Exam 1

when does opioid withdrawal peak?

1-3 days

duration —> 5-7 days

what drugs tx the symps of opioid withdrawal

clinidine

buprenorphine

anti-nausea

anti-emetic

what are symptoms of opioid withdrawal?

nausea

dysphoria

muscle aches

lacrimation

rhinorrhea

pupillary dilation

piloerection

sweating

diarrhea

yawning

fever

insomnia

what drugs are used for relapse prevention?

naltrexone

lofexidine (lucemyra)

what is naltrexone?

long acting antagonist drug

works by blocking the opioid receptors so that the use of opioid drugs don’t produce euphoria

how is naltrexone used?

alone (suboxone)

combined with buprenorphine (subutex)

what is important to know about naltrexone?

must be 1 week free from opioids to begin this therapy

what is lofexidine (lucemyra)?

newer drug

A2 agonist

what is carfentanil?

synthetic opioid, used as a vet tranquilizer

100x stronger than fentanyl

what is xylazine?

Non-opioid CNS depressant

tranq dope —> prolongs the effect of opioids, may be mixed with fentanyl

A2 agonist

what are signs of stimulant intoxication?

tachycardia

HTN

chest pain

arrhythmia

sudden cardiac death

CNS euphoria

agitation

seizures

ICH

anxiety

panic

paranoia

hallucinations

what is methamphetamine?

stronger effects that other amphetamines

pill vs. powder vs. crystallized

what is methylenedioxymethamphetamine (MDMA)?

triggers release of NTMs presynaptically and prevents uptake

primailry affects on serotonin, followed by norepi and dopamine

more calming effects than other amphetamine drugs —> euphoria, enhanced empathy, increased trust

what is cocaine?

highly addictive —> physical and psychological dependence

powdered vs. crystallized

no FDA approved pharmacotherapy (mostly symptomatic tx)

what are AE of cocaine?

rhabdomyolysis

paranoia

what is CBD?

cannabidiol —> second most prevalent active ingredient to marijuana

doesn’t cause a high

no evidence of abuse or dependence potential

low abuse liability but high doses can cause hepatotoxicity

what is tetrahydrocannabinol (THC)?

a direct CB1 receptor agonist

can produce psychoactive effectives like euphoria

what are symptoms of cannabis withdrawal?

irritability

anger

oppression

anxiety

depression

insomnia

disrupted sleep

decreased appetite

weight loss

HA

sweating

chills

tremors

craving

what are symptoms of THC withdrawal?

suicidal ideation

psychosis

cannabinoid hyperemesis syndrome

how does alcohol (ethanol) work?

causes CNS depression by dissolving lipid membranes in the CNS

imbalance of glutamate and GABA NTM

what are effects of ethanol?

resp stimulation or depression

vasodilation —> warm, flushed skin

increased sweating

diuretic effects

hypotension initially followed by delayed HTN

what are effects of chronic ethanol ingestion?

nutritional and vit deficiencies (esp B vits)

wernicke’s encephalopathy —> thiamine deficiency

korsakoff’s psychosis —> amnesia and confabulation

nicotinic acid deficiency encephalopathy

fetal alc syndrome (FAS)

what are symptoms of ethanol withdrawal?

elevated BP, HR, temp

insomnia

tremors

agitation

seizures

what are ethanol withdrawal tx?

benzos are the tx of choice

what are tx for alcoholism?

disulfiram

naltrexone

acamprosate (campral) —> newest tx

how does acamprostate work?

glutamate antagonist

balances GABA and glutamate

how does nicotine work?

acts on nicotinic receptors

releases epi which creates physiologic stress rather than relaxation

CNS and resp stimulation followed by CNS depression

what are AE of nicotine?

tremors

convulsions

resp stimulation

increased HR and BP

increased tone and motor activity of bowel

what are symptoms of nicotine withdrawal?

irritability

restlessness

decreased HR and BP —> resolve in 3-4 weeks

cravings can persist for months/years

how does nicotine withdrawal tx work?

provide nicotine w/o the carcinogens in tobacco

what are ex of drugs used for nicotine withdrawal?

bupropion (zyban) —> >first nicotine free med to tx nicotine dependence

varenicline (chantix) —> stimulates nicotine receptors

wellbutrin (antidepressant)

what is the first line drug for nicotine use d/o?

varenicline

how do anticoagulants drugs work?

inhibit the action or formation of clotting factors

prevent clot formation

for PREVENTION, no direct effect on blot that’s already formed

wha are ex of anticoagulant drugs?

heparin

warfarin

eliquis

enoxiprin

argatroban

how does heparin work?

activates anti-thrombin (natural clot inhibitor)

what is unfractionated heparin?

fast acting, for more emergent tx

heparin drips or SQ

what is low molecular weight heparin (LMWHs)?

used prophylactically to prevent clot or prevent clot from worsening

what are ex of LMWHs?

enoxaparin (lovenox) —> SQ

dalteparin (fragmin)

why would a LMWH be used?

more predicable anticoagulant response

frequent lab monitoring of bleeding times NOT needed

when are LMWH CA?

pts with an indwelling catheter d/t risk of epidural hematoma

what are CA for heparin?

thrombocytopenia

HITS (hx of heparin induced thrombocytopenia)

what are AE of heparin?

thrombocytopenia

osteoporisis

bleeding

increased potassium levels

what lab value do you want to monitor when using heparin?

aPTT (activated partial thromboplastin time) or anti-factor Xa

what is a therapeutic range for aPTT when using heparin?

