Pharm Exam 2: Pain and Inflammation, Cardiac
Uses of fentanyl
IV anesthesia, patch chronic pain control for opioid tolerance, transmucosal breakthrough pain cancer pts
Drug abuse
Use is inconsistent with medical/social norms
You should not stop prednisone ____________-
abruptly
Physical dependence
abstinence syndrome will occur if drug is abruptly withdrawn
Which cyclooxygenase inhibitor has NO inflamm effects
acetaminophen
Tx for acetaminophen toxicity
acetylcysteine
Cochicine is used for
acute gout
Acetaminophen interacts with (2)
alcohol, warfarin
Procaine has a greater risk of
allergy
Codeine has less
analgesia
Use for acetaminophen
analgesic, antipyretic
Uses for aspirin (4)
analgesic, antipyretic, anti-inflamm, antiPLT
Effects of aspirin on L&D
anemia, postpartum hemorrhage, prolong labor
Acetaminophen does not _______ properties
anti-inflammatory
Role of COX-2 "bad COX"
anti-inflammatory, pain and fever perception, renal function, vasodialation
Inhibition of COX-1 causes
antiPLT, gastric ulcers, bleeding, renal issues
Aspirin interacts with (6)
anticoags, alcohol, ibuprofen, glucocoritcoids, ACE-I, ARBs
How to minimize topical lidocaine toxicity
apply smallest amount needed, avoid large areas, avoid broken skin, avoid exercise, don't wrap site or apply heat
1st gen NSAIDs (2)
aspirin, ibuprofen
Drug addiction
behavior pattern caused by continuous use of psychoactive substance despite harm
Most common gout locaton
big toe, feet
MOA loop diuretics
block NaCl absorption in loop of Henle
MOA naloxone
blocks effects of opioid agonists
2nd gen NSAID
celecoxib
Allopurinol is used to treat
chronic gout
Tylenol 3
codeine + acetaminophen
COX-2 can cause
colon cancer
S/s opioid toxicity
coma, decreased RR, miosis
Uses for codeine
cough and pain supression
What is another name for the NSAIDs/acetaminophen
cyclooxegenase inhibitors
Caution should be used in giving opioids to pts w/ (3)
decreased resp reserve, L&D, head injury
Reye's syndrome s/s
encephalopathy, heaptic injury
Lidocaine effects extended when given with
epinephrine
If pt does not respond to nasal naloxone, additional doses can be given
every 2-3 minutes
To prevent urinary retention, encourage pt to void
every 4-6 hrs
Take aspirin with
food and full glass of water
Loop diuretics (2)
furosemide, bumetanide
Acetaminophen toxicity can cause
hepatic necosis
AE of acetaminophen
hepatotoxicity
Vicodin
hydrocodone + acetaminophen
Etiology of gout
hyperuricemia causes crystals to deposit in joints
S/E prednisone
infections, adrenal insufficiency, hyperglycemia, osteoporisis, F/E imbalance, peptic ulcers
MOA of allopurinol (2)
inhibits enzymes used for uric acid prod; lowers blood uric acid levels
Lidocaine is administered by
injection or topical
If pt is on prednisone, vaccines are
less effective
Local anesthetics (2)
lidocaine, procaine
Opioids are inactivated by
liver
Prednisone can be used for d/o such as
lupus, RA, IBD, neoplasms
What is required after admin of nasal naloxone in the community
medical attention
Use for hydrocodone
moderate-severe pain
Pts taking cochicine should report any
muscle pain/weakness
AE of cochicine
myelosuppression, myopathy, rhabdomyolysis
Opioid antagonist
naloxone
Do not give fentanyl to pts who do not have__________ or are ___________
opioid tolerance; under 18
Naloxone can be given (2)
parenteral, nasal
Corticostroid
prendisone
Role of COX-1 (3) "good COX"
protect gastric mucosa, support renal function, promote PLT aggregation
Morphine _________________ without causing ___________________
relieves pain, loss of consciousness
Codeine has lower risk of (2)
resp depression, abuse potential
In premies, prednisone can prevent
respiratory depression
Most lethal AE of opioids
respiratory depression
Main s/e opioids
respiratory depression, constipation, orho hYTN, urinary retention, cough supression
Biggest use for naloxone
reverse opioid overdose
AE of aspirin (2)
salicycism, Reye's syndrome
Cochicine can cause _________, in which case the med _________
severe GI upset; should be stopped
Salicycism occurs when aspirin levels are
slightly elevated
Cochicine interacts with
statins
At high doses, prednisone will
suppress inflammation
Salicycism s/s
tennitus, HA, dizziness
When should you increase doses of prednisone
times of high stress
Topical lidocaine has risk of
toxicity
GI effects of aspirin (2)
ulcers, bleeding
s/e IV procaine
urinary retention, hyTN
Allopurinol interacts with (3)
warfarin, theophylline, ampicillin
hold opioids for a RR <
12
Avoid colecoxib in which trimester of pregnancy
3rd
Pts w/ no comorbidities should not exceed _______ mg acetaminophen; if malnourished, _________; w/ alcohol, _________
4000, 3000, 2000
MOA for procaine and lidocaine
Block Na channels to block sensory and motor function
SE local anesthetics
CNS excitation then depression, CV
S/e colecoxib
Dyspepsia, abd pain, renal toxicity
Which opioid is 100x more potent than morphine
Fentanyl
Ibuprofen is an aspirin-like drug with fewer ... (3)
GI, renal, hemorrhagic effects
Procaine is administed by
IV
Inhibition of COX-2 causes
Inflammation suppression, pain relief, antipyretic
MOA of acetaminophen
Inhibits prostaglandin synthesis in CNS
MOA of aspirin
Irreversibly blocks COX1 and COX2
Prednisone interacts with
K+ wasting drugs, NSAIDS, insulin/oral DM medicines
Celecoxib is a last choice drug b/c it increases risk of
MI and stroke
Ibuprofen does NOT protect against
MI and stroke
MOA of opioids
Mimic actions of endogenous opioids
Opioids (4)
Morphine, fentanyl, codeine, hydrocodone
Opioids primarily act on
Mu receptors
S/E allopurinol
N/V/D, abd discomfort, drowsiness, HA, metallic taste in mouth
1st line drug for acute gout
NSAIDs
MOA of prednisone
Nearly identical to endogenous steroids
Are procaine and lidocaine selective or nonselective?
Nonselective
Uses for ibuprofen (3)
OA, RA, dysmenorrhea
S/s local anesthetic toxicity
Palpitations, tachy, anxiety, HTN
MOA of ibuprofen
Reversible inhibition of COX-1 and COX02
MOA of celecoxib
Selective COX-2 inhibitor