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122 Cards in this Set
- Front
- Back
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where do skeletal muscle relaxants/antispasiticity agents work?
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either peripherally or centrally
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what is the most common s/e to all muscle relaxants?
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muscle weakness
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what 3 muscle relaxants are often used in neurologic conditions?
-cyclobenzaprine (flexeril) -baclofen (lioresal) -diazepam (valium) -tizanidine (zanaflex) |
baclofen
diazepam tizanidine |
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which of the 3 can be used for tension h/a?
-diazepam -baclofen -tizanidine (zanaflex) |
baclofen
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which of the 3 can be given intrathecally?
-diazepam -baclofen -tizanidine (zanaflex) |
baclofen
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which of the following is typically first line drug tried in the tx of MS?
-baclofen -diazepam -zanaflex |
baclofen
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what is the main s/e of baclofen, diazepam, and zanaflex?
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sedation with ID or with dose increases
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what is the MOA of diazepam?
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augments the effects of GABA
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what is the problem with diazepam and addiction?
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it is abusable, and use cautiously as risk for seizures if a pt quits cold turkey
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t/f
a pt may be put on 2 muscle relaxants at a time as their disease progresses. |
true
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which muscle relaxant/antispasticity agents is injected in spastic muscles?
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botox
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where does botox come from?
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bacteria of botulinum
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how does botox work in the body?
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blocks the release of ACh
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where does botox work?
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works peripherally/locally, can put into the spinal cord with muscle spasms
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flexeril, soma, and norflex, are good for what type of conditions?
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non-neurologic conditions
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what is a major s/e of flexeril?
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puts you to sleep, hangover from hell!
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all of the following are good choices for CNS conditions except?
-baclofen -flexeril -valium -zanaflex |
do NOT use flexeril, is not for neurological conditions
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the anticholinergic properties of flexeril cause what s/e?
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dry mouth
can't pee |
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which of the following makes the pt highly sleepy and doesn't work as well as a relaxer, and has addictive properties?
-flexeril -soma -norflex |
soma
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which of the following has an injectable preparation and is less sedating than flexeril or soma?
-flexeril -soma -norflex |
norflex
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which of the following is last line therapy for pt's with neurological disorders?
-valium -baclofen -zanaflex -dantrium |
dantrium
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t/f
does dantrium cause sedation? |
false
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what is the major s/e of dantrium and how do you address it?
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hepatotoxicity-can only be on for 6 months and then the pt needs a 1 month drug holiday. but you must restart at low dose and retitrate
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can you use 2 muscle relaxers at one time?
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yes, but don't give 2 sedating muscle relaxers such as flexeril and soma (bad juju)
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what is the pathophysiology of parkinson's disease?
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acetylcholine relative excess
relative deficiency of dopamine |
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how many stages of PD are there?
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5
1-unilateral involvement 2-bilat involvement w/o postural abnormalities 3-b/l involvement with postural abnormalities, shuffling gait 4-b/l involvement w/ postural issues, requires alot of help 5-end stage, fully development |
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what is slowness of movement?
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bradykinesia
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a complete lack of the ability to initiate voluntary movement?
-bradykinesia -akinesia -dyskinesia -rigidity |
akinesia
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what is abnormal, involuntary movements; lip smacking, grimacing, rhythmic jerking..
-bradykinesia -akinesia -dyskinesia -rigidity |
dyskinesia
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what is, resistance to passive movement in all directions, agonist and antagonist muscles are contracted?
-akinesia -bradykinesia -rigidity -dyskinesia |
rigidity
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cogwheel stuttering is also known as what in what disease process?
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rigidity in PD
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if a pt has to lean forward to initiate ambulation, what is this a result of?
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akinesia
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dyskinesia could be a result of PD or __?
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drugs, maybe too high of a dose.
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anticholinergics can be used in the early stages of PD if the pt is under the age of ?
-40 -50 -60 -70 |
under age 50
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what may happen to elderly pt's if you use anticholinergics?
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pt could get hallucinations
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cogentin, akineton, and artane are used for what and what do they help with?
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anti-cholinergics that are used to help PD pt's with tremors and secretions, otherwise don't really have any uses.
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which of the following is used early in tx of PD, is an antiviral, and that works by pusing dopamine into the synapes?
-cogentin -sinemet -symmetrel |
symmetrel-as the dx progresses and there is less dopamine to be pushed the drug becomes less effective
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sinemet is a combo pill of what properties?
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carbidopa/levodopa
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what is the MOA carbidopa?
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inhibits peripheral metabolism of levodopa, it does NOT cross the blood brain barrier
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what is MOA of levodopa?
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it is the absorbable form of dopamine, that passes the blood-brain-barrier as levodopa and is metabolized to dopamine in the CNS
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what is the drug of choice in the tx of PD?
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carbidopa/levodopa
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what is the pathophysiology of dopamine receptor agonists?
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not dopamine by themselves but bind to dopamine receptor agonists
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name 2 dopamine receptor agonists.
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requip
mirapex |
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what is a problem with both dopamine receptor agonists?
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can cause sudden onset of sleep, kind of like a drug induced narcolepsy
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what else does requip work for?
