PHARM DRUG LIST 2

Opioid drugs

produce euphoria, inhibit pain transmission, CNS depressant, analgesia

Morphine

pain, fixed schedule with reduce dose, if RR below 12 withhold meds

Morphine

natural, endorphin receptor agonist, inhibit pain transmission , schedule 2

Oxycodone

highly addictive and abused

Opioid toxicity

coma, respiratory depression, pinpoint pupils

Naloxone

antidote to opioid toxicity

Naloxone

short ½ life, keep dosing, blocks opioid effect

Naloxone ADR

reversal of analgesia, increase BP, tremors, hyperventilation, rapid pulse, maintenance (wean off drugs)

Methadone

oral (no needles), acute (cope with physical dependence)

NSAIDS

non steroidal anti inflammatory drugs

NSAIDS use

analgesic, antipyretic, anti inflammatory (pain, fever, inflammation)

Aspirin

inhibit COX non specifically and irreversibly

Aspirin use

pain, HA, fever, RA, MI, stroke (anti thrombotic)

Aspirin ADR

GI irritation, ulcer, bleeding, renal impairment, reye syndrome (not for sick children), allergic reactions

Reye's syndrome

not for children or NOT for chicken pox or influenza

Aspirin contradiction

not for bleeding disorders, withdrawal one week before surgery or birth, not for pregnancy or lactation

Aspirin Toxicity

salicylism (tinnitus, hearing loss, hyperventilation, NV, acid base imbalance, dehydration

Other NSAID (not aspirin)

not used for anti thrombotic effect (don't protect against MI and stroke)

COX 1

protective

COX 2

pain / inflammation

Celecoxib

COX 2 inhibitory, keep protective without the GI risks, severe cardiovascular ADRs so last choice med

Acetaminophen

inhibits prostaglandin synthesis in CNS, pain and fever (not inflammation), DOC for mild pain and fever

Acetaminophen ADR

renal or hepatic toxicity (avoid alcohol \= liver damage) Acetaminophen toxicity

Acetaminophen antidote

acetylcysteine (mucomyst)

Acetaminophen advantages

doesn't irritate stomach, no interference with blood coagulation, no reye's syndrome, choice during pregnancy and lactation

Glucocorticoids

steroid hormone, bind DNA and effect protein synthesis

Prednisolone ADR

adrenal suppression, osteoporosis, muscle wasting, GI irritation, electrolyte disturbances (hyponatremia, hypokalemia), increase blood glucose, susceptible to infection, mood disturbances, cushing syndrome

Glucocorticoids nursing implication

must increase dose in times of stress (susceptible to adrenal suppression), increase during surgery/infection/trauma 3x3 rule, do not discontinue abruptly

DMARDs

suppress rheumatic disease process, takes up to 3 months to work, heterogeneous class, suppress immune system

Rheumatoid arthritis non drug

acupuncture, increase oily fish, lose weight (swimming)

Methotrexate

less toxic, relatively fast acting, NOT in pregnancy

Methotrexate ADR

hepatotoxic, NVD, bone marrow suppression, low WBC (infection)

Etanercept

more toxic, tumor necrosis factor blocker, given SubQ, check for TB before starting

Etanercept ADR

susceptible to infection (serious fungal / TB)

Gout

metabolic disease, elevated uric acid, severe joint pain, STOP beer drinking

Acute gout

inflammation due to uric acid crystalization in joints

NSAIDS gout

high dose (NOT aspirin) for acute gout

Colchicine

anti inflammatory specific for gout

Colchicine ADR

severe GI (NSAIDS now first line)

Chronic gout

tophus

Allopurinol

inhibit formation of uric acid

Allopurinol ADR

cataracts (reg eye checks), GI

Probenecid

increase rate of uric acid secretions

Probenecid ADR

hypersensitivity (rash), GI

Triptans

market leader, acute nasal spray

Sumatriptan use

migraine

Sumatriptan

serotonin agonist, vasoconstriction, decrease release of inflammatory neuropeptides

