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30 Cards in this Set
- Front
- Back
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Amytriptyline
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Inhibits reuptake of NE and serotonin; OD=life threatening CV effects
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Phenytoin and Carbamazepine
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Block Na+ channel conduction; carb is more potent
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Gabapentin
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Binds voltage-dependent Ca2+ channels; may develop tolerance
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Celecoxib
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COXII selective; ankylosing spondylitis, pain, OA, RA, Crohn's disease, colorectal polyps; 2D6 inhibitor; Contra pregnancy d/t premature closure of patent ductus arteriosis
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Rofecoxib
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COXII selective; pain, OA, RA, Dysmenorrhea; increased CV ADR; contra pregnancy
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Valdecoxib
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Dysmenorrhea
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Etoricoxib
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Ankylosing spondylitis, Gout
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Lumaricoxib
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Binds to different site on COXII than others; not approved d/t liver failure
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Nabumetone
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Somewhat selective for COXII inhibitor; may cause tinnitus, does not affect GI so much
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Non-salicylic NSAIDS
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HA, mostly for anti-inflamm; Similar mech as aspirin; reversible cox inhibitor; naproxen and piroxicam= more potent and longer 1/2 lives; less severe GI effects than aspirin; risk of hypersensitivity d/t shift toward leukotriene pathway
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ASA
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Centrally + peripherally inhibits PG synthesis; anti-inflamm at high doses; decreased PGI2 and decreased TXA2= decreased platelet aggregation; decrease colon cancer; stimulate respiratory center; GI bleeds; Tinnitus, vertigo; prolong gestation, spontaneous abortion; bronchoconstriction; contra gout
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APAP
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Centrally inhibits PG synthesis in hypothalamus; Toxic CYP450 metabolites can cause hepatic necrosis; contra-ppl who drink >3 EtOH per day
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APAP Toxic Dose
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200mg/kg for children; 6-7g for adults; less can cause problems in ppl taking INH, phenobarbital, excessive EtOH or ppl fasting or w/poor nutrition
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APAP OD clinical presentation
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Before 24 Hrs- maybe GI, transient rise in prothrombin time; After 24-48 Hrs- increased liver transaminases, acute liver failure, hypoglycemia, encephalopathy, metabolic acidosis, rise in PT/INR
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APAP OD diagnosis
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Take serum APAP level initially, after 4Hrs, 8Hrs; use nomogram to predict likelihood of toxicity in acute overdose
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APAP OD Treatment
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Use NAC if serum levels above upper "toxicity" line (must be given within 8-16Hrs); Use IV NAC if oral route compromised; Give PO as 17 doses in 4-6Hr intervals over 72Hrs; IV only give 20Hrs w/successful outcome; continue administering NAC until liver function tests improve; Do not give charcoal if >3-4Hrs have passed
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NSAID Toxicity
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moreso w/1st generation (phenylbutazone, oxyphenbutazone, mefenamic acid, piroxicam, diflunisal); OD generally asymptomatic; treat w/charcoal
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Meperidine
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Full M agonist; labor to increase contractions; less potent; better PO; less GI, antitussive, resp depression; increased siezures, hypotension
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Hydromorphone, Oxymorphone, Levorphanol
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Full M agonist; more potent
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Methadone, Levomethaldyl, Acetylmethadol
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Full M agonist; for opiate addiction; longer 1/2 life; withdrawal Sx delayed and last longer
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Fentanyl
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Full M agonist; 100x more potent; IV for anesthesia; Transderm for chronic pain; Transmucossally for preanesthetic
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Sulfentanyl, Alfentanyl, Remifentanyl
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Full M agonist; IV for induction in maintenance in surgery; rapid onset; brief duration
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Codeine
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Partial M agonist; antitussive; less potent; siezures
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Hydrocodone, Oxycodone
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Partial M agonist; Similar to codeine
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Propoxyphene
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Partial M agonist; less effective than ASA; serious resp depression
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Tramadol
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Produces analgesia thru both opioid and non-opioid mechs; analog of codeine
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Pentazocine, Nalbuphine, Butorphanol, Buprenorphine, Dezocine
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K + M mixed antag/ags; Butorphanol sublingual for opioid dependence b/c slow dissociation; less abuse potential; serious resp depression; can precipitate withdrawal; more likely to cause dysphoria; psychomimetic ADR
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Naloxone
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M receptor antagonist; not orally effective; for opioid OD, esp to reverse resp depression post-op; short 1/2 life; may precipitate withdrawal
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Naltrexone
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longer 1/2 life than naloxone
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Nalmefene
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longest 1/2 life
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