Pharm 3 Exam 2

What class is propofol?

Sedative-hypnotic

What is the MOA of propofol?

Activates the gamma-aminobutyric acid (GABA) receptor complex and has NMDA receptor antagonism.

What is the therapeutic use of propofol?

Induction and maintenance of general anesthesia and sedation for mechanically ventilated clients.

What are the side effects of propofol?

Dizziness, headache, nausea, vomiting.

What are the adverse effects of propofol?

Hypotension and respiratory depression.

What are the contraindications and precautions for propofol?

Contraindicated in hypersensitivity to the drug or its components, including allergies to soybean oil, egg lecithin, or glycerol; use caution in older adults and hemodynamically unstable clients because dose reduction may be needed to avoid severe hypotension.

What class is etomidate?

Sedative-hypnotic

What is the MOA of etomidate?

Activates the GABA receptor complex.

What is the therapeutic use of etomidate?

Induction of general anesthesia.

What are the side effects of etomidate?

Sedation, respiratory depression, postoperative nausea and vomiting, pain on injection.

What are the adverse effects of etomidate?

Adrenal suppression/adrenal insufficiency and hypertension.

What are the contraindications and precautions for etomidate?

Contraindicated in allergy to the drug or its components, such as propylene glycol; use caution because it can cause adrenocortical suppression, which may be harmful in seriously ill clients.

What class is ketamine?

Sedative-hypnotic

What is the MOA of ketamine?

Noncompetitive antagonism of glutamate at the NMDA receptor and excitation of opioid receptors.

What is the therapeutic use of ketamine?

IV: intubation and maintenance of general anesthesia; IM: reduced agitation.

What are the side effects of ketamine?

Increases in heart rate, BP, and cardiac output due to increased sympathetic tone.

What are the adverse effects of ketamine?

• Hallucinations,

• nightmares,

• vivid disturbing dreams,

• cardiac arrhythmias,

• airway obstruction,

• muscle rigidity,

• pain and rash at injection site.

What are the contraindications and precautions for ketamine?

Contraindicated in hypersensitivity, procedural sedation in infants younger than 3 months old, and schizophrenia; use caution in clients with ischemic heart disease, pulmonary hypertension, or cocaine use because they may experience significant cardiac dysfunction.

What class is fentanyl?

Synthetic opioid

What is the MOA of fentanyl?

Acts on mu receptors in the brain to relieve pain and increase anesthetic depth.

What is the therapeutic use of fentanyl?

Pain relief in general and regional anesthesia.

What are the side effects of fentanyl?

Drowsiness, euphoria, nausea, constipation, bradycardia, hypotension, blurred or double vision, pupillary constriction, confusion, vomiting.

What are the adverse effects of fentanyl?

chest wall rigidity and respiratory depression.

What are the contraindications and precautions for fentanyl?

Contraindicated in hypersensitivity; clients taking MAOIs can experience severe adverse reactions within 14 days; use caution because of risk for respiratory and cardiovascular depression.

What class is midazolam?

Benzodiazepine

What is the MOA of midazolam?

Binds to benzodiazepine receptors to enhance the inhibitory effect of GABA on the brain, resulting in increased sedation.

What is the therapeutic use of midazolam?

Treatment of agitation, intoxication, or seizures; sedation for mechanically ventilated clients in the ICU.

What are the side effects of midazolam?

• Retrograde amnesia,

• blurred vision,

• hiccups,

• headache,

• pain at IM injection site.

What are the adverse effects of midazolam?

apena, respiratory depression

What are the contraindications and precautions for midazolam?

Contraindicated in hypersensitivity or allergy to the drug or its components; use caution because it can cause prolonged sedation in clients who have kidney failure.

What class is methohexital sodium?

Barbiturate

What is the MOA of methohexital sodium?

Rapid, short-acting anesthetic.

What is the therapeutic use of methohexital sodium?

Induction of BRIEF anesthesia or sedation

What are the side effects of methohexital sodium?

Hiccups, coughing, muscle twitching, pain on injection, phlebitis.

What are the adverse effects of methohexital sodium?

• Laryngospasm during induction;

• emergence delirium,

• hypotension, and

• irregular respirations during administration.

