Nursing 101 Pharmacology Notes
Morphine Overdose
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List the adverse reactions associated with acetaminophen
Risk for liver damage especially with alcohol use. Not recommended for malnourished patients due to risk for acute renal failure. Nausea, vomiting, chills, abdominal discomfort and fatal hepatic necrosis. Severe allergic reactions.
identify 2 opioids with agonist-antagonist effects
buprenorphine (Buprenix, Butrans, Suboxone) butorphanol (Stadol) dezocine (Dalgan) nalbuphine (Nubain) pentazocine (Talwin)
Blood Serum levels
can be monitored by drawing blood to measure level drug in serum. To be effective, the active component of a medication must be present in the blood within a therapeutic range. The blood level of a med is the amount circulating in the bloodstream at a given point in time.
Metabolism
(biotransformation) the process of inactivating and breaking down a med. Liver mainly.
What is the difference between oxycontin and percocet?
-Oxycontin and Percocet both relieve pain. Oxycontin last for 12 hours and percocet lasts for about 5. -Percocet contains 5 mg of oxycodone, which is all released when the pill is taken. Percocet also contains acetaminophen (drug in Tylenol), which makes people sick if they take a lot. -Oxycontin doesn't contain acetaminophen. It is pure oxycodone in amounts much larger than in Percocet. -Oxy comes in 10, 20, 40, 80mg of oxycodone. One pill can have the same amount as 16 perc pills. Oxy, only part of the oxycodone is released. the rest of it is coated so that it is released into the body slowly.
Prototype Drug - Morphine Actions and Uses
-morphine binds with both mu and kappa for analgesia. -euphoria, constriction of the pupils, stimulation of cardiac muscle -used for symptomatic relief of serious acute and chronic pain after non-narcotic analgesics have failed. -
Morphine Admin alerts
-oral solution may be given sublingually -
Aspirin and Ibuprofen inhibit both COX-1 and COX-2 so COX INHIBITION is the basis of NSAID therapy
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Morphine adverse effects
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Morphine black box warning
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morphine contraindications
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3 Checks
1. when the nurse reaches for the container or unit dose package. 2. after retrieval from the drawer and compared with the CMAR (second label check. Or compared with the CMAR immediately before putting from a multi dose container. 3. when replacing the container to the drawer or shelf or before giving the unit dose medication to the patient.
Normal Albumin level
3.5-5
What physiological effects occur with the administration of nalaxone (NARCAN)?
A OPIOD ANTAGONIST, nalaxone (Narcan) blocks but the Mu and Kappa receptors. It is used for complete or partial reversal of opioid effects in an emergency situation when overdose is suspected
Drugs used to treat fever are called
ANTIPYRETICS
What is meant by a mixed opioid a - antagonist effect?
Activates the Kappa receptors but blocks the MU receptors. Pentazocine hydrochloride (Talwin)
Relevance of Mu and Kappa receptor sites in pain management?
Analgesia MU KAPPA Decreased GI Mobility MU KAPPA Euphoria MU Miosis KAPPA Physical Dependence MU Respiratory Depression MU Sedation MU KAPPA
What are the effects of opiods? MU
Analgesia, decreased GI motility, respiratory depression, sedation, physical dependence
Drugs most likely to cause drug-induced fever include:
Anti-infectives (antibiotics) Selective sertonin reuptake inhibitors (SSRIs) taken for depression or mood disorders Conventional antipsychotic drigs (Thorazine) Volatile anesthetics and depolarizing neuromuscular blockers Immunomodulators (Interferons and monoclonal antibodies) Cytotoxic drugs (chemo, immunosuppressents) Neutropenic drugs (NSAIDS, antithyroid, antipsychotic)
Identify the pharmacological effects of SALICYLATES
Aspirin binds to COX-1 and COX-2 enzymes, changing their structures and preventing them from forming inflammatory prostaglandins.
Mixed Opioid agonist
Buprenorphine
What is tramadol (Ultram)?
Centrally acting analgesics. Weak opioid activity for moderately severe pain. Main action is to inhibit reuptake of NOREPINEPHRINE and SEROTONIN in spinal neurons.
Factors affecting drug action
Children require lower doses, older people are sensitive due to decreased GI motility, Dec muscle mass, decreased liver function, decreased cardiac output.
identify 2 opioid agonists with moderate effectiveness
Codeine hydrocodone (hycodan) Oxycodone (oxycontin, oxecta) oxycodone terephthalate (percocet, roxicet)
Indicate select patients for whom acetaminophen is preferred instead of ASA
Has no effect on platelets and does not exhibit cardiotoxicity-preferred for patients with bleeding disorders, before/after surgery Does not cause GI bleeding or ulcers
What is salicylism?
High doses of Aspirin
Identify select patients with whom salicylate use would be contraindicated and why?
