Exam 1 Drugs

what drug class is morphine?

opioid analgesic

what is morphine’s MOA?

decreases pain impulse transmission at spinal cord by interacting with opioid receptors

what are the indications for morphine?

moderate-severe pain

cancer pts

acute pain (sometimes chronic pain)

what drug class is fentanyl?

opioid analgesic

what is fentanyl’s MOA?

inhibits ascending pain pathways in CNS

alters pain perception by binding to opioid receptors

what is fentanyl indicated for?

moderate-severe pain

adjunct general or regional anesthesia

post op

what are some drug nuances for fentanyl?

100x as strong as morphine, extreme potency

small lethal threshold

what is the drug class for naloxone?

opioid antagonist, antidote

what is naloxone’s MOA?

competes with opioids at opioid receptor sites

what is naloxone indicated for?

resp depression induced by opioids (OD)

hypotension

shock

what drug class is buprenorphine?

opioid analgesic, partial agonist

what is buprenorphine’s MOA?

depresses pain impulse transmission at spinal cord level by interacting with opioid receptors

partial agonist at mu-opioid receptor

what is buprenorphine indicated for?

moderate-severe pain

opiate agonist withdrawal/dependence

what are some drug nuances for buprenorphine?

ceiling effect

used to treat OUD

what is the drug class for acetaminophen?

non-opioid analgesic

antipyretic no anti-inflammatory events

what is acetaminophen’s MOA?

activates descending serotonergic inhibitory pathway in CNS

antipyretic action results from hypothalamic heat-regulating center

what are some drug nuances for acetaminophen?

works CENTRALLY in its inhibition of COX, NSAIDS work peripherally

lacks anti-inflammatory activity and doesn’t impair platelet function or cause GI bleeding

dosing —> max limit is 4,000mg for a healthy adult, 3,000mg for chronic/alc users, 2,000mg for elderly

n-acetylcysteine treats OD

what drug class is aspirin/ASA?

nonopioid analgesic

what is ASA’s MOA?

blocks pain impulses by blocking COX-1 in CNS

decreases inflammation by inhibition of prostaglandin synthesis

antipyretic action results from vasodilation of peripheral vessels

decreased platelet aggregation

what is ASA indicated for?

mild-moderate pain and fever

EX: rheumatoid arthritis, osteoarthritis, thromboembolic d/o, transient ischemic attacks, angina, etc.

what are some drug nuances for ASA?

irreversible anti-clotting effect

children <12 yrs old with flulike symptoms (reyes syndrome)

what is the drug class for indomethacin?

NSAID

antirheumatic

what is indomethacin’s MOA?

inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis

analgesic, antiinflammatory, antipyretic

what is indomethacin indicated for?

mild-moderate pain and inflammation

what drug class if ketorolac?

NSAID

nonopioid analgesic

what is ketorolac’s MOA?

inhibits prostoglandin synthesis analgesic

antiinflammatory, antipyretic effects

what is ketorolac indicated for?

moderate-severe pain

post op

ocular itching for seasonal allergies wh

what are some drug nuances for ketorolac?

only NSAID indicated for moderate-severe pain

limit use to <5 days due to risk of adverse effects including GI bleeding and renal impairment.

what drug class is celecoxib?

NSAID

antirheumatic

what is celecoxib’s MOA?

inhibits prostaglandin synthesis by selectively inhibiting COX-2 (enzyme needed for biosynthesis)

what is celecoxib indicated for?

mild-moderate pain and inflammation

acute/chornic rheumatoid arthritis

what are some drug nuances for celecoxib?

targets COX-2, minimal effect on COX-1 (GI protective)

what is the drug class for allopurinol?

antigout

antihyperuricemic

what is allopurinol’s MOA?

inhibits the enzyme xanthine oxidase, decreases uric acid synthesis

what is allopurinol indicated for?

chronic gout, uric acid calculi

what are some drug nuances for allopurinol?

for maintenance therapy of gout it can cause drug interactions; patients should be monitored for skin rashes.

what is drug class is colchine?

antigout agent wh

what is colchicine’s MOA?

inhibits microtubule formation of lactic acid in leukocytes which decreases phagocytosis and inflammation in joints

what is colchicine indicated for?

gout

arrest progression of neurological disability in MS

what are some drug nuances of colchicine?

for acute therapy of gout, pt to take at first sign of an attack

what are contraindications for opioids?

resp depression

GI obstruction (ex: paralytic lleus)

other CNS depressants

chronic pulmo or cardiac dz (ex: sleep apnea)

hepatic or renal impairment (increase toxicity)

what are adverse effects of opioids?

resp depression

decreased GI motility (constipation)

tolerance and dependence

sedation/cognitive impairment

orthostatic HTN

urinary retention

what are contraindications for NSAIDS?

GI bleeding or ulcers

bleeding d/o (ex: hemophilia)

hepatic/renal impairment

what are adverse effects of NSAIDS?

GI bleeding (ex: black, tarry stools)

MI

stroke

kidney and liver damage

what is hydromorphone (dilaudid)?

opioid agonist

7x as strong as morphine

how do you apply a fentanyl patch?

clean and dry skin

rotate and assess sites

check for other patches on skin before applying a new patch

change every 72 hrs

do NOT apply heat

what are drug nuances for naloxone?

can cause withdrawal effects especially in opioid-dependent patients, may also have limited effectiveness with certain synthetic opioids.

what is methadone?

opioid agonist

synthetic and long acting

typically for opioid use d/o, med assisted tx

what are opioids indicated for?

moderate-severe pain

part of balanced anesthesia

cough suppression

anti-diarrheal agents

what are drug-drug interactions for opioids?

any CNS depressant

monoamine oxidase inhibitors —> enzyme group that breaks down NTMs, generally want a 14 day washout

anticholinergic drugs

what are the primary agents for non-opioid drugs?

acetaminophen

NSAIDS

anti-gout meds

what gout medication is for excretion?

probenecid

what are potential adverse effects of out medications?

hematological probs like leukopenia

bone marrow suppression (thrombocytopenia)

skin disorders (steven-johnson syndrome)

what are CNS depressants?

class of meds that reduce neuronal excitability throughout the CNS, primarily by enhancing (agonist) GABA inhibitory neurotransmission

what are the classes of CNS depressants?

benzodiazepines

barbiturates

non-benzodiazepine

sedative-hypnotics (z-drugs)

opioids

certain muscle relaxants

anticonvulsants

what are benzodiazepines indicated for?

anxiety d/o

panic d/o

insomnia

alcohol withdrawal

seizures

muscle-spasms

procedural sedation

what are z-drugs indicated for?

short term (generally) tx of insomnia

what are muscle relaxants indicated for?

acute muscle spasm

spasticity

what drug class are benzodiazepines?

GABA agonist drugs

GABA —> primary inhibitory NTM found in the brain

what is the MOA for benzodiazepines?

enhance GABA-A receptors by binding to GABA-A receptors (inducing GABA response = agonist)

what are contraindications for benzodiazepines?

pupillary dilation —> increased intraocular pressure

resp depression

severe hepatic impairment

pregnancy (category x)

SUD

what are drug nuances for benzodiazepines?

NEVER stop abruptly

do not take with grapefruit juice, prolongs effects

what are symptoms of a benzodiazepine OD?

somnolence

confuion

diminished reflexes

coma

dilate pupils

hypoventilation

what is the antidote for a benzodiazepine OD?

flumazenil —> give cautiously, can precipitate withdrawal