Pharm Test 2

Front 1

causes of nociceptive somatic pain

Back 1

noxious stimulation of peripheral sensory nerve fibers (burning hand)

Front 2

causes of visceral pain

Back 2

noxious stimulation of visceral nerve fibers (appendicitis)

Front 3

causes of neuropathic pain

Back 3

abnormal processing of sensory information either in the peripheral or central nervous system (diabetic neuropathy)

Front 4

P in PQRST

Back 4

palliative factors, provocative factors

Front 5

Q in PQRST

Back 5

quality

Front 6

R in PQRST

Back 6

radiation

Front 7

S in PQRST

Back 7

severity/intensity

Front 8

T in PQRST

Back 8

temporal factors (does the pain change with time)

Front 9

How do NSAIDS work?

Back 9

antipyretic, analgesic, anti-inflammatory; inhibits prostaglandin synthesis, inhibit cyclooxygenase (COX), prostaglandins decrease gastric synthesis, stimulate the production of glutathione that scavenges superoxides, promotes generation of a protective barrier of mucus and bicarbonate, promotes adequate blood flow to gastric mucosal cells

Front 10

what is COX

Back 10

the enzyme that catalyzes the synthesis of cyclic endoperoxides from arachidonic acid to form prostaglandins

Front 11

How do the prostaglandins work in NSAIDS

Back 11

prostaglandin in the kidneys modulates intrarenal plasma flow and electrolyte balance (could predispose pt to renal failure)

Front 12

COX-1 characteristics

Back 12

inhibits everywhere, present in all tissues and cell types (mostly platelets, endothial, GI tract, renal, glomerulus, collecting ducts). Important for homeostatic maintenance (for platelet aggregation, reg of blood flow in kindeys and stomach and reg of gastric acid secretion)

Front 13

cause of GI upset in NSAIDS

Back 13

inhibition of COX-1 activity

Front 14

COX-2 characteristics

Back 14

selective, inducible isoenzyme, expressed in kidney, brian, bone, female reproductive, neoplasias, and GI tract. Induced druing pain and inflammatory stimuli

Front 15

COX-1 selective NSAIDS

Back 15

aspirin, ketoprofen, indomethacin, piroxicam, sulindac, ibuprofen, naproxen, diclofenac

Front 16

COX-2 selective NSAIDS

Back 16

etodolac, nabumetone, meloxicam, celecoxib (celebrex, pfizer), rofecoxib (merck , vioxx-off market), valdecoxib (bextra, pfizer)

Front 17

contraindication for fenoprofen or mefenamic acid

Back 17

preexisting renal disease

Front 18

contraindication for mefenamic acid

Back 18

active ulceration or chronic inflammation of upper or lower GI tract

Front 19

contraindication for indomethacin suppositories

Back 19

hx of proctitis or rectal bleeding

Front 20

contraindication for celecoxib

Back 20

hypersensitivity to sulfonamides

Front 21

contraindications for ketorolac

Back 21

PUD, GI bleed/perforation, renal impairment, labor and delivery-risk of uterine hemorrhage

Front 22

cardiovascular risk with NSAIDS

Back 22

increased risk of thrombotic events, MI, and stroke
(increased risk if hx of cardiovascular disorder)

Front 23

GI risks with NSAIDS

Back 23

bleeding, ulceration, perforation of stomach or intestines
(increased risk with elderly)

Front 24

renal risks with NSAIDS

Back 24

acute renal insufficiency (if hx of renal disease), reduced renal blood flow or blood volume, renal decompensation

Front 25

groups at risk for renal problems when using NSAIDS

Back 25

elderly, premature infants, heart failure pts, renal or hepatic dysfcn, SLE, chronic glomerulonephritis, dehydration, DM, ACE inhibitors

Front 26

characteristics of tylenol

Back 26

no anti-inflammatory, less GI effects, antipyretic so interferes with fever monitoring, give with food

Front 27

moa of aspirin (salicylate)

Back 27

inhibits prostaglanding synthesis, irreversibly blocks COX, prevents formation of platelet aggregating substance (TX), acts on hypothalamus to reduce fever

