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61 Cards in this Set
- Front
- Back
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Alcohol oxidation pharmacokinetics
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1)zero-order kinetics - constant amount is oxidized at a constant rate; metabolism independent of time or conc of alcohol in body
2) |
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Typical adult metabolizes how much alcohol per hour?
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7-10grams of alcohol per hour
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Pathways that alcohol is metabolized
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1)alcohol dehydrogenase (liver) producing acetaldehyde
2)microsomal ehtanol oxidizing system (MEOS) -chronic alcohol consumption induces microsomal enzyme system |
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role of aldehyde dehydrogenase
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acetaldehyde -> acetate -> H2O + CO2
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MOA of antabuse (disulfiram)
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1)inhibits aldehyde dehydrogenase
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alcohol and antabuse used together
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severe reaction consisting of headache, nausea, flushing, confusion
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graded depression of CNS with alcohol
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release of inhibitions -> anxiolytic effect -> sedation -> hypnosis -> anesthesia -> respiratory depression -> coma -> death
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High doses of alcohol effect
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depress respiration and may cause respiratory arrest
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management of acute alcohol intoxication
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1)main goal is to prevent or treat severe respiratory depression
2)prevent aspiration of vomitus |
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Ohter actions of alcohol
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1)HTN, cardiomyopathies, arrhythmias (chronic use)
2)inhibits secretion of ADH 3)stimulates gastric acid secretion 4)stimulate appetite (small amts); suppress appetite (large amts) 5)pancreatitis 6)anemia, folic acid deficiency 7)gynecomastia, testicular atrophy |
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Management of alcohol withdrawal
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1)main objective is to prevent SZRs, delirium, and arrhythmias
2)BZDs (lorazepam, oxazepam, diazepam) 3)phenytoin (control SZRs) 4)beta blockers, clonidine alleviate automonic effects 5)vitamin supplementation (thiamine) 6)antipsychotics for hallucinations may increase risk of SZRs |
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Management of alcohol dependence after withdrawal
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1)NALTREXONE (long-acting opiod antagonist) reduce craving for alcohol
2)ACOMPROSATE decrease craving and help maintain abstinence (possible MOA may involve actions at both glutamate and GABA receptors |
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MOA of morphine/opiods
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agonist at receptors for endogenous opiod peptides (endorphins and enkephelins) and modifies the processing of pain information in CNS
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mu receptor effects
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1)respiratory depression
2)euphoria 3)dependence 4)suprespinal analgesia |
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kappa receptor effects
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1)miosis
2)sedation 3)dysphoria 4)spinal analgesia |
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delta receptors effects
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1)dysphoria
2)hallucinations |
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morphine effects at receptors
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1)strong agonists at mu
2)moderate agonists at kappa 3)weak agonists at delta |
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pentazocine effects at receptors
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1)strong agonists at kappa
2)partial agonists or antagonists at mu receptors |
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naloxone effects at receptors
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1)antagonist at all types of opiod receptors
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what type of receptor agonists have the highest abuse potential
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mu agonists
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morphines analgesia effects
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1)limbic system (modify patient's rxn to pain)
2)spinal cord (modify physiological sensation of pain) |
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what types of pain is morphine most effective
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dull, constant, visceral pain
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difference between opiates and non-opiates at therapeutic doses
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morphine does not cause loss of consciousness which differs from non-opiate drugs
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other effects of morphine/opiods
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1)nausea (tolerance develops)
2)respiratory depression (usual cause of death in opiod poisoning-dec sensitivity to CO2 at chemoreceptors in medulla) 3)miosis (pin-point pupils) 4)antitussive effect 5)constipation/urine retention 6)bronchoconstriction 7)increased biliary pressure 8)orthostatic hypotension 9)cutaneous vasodilation 10)increased CSF pressure 11)immunosuppression |
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standard therapeutic dose of morphine
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10mg SC or IM
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medications that can enhance the effects of opiods
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1)antihistamines (hydroxyzine)
2)TCAs |
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Examples of strong mu agonists
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morphine, codeine, hydromorphone, oxymorphone, levorphanol, oxycodone, hydrocodone, meperidine, heroin, methadone, levo-alpha-acetylmethadol, propoxyphene, fentanyl, sufentanil, alfentanil
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Meperidine characteristics
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1)1/10 potency of morphine
2)less constipation and urine retention 3)used for mod-sev pain 4)used in obstetrics (less respiratry depression in newborn than morphine) 5)active metabolite that can cause SZRs (not for chronic pain) |
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methadone characteristics
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1)less euphoric
2)longer duration of action (12-24hr) than heroin (2-4hr) or morphine (4-6hr) 3)used as analgesic (4-6h) and in treating opiod addiction (24hr) 4) |
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drugs that can induce neuroleptic analgesia
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fentanyl plus droperiodol (Innovar)
-used for diagnostic and minor surgical procedures |
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drugs that can induce neuroleptic anesthesia
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Innovar plus nitric oxide
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these agents are similar to fentanyl but used I.V. as adjuncts for surgical anesthesia
