses

• Muscle spasms, anxiety/panic, insomnia, status epilepticus, EtOH withdrawal, anesthesia

diazepam complications

• CNS depression: sleepiness, fatigue, apathy, confusion, weakness

• Bradycardia, respiratory depression, cardiac arrest

• Incontinence, retention

• Dependence

diazepam contranindications/precautions

• Pregnancy: risk for fetal malformations

• Caution with renal/hepatic impairments

• Comorbid cardiopulmonary conditions

diazepam interactions

CNS depressants

diazepam client education

• do not stop taking this abrubtly (can cause withdrawl manifestations)

diazepam nurse interventions

• prevent falls

• watch for a paradoxical reaction, especially in older adults

• benzodiazepine antidote, flumazenil, can be administered as an adjunct in management of toxicity or overdose

Cyclobenzaprine drug class

Centrally-Acting Antispasmodics

Cyclobenzaprine therepeutic uses

• Relief of muscle spasm related to muscle injury

Cyclobenzaprine complications

• CNS depression

• Anticholinergic effects

• Cardiac dysrhythmias, MI

• Seizures

Cyclobenzaprine contraindications/precautions

• Caution in those with cardiac history

• Caution in those with seizure history

Cyclobenzaprine interactions

• CNS depressants

• Antihistamines

• MAOIs

cyclobenzaprine client education

• drink water and fiber to prevent constipation

• taper dose when d/c

• adverse effects tend to decrease with time

*baclofen drug class

Centrally Acting Muscle Relaxants

*baclofen therepeutic uses

treat painful muscle spasms related to spinal cord injury, multiple sclerosis, cerebral palsy, or spasms due to musculoskeletal injury or other acute musculoskeletal disorders

*baclofen complications

• drowsiness and dizziness, weakness and fatigue (subside with continued use)

• withdrawal manifestations can occur if clients abruptly discontinue them after long-term therapy.

*baclofen contraindications/precautions

Hypersensitivities and MAOIs

*baclofen interactions

MAOIs

*baclofen administration

• Give with food or milk to prevent gastrointestinal upset

• If oral doses are ineffective, administer baclofen by intrathecal infusion directly into the spine via a needle attached to a pump

  • (is you stop intrathecal administration abruptly, it can lead to organ failure and even death)

*dantrolene drug class

Peripherally Acting Muscle Relaxants

*dantrolene therepeutic uses

• stroke, spinal cord injury, multiple sclerosis, and cerebral palsy.

• prevent and treat malignant hyperthermia, which is an adverse effect of general anesthesia.

*dantrolene complications

• muscle weakness

• drowsiness

• dizziness

• diarrhea

• liver toxicity

*dantrolene contraindications/precautions

• liver disease

• cardiac and pulmonary disease

*dantrolene interactions

CNS depressants

CCB