Front 28

contraindicated patients for aspirin

Back 28

PUD, hx of gout, hypersensitivity, age, renal insufficiency, hypoalbuminemia

Front 29

sx of reye's

Back 29

vomiting, CNS damage, hepatic injury, hypoglycemia

Front 30

MOA of NSAIDS

Back 30

inhibits prostaglandin synthesis, blocks pain impulse generation, reduces fever by inhibiting hypothalamic heat regulating center

Front 31

interaction of aspirin and ibuprofen

Back 31

competitive inhibition of acetylation site of COX in the platelet. (ibuprofen is reversible, aspirin irreversible, both occupy sites on COX, presence of Ibuprofen interferes with aspirin

Front 32

patient risk factors with NSAIDS

Back 32

PUD, hx of gout, hypersensitivity, age, hx of liver and renal failure

Front 33

ADR's with NSAIDS

Back 33

dyspepsia, heartburn, nausea, GI bleed, blood dyscrasias, hepatotoxicity, nephrotoxicity, pulm edema, rash

Front 34

MOA of GI bleed with NSAIDS

Back 34

topical mucosa damage, suppression of prostaglandin synthesis

Front 35

those at risk for GI bleed using NSAIDS

Back 35

elderly, hx PUD, corticosteroid use, high dose and long duration of NSAID use

Front 36

DI's of NSAIDS

Back 36

ACE1, warfarin (prolonged PT), BB's (impaired antihypertensive), diuretics (decreased effect), lithium (increases), MTX (increased risk of toxicity), digoxin (increase dig level)

Front 37

Diclofena (voltaren) good points

Back 37

enteric coated, good GI safety profile

Front 38

ADR of voltaren

Back 38

hepatotoxicity

Front 39

composition of arthrotec

Back 39

diclofenac and misoprostol combined

Front 40

Drug of choice fore Osteoarthritis

Back 40

Etodolac (Lodine)

Front 41

ADRs of sulindac (clinoril)

Back 41

renal sparing, CNS effects, prodrug(long half life), may cause pancreatitis

Front 42

characteristics of ketorolac (toradol)

Back 42

IV and IM, short-term <5 days (renal impairment or ulcers), adjust dose for >65, weight <50kg, renal impairment

Front 43

characteristics of tolmetin (tolectin)

Back 43

higher frequency of anaphylactic rxns

Front 44

ADRs with fenoprofen (nalfon)

Back 44

renal tox, dysuria, hematuria, decreased auditory fcn, overdose causing hypotension, tachycardia

Front 45

characteristics of nabumetone (relafen)

Back 45

less GI toxicity, prodrug

Front 46

characteristics of indomethacin (indocin)

Back 46

injection, dizziness in 50%, extended release capsules

Front 47

characteristics of piroxican (feldene)

Back 47

12 times more GI tox than ibuprofen, cutaneous eruptions

Front 48

what are some risk factors for COX II inhibitors

Back 48

sulfa allergy, hx PUD or GI bleed, kidney disease

Front 49

Opioid

Back 49

drugs applying to all agonists and antagonists with morphine like activiity as well as naturally occuring and synthetic opioid peptides

Front 50

endorphin

Back 50

3 families of endogenous opioid peptides, the enkephalins, the dynorphins, and beta-endorphins

Front 51

Opioid MOA

Back 51

affinity for opioid U-receptor located in the brain, spinal cord, and smooth muscle; tramadol and its active metabolite (M1) bind to u-opioid receptors and weakly inhibit reuptake or norepinephrine and serotonin

Front 52

classes of narcotic analgesics

Back 52

full agonists, mixed agonist-antagonists, or partial agonists

Front 53

3 classes of opioid receptors

Back 53

mu, kappa, delta

Front 54

effect of opioids at u-receptor

Back 54

alalgesia, resp depression, miosis, reduced GI motility, and euphoria

Front 55

cardiovascular SE's of opioids

Back 55

peripheral vasodilation, reduced peripheral resistance, and inhibition of baroreceptors. orthostatic hypotension and fainting may occur

Front 56

CNS SE's of opioids

Back 56

euphoria, drowsiness, apathy, mental confusion, relaxation, pupillary constriction (miosis), n/v by stimulation of emetic chemoreceptors (hydromorphone increases CSF pressure)

Front 57

Dermatologic SE's of opioids

Back 57

histamine release, pruritus, flushing and red eyes

Front 58

GI SE's of opioids

Back 58

decreases gastric motility which prolongs emptying, may lead to esophageal reflux