What are the contraindications and precautions for methohexital sodium?

Contraindicated in hypersensitivity to the drug or its components, history of porphyria, or status asthmaticus; use caution in clients with a history of partial seizure disorder.

What class is succinylcholine?

Depolarizing muscle relaxant

What is the MOA of succinylcholine?

Agonist at the nicotinic receptor to prevent further action potentials, ultimately resulting in sustained flaccid skeletal muscle paralysis.

What is the therapeutic use of succinylcholine?

Facilitate endotracheal intubation and relieve laryngospasm.

What are the side effects of succinylcholine?

Bradycardia, myalgias, increased potassium levels, increased intraocular pressure, increased ICP.

What are the adverse effects of succinylcholine?

Anaphylactic reactions and malignant hyperthermia in clients who have a history of defects at the ryanodine receptor.

What are the contraindications and precautions for succinylcholine?

Contraindicated in family history of malignant hyperthermia, hyperkalemia, and neuromuscular conditions such as muscular dystrophies; use caution because duration of action may be prolonged in clients who have plasma cholinesterase deficiencies.

What class is rocuronium?

Nondepolarizing muscle relaxant

What is the MOA of rocuronium? Roc Ac

Binds to the alpha-subunit of the acetylcholine receptor to keep acetylcholine from attaching to the receptor and causing a muscle contraction.

What is the therapeutic use of rocuronium?

Facilitate endotracheal intubation and enhance mechanical ventilation.

What are the side effects of rocuronium?

Muscle relaxation, hypertension, increased peripheral vascular resistance.

What are the adverse effects of rocuronium?

Paralysis without sedation

What are the contraindications and precautions for rocuronium?

Contraindicated in hypersensitivity to the drug or its components; use caution because duration of action may be prolonged in clients who have renal and hepatic diseases.

What class is nitrous oxide?

Inhalation anesthetic

What is the MOA of nitrous oxide?

Works on NMDA receptors to inhibit the CNS and facilitate release of endogenous opioids that provide mild analgesic effects.

What is the therapeutic use of nitrous oxide?

Light to moderate sedation as a single agent; enhances effects of volatile anesthetics or other IV medications.

What are the side effects of nitrous oxide?

State of euphoria and relaxation.

What are the adverse effects of nitrous oxide?

Postoperative nausea and vomiting.

What are the contraindications and precautions for nitrous oxide?

Contraindicated in surgical procedures that may involve air expansion; use caution because although nonflammable, it can support combustion.

What class is lidocaine?

Anesthetic (topical or local), class IIb antidysrhythmic

What is the MOA of lidocaine?

Inhibits initiation and conduction of nerve impulses; blocks sodium channel transmission to reduce sensory and motor transmission.

What is the therapeutic use of lidocaine?

Local anesthesia; epidural, intrathecal, perineural, subcutaneous, and topical anesthetic use.

What are the side effects of lidocaine?

Lowers gag reflex, hoarseness, fever, contact dermatitis, blistering, erythema of treated area.

What are the adverse effects of lidocaine?

Cardiac arrest, arrhythmias, dyspnea, bronchospasm, seizures, anaphylaxis.

What are the contraindications and precautions for lidocaine?

Contraindicated in hypersensitivity, third-degree heart block, and Wolff-Parkinson-White syndrome; use caution in heart, pulmonary, or hepatic disease and glucose-6-phosphate dehydrogenase deficiency.

What is the MOA of topiramate?

Inhibits the release of CGRP and glutamate from the nerve endings of the trigeminal vascular system.

What are the indications for topiramate?

Migraine and cluster headache prevention.

What are the side effects of topiramate?

Paresthesia, fatigue, somnolence, weight loss, anorexia, dysgeusia.

What are adverse effects of topiramate?

Suicidal ideation, metabolic acidosis, fetal toxicity, kidney stones, hyperammonemia, hepatotoxicity.

What are the contraindications for topiramate?

Alcohol use, allergy to topiramate, and individuals prone to metabolic acidosis.

What precautions are needed with topiramate?

Monitor for manifestations of closed-angle glaucoma or myopia and stop medication immediately if this occurs.

What is the MOA of amitriptyline?

Inhibits the reuptake of serotonin and norepinephrine, leaving more of these neurotransmitters in the synaptic gap.