History of GI bleed or ulcer: risk of bleeding Chronic alcohol abuse: severe renal disease Cardiovascular disease: may increase risk of cardiovascular thrombotic events, myocardial infarction and stroke with prolonged use. Pregnancy: adverse effects on fetus and mother especially during 3rd trimester Lactating females: safety not established Geriatrics: increased risk of GI bleeding due to being more sensitive to toxic levels
route
IV, topical, oral, IM, subg, inhalation, sublingual.
absorption factors
Lipid solubility - can pass through cell membrane easily. pH - acidic drugs are well absorbed in the stomach.
Identify common uses of salicylates.
Mild pain and inflammation. Protective effect on cardiovascular system in small doses to prevent strokes and clot formation.
Pure opioid agonist
Morphine, codeine
Treating inflammation with NSAIDS p.461-463
NSAIDS act by INHIBITING PAIN MEDIATORS at the nociceptor level. They INHIBIT CYCLOOXYGENASE-the enzyme that forms PROSTAGLANDINS. When cyclooxygenase is inhibited, inflammation and pain are reduced. After tissue damage, prostaglandins form with help of cyclooxygenase type 1 (COX-1) and cyclooxygenase type 2(COX-2)
Pure opioid antagonist
Naloxone
Lifespan considerations
Older adults need to be monitored closely due to decreased hepatic metabolism and renal excretion. Smaller doses are usually needed and adverse effects are usually heightened. Some opioids may cause orthostatic hypotension.
What is the action of an OPIOID ANTAGONIST?
Opiod antagonists prevent the effects of or BLOCK OPIOID AGONISTS. They many compete with opioids for access to the opioid receptors.
Therapeutic Physiological effects of opioids?
Opioids are narcotic substances: they produce numbness or stupor-like symptoms
Identify several uses of NSAIDS
Pain, fever and inflammation.
Mixed opioid agonist
Pentazocine, butorphanol
Identify the pharmacological effects of acetaminophen.
Pharmacologic Class: Centrally acting COX inhibitor. Classification: Theraputic: antipyretic, nonopiod analgesics Reduces fever by direct action at the level of the hypothalamus and dilation of peripheral blood vessels which enables sweating and dissipation of heat. Has no anti-inflammatory properties
Identify the pharmacological effects of the NSAIDS
Pharmacologic class: non-opioid analgesics Theraputic Class: analgesic, anti-inflammatory, antipyretic NSAIDS act by INHIBITING PAIN MEDIATORS at the nociceptor level. They INHIBIT CYCLOOXYGENASE-the enzyme that forms PROSTAGLANDINS. When cyclooxygenase is inhibited, inflammation and pain are reduced.
Distribution
Process begins with absorption into the circulation and ends with its arrival at the site of action. Pts overall health, chemical properties of med, site absorption
What is the intended action of naloxone hydrochloride (Narcan)
Pure Opioid antagonist that blocks MU and Kappa receptors. Used for complete or partial reversal of opioid effects in emergency situation when acute opioid overdose is suspected. Reverses opioid-initiated cns and respiratory depression within minutes.
Peak action
Represents the amount of of time needed for a drug to reach the highest concentration for effectiveness
5 Rights of med administration
Right MEDICATION is given right PATIENT right DOSAGE right ROUTE right TIME
What symptoms are associated with salicylism?
SALICYLISM produces symptoms such as tinnitus, dizziness, headache and excessive sweating.
How do salicylates decrease body temperature?
Salicylates act as antipyretics by binding to COX-2
List the adverse reactions associated with salicylates
Stomach pain, heartburn, nausea, vomiting, tinnitus, prolonged bleeding, severe GI bleeding, bronchospasm, anaphylaxsis, hemolytic anemia, Reyes syndrome in children, metabolic acidosis.
What are the signs of acetaminophen overdose and how is it treated?
Symptoms, which occur in 4 stages include: anorexia, nausea, vomiting, and right upper quadrant abdominal pain. Renal failure and pancreatitis may occur, occasionally without liver failure. acetylcyseine (Acetadote) is the antedote for overdose.
Local effect
Target organ, med induced specific effect on one type of body tissue. ie Diuretic - kidneys
Time of Onset
The amount of time needed after administration of a drug to produce the desired effect
What effect does ASA have on bleeding?
The inhibition of COX is prolonged in the platelets causing an anti-platelet effect causing a high risk for bleeding without clotting.
Mechanism of Action - Pharmacodynamics
The physiological change caused by the medication that results in the body's response to the medication. This change alters either the chemistry of the cell environment of the cell itself. Interacts with the cell receptor site creating physiological events ending with the therapeutic effect.
Identify 2 nursing considerations when administering nalaxone (Narcan)
The reversal of opioids may result in rapid loss of analgesia, increased blood pressure, tremors, hyperventilation, nausea, vomiting and drowsiness.
Systemic effect
Throughout the body
Identify uses of acetaminophen
Treatment of of fever in children and mild to moderate pain when aspirin in contraindicated.
List specific nursing interventions related to the administration of salicylates.
Use the lowest dose possible PO: Adminster AFTER meals or with food or an antacid to minimize GI irritation. Do not crush tablets. Caution patient to avoid use of alcohol to minimize GI irritation/bleeding. Instruct patient to notify health care professional if any rash occurs.
What are some adverse reactions of tramadol (Ultram)?