60-80sec

~1.5-2.5x normal time —> want to prolong clotting times

what are symps of heparin toxicity?

tachycardia

hypovolemia

dizziness

pallor

decrease UP

what drug reverses heparin?

protamine sulfate 1mg

what are drug nuances for heparin?

can be used in pregnancy

what are coumarins?

less predictable anticoagulants

inhibits vit K dependent clotting factors II, VII, IX, X

what is an ex of a coumarin anticoagulant?

warfarin

how does warfarin work?

inhibits vit K synthesis by bacteria in the GI tract

inhibits production of vit K dependent clotting factors II, VII, IX, and X

what are AE of warfarin?

purple toe syndrome

alopecia

elevated liver enzymes

bruising

bleeding

what labs are monitored when taking warfarin?

PT/INR (internationalized normal ratio)

what is the therapeutic range for PT/INR when taking warfarin?

2-3.5

takes 3-5 days for therapeutic effect

what are drug nuances for warfarin

preg x drug

consistent vit K intake —> don’t increase or decrease

what is the antidote for warfarin?

vit k

may take 36-42 hrs before liver an resynghesize enough clotting factors to reverse the warfarin effects

what does bridging mean?

when you use two anticoagulants until therapeutic effect is reached

how do factor Xa drugs work?

inhibit thrombosis by their specific action against factor Xa

what are examples of factor Xa drugs (direct oral anticoagulants)?

rivaroxaban (xarelto)

apixaban (eliquis)

edoxaban (savaysa)

betrixaban (bevyxxa)

THINK “ABAN”

what is the antidote for factor Xa drugs?

andexanet alfa

how do antiplatelet drugs work?

inhibit platelet aggregation (prevents platelets from sticking to each other)

prevent platelet plugs

associated more with secondary prevention of arterial clots

what are ex of antiplatelet drugs?

ASA

clopidogrel (plavix)

how does clopidogrel work?

P2Y12 inhibitor

most widely used ADP inhibitor

GI drugs can impair efficiency

what a

how do hemorheologic drugs work?

alter platelet fxn w/o preventing the platelets from working

how do thrombolytic drugs work?

lyse (break down) existing clots

for ischemic stroke not hemorrhagic

what are CA for thrombolytic drugs?

active bleeding

what are ex of thrombolytic drugs?

altapase (activase)

what is the timeline range for a thrombolytic drug to be effective?

3-4.5 hrs (works in that time)

how do antifibrinolytic or hemostatic drugs work?

promote blood coagulation by preventing the lysis of fibrin

what are CCS drugs (antineoplastic meds)?

drugs that are cytotoxic during a specific cell cycle phase

what are ex of chemo drugs?

methrotrexate

5FU

doxorubicin

cisplatin

vincristine

paclitaxel

how does chemo work?

harmful to all rapidly growing cells

how do antimetabolites work?

primarily in the S phase of the cell cycle when DNA synthesis is most active

what are AE of antimetabolites?

hair loss

N/V

myelosuppression

tumor lysis syndrome

how do folate antagonist drugs work?

interferes w the use of folic acid, as a result DNA isn’t produced and the cell dies

what is an ex of a folate acid antagonist?

methotrexate (MTX)

what are AE of MTX?

bone marrow suppression

alopecia

GI upset

tumor lysis syndrome

what are drug nuances for MTX?

preg x drug

how does a pyrimidine antagonist work?

interrupts metabolic pathways of pyrimidine bases resulting in interruption of DNA and RNA synthesis

what are ex of pyrimidine antagonists?

5FU

what are AE of 5FU?

diarrhea

N/V

bone marrow suppression

how does paclitaxel (taxol) work?

works right before or during mitosis to stop cell division

what are drug nuances for paclitaxel?

premedicate with dexamethasone, diphenhydramine, famotidine

extravasation warning

how does doxorubicin work?

prevents DNA synthesis

what are drug nuances for doxorubicin?

extravasation

how does cisplatin work?

prevents cancer cells from reproducing by altering DNA

what are AE of cisplatin?

significant nephrotoxicity

how does vinicristine work?

how does cyclophosphamide (cytoxan) work?

how does cyclosporine work?

what are AE of iron?

black, tarry stools

liquid oral preparations may stain teeth

what is important pt education for ferrous sulfate?

vit c increases absorption

avoid calcium and antacids

remain upright for 15-30 min after taking

what is a SABA?

short acting B2 agonist —> primarily selective for B2, some B1

bronchodilator —> rescue drug

what are AE of SABA?

tachycardia

nervousness

anxiety

tremors

HTN

hyperglycemia

what are ex of SABAs?

albuterol

what is a LABA?

long acting B2 agonist

bronchodilation

what are ex of LABAs?

salmeterol

formoterol

what is the difference between salmeterol and formoterol?

salmeterol is a partial agonist (slower onset)

formoteral if a full agonist (rapid onset)

don’t use either in monotherapy in asthma —> combine with ICS

can be used as monotherapy for COPD

what is a LAMA (anti-cholinergics)?

long acting muscarinic antagonist

prevents bronchoconstriction and mucus secretion

what are ex of LAMAs?