Sumatriptan ADR

nausea, weakness, numbness, tingling extremities, chest pain and tightness, heavy arms

Sumatriptan contraindications

not for patients with CV problems, no smoking

Ergot derivatives

acute/chronic migraine serotonin agonist, add caffeine for rapid onset

Ergotamine / dihydroergotamine

ergot derivatives

Ergotamine / dihydroergotamine ADR

CNS excitation effects, uterine cramps, nausea, weakness, tingling extremities, chest pain and tightness, heavy arms

Ergot derived toxicity

ergotism (bringin pain, hallucinations)

H2 blockers

block receptors on gastric parietal cells (reduce gastric secretions)

H2 blockers and proton pump inhibitor uses

hyperacidity, GERD, combo therapy for ulcers

Cimetidine / ranitidine

H2 blocker, reduce gastric secretions

Cimetidine / ranitidine ADR

CNS pneumonia, care with liver/kidney function, imparis other absorption (less acid)

Proton pump inhibitor

blocks gastric acid formation

Omeprazole

inhibits gastric acid formation, proton pump inhibitor

Omeprazole ADR

HA, dry mouth, diarrhea, pneumonia (take before meals, impaired absorption of other drugs)

Acid suppressive + antibiotic

combo therapy for ulcers with H pylori, coating and protecting effect

Acid suppressive + antibiotic ADR

tongue and stool are black

Bismuth subsalicylate

acid suppression and antibiotic, anti inflammatory, coating and protective effect

Bismuth subsalicylate ADR

black stool

Antacids

no acid suppression, neutralization (of stomach acid)

Antacids care with

long term use (can be masking something serious), impaired absorption of other drugs \= take an hour after other meds)

Constipation

Aluminium and calcium

Laxative

magnesium salts

Misoprostol

mimics prostaglandin protective effects in stomach

Misoprosal use

treat gastric ulcers, 2nd to NSAIDs use

Sucralfate

polymerization in acidic conditions \= viscous sticky protective gel (take with water hour before eating)

Sucralfate ADR

very few

CINV

chemotherapy induced nausea and vomiting

Ondansteron

blocks serotonin and GI impulses

Ondansteron use

CINV, post op

Ondansteron ADR

HA, constipation, diarrhea

Antiemetics

more effective at preventing CINV than supressing it (give before chemo drugs)

Chlorpromazine

dopamine blocker

Chlorpromazine use

CINV and post op

Chlorpromazine ADR

NOT with movement disorders, sedation

Nabilone

pharm grade THC (cannabis), only resin capsules, for CINV

Nabilone contradictions

not for patients with mental disturbances or psychiatric disorders

Nabilone ADR

mental disturbances, drowinness, abuse/dependence

Scopolamine

anticholinergic, block muscarinic receptors

Scopolamine use

motion sickness / vertigo, prophylaxis

Scopolamine ADR

dry mouth, blurred vision, constipation

Diphenhydramine

antihistamine, central anticholinergic action

Diphenhydramine use

motion sickness / vertigo, prophylaxis

Diphenhydramine ADR

drowsiness, dry mouth, blurred vision

Slow acting

1 to 3 days for soft stool

Bulk forming

must mix with fluids

Polycarbophil / methylcellulose

act like fiber, increase bulk (stim peristalsis) and decrease transit time, swell in water, form emollient gel

Polycarbophil / methylcellulose use

constipation and prevent straining diarrhea

Polycarbophil / methylcellulose ADR

least harmful

Docusate

Surfactant (lowers fecal surface tension and allows water to soften stool)

Docusate use

constipation and prevent straining

Docusate ADR

mild and cramp

Intermediate acting

6 to 12 hrs, semi fluid stool

Stimulant (bisacodyl / senna)

stimulate intestinal motility and water/ions secretions into lumen

Stimulant (bisacodyl / senna) use

promote bowel movements (slow transit times, constipating drugs)