What are the indications for amitriptyline?

Relief of IBS manifestations cluster headaches, and migraines.

What are the side effects of amitriptyline?

Orthostatic hypotension, dizziness, sedation, lethargy, blurred vision, dry mouth, constipation, weight gain.

What are the adverse effects of amitriptyline?

• Dysrhythmias,

• torsades de pointe,

• suicidal thoughts and behaviors,

• glaucoma,

• seizures at high doses,

• bone marrow suppression.

What are the contraindications for amitriptyline?

Hypersensitivity to any TCA, heart failure, known history of QT prolongation, recent MI, seizures, or closed-angle glaucoma.

What precautions are needed with amitriptyline?

Use caution in clients who have suicidal thoughts or behaviors and those under 26 years of age.

What is the MOA of diphenhydramine?

Blocks H1 receptors in peripheral and CNS tissue; reduces or prevents effects of histamine.

What are the indications for diphenhydramine?

Reduction of allergy-associated manifestations, prevention of motion sickness, and cough suppression.

What are the side effects of diphenhydramine?

Drowsiness, dizziness, dry mouth, constipation, anorexia, blurry vision, photosensitivity.

What are the adverse effects of diphenhydramine?

• Palpitations,

• chest tightness,

• wheezing,

• increased bronchial secretions,

• paradoxical excitation in children.

What is the MOA of propranolol?

Blocks stimulation of beta1 and beta2 adrenergic receptor sites, decreasing heart rate, contractility, oxygen demand, and blood pressure.

What are the indications for propranolol?

migraines and HTN

What are the side effects of propranolol?

Fatigue, weakness, dizziness, drowsiness, nausea, constipation.

What are the adverse effects of propranolol?

Arrhythmias, bradycardia, heart failure, pulmonary edema, erythema multiforme.

What is the MOA of verapamil?

Stops the entry of calcium ions into calcium channels of the heart and smooth muscle, resulting in vasodilation.

What are the indications for verapamil?

Migraine and cluster headache prevention.

What are the adverse effects of verapamil?

• Atrioventricular (AV) heart block

• Hypotension

What is the MOA of ubrogepant?

Maintains a higher affinity for the CGRP receptor than CGRP, blocking the relationship between CGRP and the receptor.

What are the indications for ubrogepant?

Acute migraine treatment with or without aura.

What are the side effects of ubrogepant?

Sensitivity reactions

What is the MOA of galcanezumab?

Prevents CGRP receptor activation.

What are the indications for galcanezumab?

Prevention and treatment of migraine headaches.

What is the MOA of pseudoephedrine?

Stimulates alpha-adrenergic receptors, resulting in the release of norepinephrine and causing vasoconstriction.

What are the indications for pseudoephedrine?

Decrease in congestion of the sinus, nasal cavity, and eustachian tubes.

What is the MOA of onabotulinumtoxin A?

Binds to cholinergic nerve receptors, blocking the presynaptic release of acetylcholine.

What are the indications for onabotulinumtoxin A?

Muscle spasticity, chronic migraine, cervical dystonia.

What class is sumatriptan?

Serotonin receptor agonist (5-HT1B/5-HT1D)

What is the MOA of sumatriptan?

Works as an agonist on serotonin receptors by causing vasoconstriction or affecting trigeminal vascular nerves that reduce peripheral nociception.

What is the therapeutic use of sumatriptan?

Relieves manifestations of migraine headaches.

What are the side effects of sumatriptan?

Drowsiness, fatigue.

What are the adverse effects of sumatriptan?

• angina

• CNS effects such as tingling sensations or vertigo.

What are the contraindications for sumatriptan?

Coronary artery disease, angina, previous myocardial infarction, severe hypertension, peripheral vascular disease, older adults, stroke, use of an MAOI in the last 2 weeks, or use of another triptan within the last 24 hours.

What are the precautions for sumatriptan?

Liver or kidney insufficiency, coronary artery disease risk factors, seizure disorder, blood pressure elevation, serotonin syndrome, chest/jaw/neck tightness, fertility impairment, pregnancy, and lactation.

What class is lasmiditan?

Serotonin receptor agonist (5-HT1F)