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sufentanil and alfentanil
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percocet components
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oxycodone/APAP
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opium tincture characteristcs
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10mg morphine per mL
-orally for mild pain or diarrhea |
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paregoric characteristics
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2mg morphine per 5mL
-diarrhea |
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pentazocine (Talwin) characteristics
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1)agonist at kappa receptors, partical agonist at mu receptors
2)mu antagonist at high doses 3)CNS stimulation and hallucinations more common than w/ morphine 4)less sedation and respiratory depression than w/ morphine |
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buprenorphine characteristics
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1)partical agonist at mu receptors, possibly kappa receptors
2)used for opiod dependence 3)reduce craving in heroin addicts |
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Suboxone components
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buprenorphine/naloxone
-high doses, naloxone blocks effects of buprenorphine |
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tramadal (Ultram) characteristics
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1)weak mu agonist
2)inhibits synaptic uptake of NE and 5-HT 3)used for mild-mod pain |
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drug of choice for opiod poisoning-can reverse respiratory depressant effects of opiods
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naloxone
-must be given parenterally -short acting (2hr) |
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naltrexone characteristics
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-long acting (24hr)
-immunizes addicts (prevents high) -HEPATOTOXICITY -patient must be detoxified -treatment of alcoholism |
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opiod poisoning symptoms-characteristic triad
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1)CNS depression-stupor or coma
2)depressed depth and rate of respiration 3)pin point pupils (may be dilated if severely hypoxic - close to death) |
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treatment of opiod poisoning
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1)support respiration (O2 administration may remove hypoic drive or respiration and cause apnea)
2)NALOXONE |
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duration and intensity of actue withdrawal
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1)short acting drug (heroin)
-intense sxs, short duration (2-3d) 2)long acting drug (methadone) -moderate sxs, long duration (4-7d) 3)followed by prolonged syndrome of mild anxiety, irritability, sleep disturbances, autonomic excitability that may last for several weaks-months |
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treatment of opiod dependence
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1)methadone
2)buprenorphine 3)naltrexone 4)clonidine 5)antidepressants |
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opiod poisoning symptoms-characteristic triad
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1)CNS depression-stupor or coma
2)depressed depth and rate of respiration 3)pin point pupils (may be dilated if severely hypoxic - close to death) |
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treatment of opiod poisoning
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1)support respiration (O2 administration may remove hypoic drive or respiration and cause apnea)
2)NALOXONE |
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duration and intensity of actue withdrawal
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1)short acting drug (heroin)
-intense sxs, short duration (2-3d) 2)long acting drug (methadone) -moderate sxs, long duration (4-7d) 3)followed by prolonged syndrome of mild anxiety, irritability, sleep disturbances, autonomic excitability that may last for several weaks-months |
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treatment of opiod dependence
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1)methadone
2)buprenorphine 3)naltrexone 4)clonidine 5)antidepressants |
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opiod poisoning symptoms-characteristic triad
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1)CNS depression-stupor or coma
2)depressed depth and rate of respiration 3)pin point pupils (may be dilated if severely hypoxic - close to death) |
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treatment of opiod poisoning
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1)support respiration (O2 administration may remove hypoic drive or respiration and cause apnea)
2)NALOXONE |
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duration and intensity of actue withdrawal
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1)short acting drug (heroin)
-intense sxs, short duration (2-3d) 2)long acting drug (methadone) -moderate sxs, long duration (4-7d) 3)followed by prolonged syndrome of mild anxiety, irritability, sleep disturbances, autonomic excitability that may last for several weaks-months |
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treatment of opiod dependence
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1)methadone
2)buprenorphine 3)naltrexone 4)clonidine 5)antidepressants |
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opiod poisoning symptoms-characteristic triad
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1)CNS depression-stupor or coma
2)depressed depth and rate of respiration 3)pin point pupils (may be dilated if severely hypoxic - close to death) |
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treatment of opiod poisoning
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1)support respiration (O2 administration may remove hypoic drive or respiration and cause apnea)
2)NALOXONE |
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duration and intensity of actue withdrawal
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1)short acting drug (heroin)
-intense sxs, short duration (2-3d) 2)long acting drug (methadone) -moderate sxs, long duration (4-7d) 3)followed by prolonged syndrome of mild anxiety, irritability, sleep disturbances, autonomic excitability that may last for several weaks-months |
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treatment of opiod dependence
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1)methadone
2)buprenorphine 3)naltrexone 4)clonidine 5)antidepressants |
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opiod poisoning symptoms-characteristic triad
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1)CNS depression-stupor or coma
2)depressed depth and rate of respiration 3)pin point pupils (may be dilated if severely hypoxic - close to death) |
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treatment of opiod poisoning
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1)support respiration (O2 administration may remove hypoic drive or respiration and cause apnea)
2)NALOXONE |
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duration and intensity of actue withdrawal
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1)short acting drug (heroin)
-intense sxs, short duration (2-3d) 2)long acting drug (methadone) -moderate sxs, long duration (4-7d) 3)followed by prolonged syndrome of mild anxiety, irritability, sleep disturbances, autonomic excitability that may last for several weaks-months |
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treatment of opiod dependence
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1)methadone
2)buprenorphine 3)naltrexone 4)clonidine 5)antidepressants |