Front 59

small intestine S/E's of opioids

Back 59

decreases biliary, pancreatic, and intestinal secretions delaying digestion, resting tone increases and periodic spasms occur

Front 60

large intestine S/E's of opioids

Back 60

propulsive peristaltic waves are diminished and tone increases until spasm, contributes to constipation

Front 61

respiratory S/E's of opioids

Back 61

depressant which diminishes tidal volume then resp rate

Front 62

cough effects of opioids

Back 62

suppresses cough reflex by direct effect on cough center in medulla

Front 63

List some short acting opioids

Back 63

morphine (roxanol, MSIR), hydrocodone (vicodin, lortab), oxycodone (toxicodone, oxy IR, percocet), hydromorphone, dilaudid and iv hydromorphone, iv fentanyl

Front 64

list some long acting opioids

Back 64

extended release:MS contin, oxycontin, duragesic

Front 65

where are all opioids metabolized?

Back 65

liver

Front 66

advantages of methadone

Back 66

morphine and derivatives allergy, NMDA receptor antagonism, no active metabolites, inexpensive

Front 67

disadvantages of methatdone

Back 67

variable kinetics, high prob of ADRs

Front 68

morphine characteristics

Back 68

gold standard, active metabolites

Front 69

when should morphine be used with caution

Back 69

elderly, renal or hepatic impairment

Front 70

Advantages of dilaudid

Back 70

semisynthetic opioid, few metabolites, most concentrated

Front 71

Disadvantages of dilaudid

Back 71

no long acting form, low oral bioavailability, under-appreciated potency

Front 72

Characteristics of oxycodone

Back 72

semisynthetic opioid, similar potency and duration as morphine, minimally metabolized, can be given w/aspirin/acetaminophen

Front 73

Characteristics of fentanyl

Back 73

full synthetic, can be used w/renal and hepatic impairment, extremely potent! (100 times more than morphine)

Front 74

characteristics of fentanyl patch

Back 74

lasts 72 hrs, slow onset (12 hrs), long elimination after removal, caution with fever and cachexia

Front 75

characteristics of codeine

Back 75

affinity for opioid receptor is low, ceiling effect, constipation and nausea, can be used as combo

Front 76

characteristics of hydrocodone

Back 76

undergoes hepatic metabolism, similar dosing and structure with oxycodone, combo with tylenol or ibuprofen

Front 77

characteristics of meperidine

Back 77

not for chronic pain, low oral potency, accumulation of normoperidine (metabolite that can cause seizures), avoid in elderly

Front 78

when is meperidine accepted?

Back 78

post op shivering, allergies to other opioids

Front 79

disadvantages to darvocet

Back 79

same effect as tylenol, s/e's of active metabolite with long half life which increases confusion, may cause seizures

Front 80

emollient laxatives

Back 80

docusate

Front 81

stimulant laxative

Back 81

senna, bisacodyl (use these)

Front 82

saline laxatives

Back 82

max citrate, MOM, sodium phosphate

Front 83

hyperosmotic laxative

Back 83

lactulose, sorbitol

Front 84

prokinectic agent for constipation

Back 84

metoclopramide (reglan)

Front 85

what medications are given to counteract n/v

Back 85

metoclopramide (prokinetic), meclizine (antihistamine), haloperiol (butyrophenones), phenothiazide, scopolamine

Front 86

characteristics of naloxone (narcan)

Back 86

antidote, pure competitive antagonist, reverses opioids, for profound resp depression, causes severe rebound pain

Front 87

characteristics of opium tincture, deodorized (DTO)

Back 87

potent (.6ml=6 mg morphine), used in treatment of diarrhea or pain relief

Front 88

characteristics of paregoric (camphorated tincture of opium)

Back 88

treatment of diarrhea or pain relief, neonatal opiate withdrawal

Front 89

MOA of ziconotide (Prialt)

Back 89

binds to n-type calcium channels located at the primary nociceptive afferent nerves in the superficial layers of dorsal horn in the spinal cord

Front 90

uses for prialt

Back 90

severe chronic pain (patients whose intrathecal therapy is warranted), pts intolerant of other treatment, FOR INTRATHECAL ADMINISTRATION

Front 91

s/e's of ziconotide (prilat)

Back 91

severe psychiatric symptoms, neurological impairment