Vertigo, dizziness, headache, nausea, vomiting, constipation, lethargy.
Generic Factors affecting drug action
Weight, gender, cultural/genetic factors, psychological factors (placebo), pathology, environment (nutrition, living conditions, stress levels, O2) timing of administration (presence of food in the stomach, circadian rhythms)
Pharmacokinetics
a drug's activity from the time it enters the body unit until it leaves
allergic responses
an antigen-antibody response
What are the effects of opiods? Kappa
analgesia, decreased GI motility, sedation
BUN (Blood Urea Nitrogen)
and Creatinine are waste products and their levels determine if is excretion is diminished or abnormal. increased = abnormal.
PRN
as needed
List examples of NSAIDS:
celecoxib (Celebrex)-Selective COX-2 inhibitor ibuprofen ketorolac naproxen
Barriers to patient taking meds
cognitive, lack of knowledge, physical, lack of family support
Nociceptive pain
comes from injury to tissues, maybe described as somatic (sharp, localized sensations) or Visceral (dull, throbbing or aching)
Delta receptor
connected to the emotional and effective components of pain
8 common adverse effects of opioids
constipation, nausea, sedation, drowsiness, dizziness, respiratory depression, vomiting
what are opioid antagonists?
drugs that block a particular opioid receptor
What are opioid agonists?
drugs that stimulate a particular opioid receptor (morphine)
Nociceptors
free nerve endings/pain receptors
List the adverse reactions associated with NSAIDS: Most serious
gastric ulceration and bleeding Adverse gastric effects (mucosa) Kidney toxicity Increased potential for bleeding Increased risk of thromboembolic events
narcotic
general term used to describe opioid drugs that produce analgesia and CNS depression
drug tolerance
getting used to the therapeutic effect
In additions to the cumulative effects of opioids, what is the risk of administration of hydrocodone (Vicoden) and oxycodone hydrochloride (percocet)
hepatoxicity (liver damage), respiratory depression, circulatory collapse, coma
peak level
highest plasma concentration of the drug. should be measured when absorption is complete
Placental barrier
inhibits transport of some drugs from crossing the placenta
Therapeutic range
is the concentration of drug in blood serum that produces the desired effect without causing toxicity.
loading dose
larger than normal dose, usually when max therapeutic levels is needed
Anaphylaxis
life threatening reaction, dyspnea, wheezing, stridor, tachyacardia, hypotension
conditions at absorption site
make sure the IV is properly put in; see if the site is impaired (bruise, edema, scar)
Protein binding capacity
meds partially bind to protein (albumin). If low; pt could show signs of toxicity. Elderly, poor nutrition, liver disease
hypersensitivity reaction
mild allergic reaction - rash, urticaria, prurtis, headache, rhinitis, N&V
Opioids with agonists with high effectiveness
morphine (Astramorph PF, Duramorph) fentanyl (Duragesic, Fentora, Lazanda, Onsolis, Oralet, Actiq, Abstral) hydromorphone (Dilaudid, Exalgo) meperidine (Demerol) levorphanol (Levo-Dromoran) methadone (Dolophine) oxymorphone (Opana)
what is the dosage relationship between morphine sulfate and hydromorphone hydrochloride (dilaudid)
morphine sulfate - PO 10-30mg every 4h prn hydromorphone hydrochloride PO 1-4mg every 4-6h prn
Excretion
movement of a drug from the site of metabolism back into the circulation and its transport to the sit of sit from the body. Action of kidneys mainly (also lungs, exocrine glands, intestinal tract)
Opioid receptors
mu, kappa, delta, orphanin FQ peptide.
List the adverse reactions associated with NSAIDS Which are the most common
nausea and vomiting
synergistic effect
one drug enhances the effect of another drug
antagonistic effect
one drug reduces the effect of another drug
MU and Kappa Receptors
opiods act on these to manage pain
1st pass effect
oral; enters digestive system first where most of the drug gets absorbed,.
blood brain barrier
physiological barriers; permits transport of lipid-bound meds while preventing transport of many water-soluble drugs
Neuropathic pain
results from injury to nerves, may be described as burning, shooting or numb
toxic effects
serious adverse effects that maybe life threatening
Dehydrated or Renal Disease dosage
should be lower because kidney's can't excrete properly
adverse effects
side effects; effects of a med that are not intended.
STAT
single order, immediately
sustained response
small dosages to sustain therapeutic effect.
Other effects of opioids
suppression of cough reflex, euphoria, relaxation, respiratory depression, nausea, vomiting
Half-Life
the amount of time it takes for half of the the original dose to be removed.
Therapeutic effect
the intended effect or action of the medication
Trough level
the point when the drug is at its lowest concentration. specimen usually drawn 30 minutes before the next dose
Plateau
the serum concentration or level of a drug that has been reached and sustained with a series of fixed doses
Duration
the span of time during which the serum drug concentration is high enough to produce the intended effect
absorption
the transference of drug molecules from the point of entry in the body into the bloodstream, often systemic. Influenced by route, dosage and form, conditions of the absorption site.
idiosyncratic response
unexplained and unpredictable response to a med