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requip
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what can excess dopamine and a lack of dopamine cause?
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excess can cause hallucinations and other psych features. a lack of dopamine causes PD
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which class of drugs works in the brain to inhibit CNS metabolism of dopamine, but also serotonin and norepinephrine?
-dopamine receptor agonists -MAOI's -anticholinergics |
MAOI's
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t/f
should use MAOI's early to spare dopamine neurons |
true
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what is the goal of MAOI therapy?
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to help prevent the formation of neurotoxic byproducts
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name 2 MAOI's
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selegiline (eldepryl)
rasagiline (agilect) |
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what class of drug must be used with sinemet?
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catechol O-methyl transferase inhibitors (COMT)
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what is MOA of COMT?
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secondary enzyme responsible for metabolism of catecholamines
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name 2 COMT's
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tasmar
comtan |
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why is tasmar not used much anymore?
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r/t hepatotoxicity
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which of the COMT inhibitors is used most often and why?
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comtan is because it seems to prolong the duration of action of sinemet, so you can decrease the dose/schedule of sinement
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what is the name of the drug that has carbidopa/levadopa/entacapone all in one?
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stalevo
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which of the following has more problems than benefits, and frankly just sucks?
-stalevo -apokyn -comtan |
apokyn
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what are a couple of major problems with drug therapy of PD?
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motor flucations
dyskinesia |
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if a pt has motor flucuations of on levo/carbo what can you do to fix it?
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increase dosing schedule
switch to CR levo/carbo add a COMT inhibitor (helps prolong effectiveness of sinemet) add dopamine agonist |
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if a PD pt is having problems with dyskinesia (painful/abnormal movements when taking levo/carbo) what can you do?
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reduce dose
add amantiadine (early in dx course) reduce or stop anticholinergic drug |
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what is the algorhythm of tx for PD pt's?
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1) diagnosis
2) anticholinergic for tremors 3) neruprotection (selegiline) 4) start dopamine agonist 5) add levo/carbo 6) add COMT inhibitor can use SSRI for depression |
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what can you use for a PD pt with a sleep disorder?
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use anything that does NOT interfere with dopamine
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should you give a PD pt reglan for nausea?
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no it will make the PD worse
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what is the DOC for n/v in PD?
-phenergan -zofran -kytril |
zofran
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what is the maximum amount of demerol that you can give a pt with a PCA in 4 hours?
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300mg/q4hrs
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why does PCA work better for both the pt and the hospital staff?
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pt. uses less amt of narc's and doesn't call the nurses as much
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what is the lockout dose usually on pca's
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every 10 minutes
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all the following meds except one can be used in a pca.
-demerol -morphine -lortab -dilaudid -fentanyl |
lortab is not iv
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what is the max dose for pure narcotics.
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there is none, give as much as needed
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which works faster po or iv?
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iv
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prn narcs are for...
chronic pain periodic pain |
periodic pain
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what other classes of drugs can supplement pain meds?
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TCA's
SSRI's topical agents |
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what routes can pain meds be given?
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po, pr, iv, im, topical
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what is a common tca given for adjunctive therapy to pain control?
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elavil
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what are problems with giving elavil for pain?
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very sedating use at HS
anticholinergic effects, dries up the mouth and pt's can't pee fatal in OD |
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if a pt can't tolerate TCA's what other class of meds can be used?
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ssri's such as....
prozac zoloft paxil |
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with which of the following can a pt quit cold turkey without s/s of withdrawal?
-prozac -zoloft -paxil |
prozac
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t/f
ssri's are not as helpful in the tx of neuropathic pain as other classes of meds |
true
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what are s/s of withdrawal from ssri's?
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nausea and profound anxiety
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t/f
you should taper off paxil and zoloft |
true
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what is capsaicin?
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substance P which is ground up red peppers
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what local injectable anesthetic has rapid onset and short half life?
-lidocaine -marcaine |
lidocaine
marcaine has slower onset but much longer half life |
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lidocaine and marcaine are which type of local anesthetic?
-amides -esters |
amides
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which type of local anesthetic are novocaine and nesacaine?
-amides -esters |
esters
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which can be continuously infused into a surgical wound?
amides esters |
esters
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what anticonvulsants are used frequently to tx pain?
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tegretol
dilantin neurontin lyrica |
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which anticonvulsant is the first line therapy?
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lyrica
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what is the major issue with tegretol?
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is an enzyme inducer, speeds up other drug metabolism
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if tegretol is ineffective what is 2nd line therapy anticonvulsant in the tx of pain?
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neurontin
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where is lyrica eliminated?
how long does it take to work? what are its drug interactions? |
kidney's
1-2 weeks non except iv dye |
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which of the following is possibly addictive?
-tegretol -dilantin -lyrica -neuontin |
lyrica
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how long does it take for lyrica to work?
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a couple of days
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what are the s/e with dilantin?
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eliminated by kidneys
enzyme inducer-so you have to watch other drug doses |
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when titrating narcotics for chronic cancer pain what is the key?
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titrate to effectiveness or side effects
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what are dose limiting side effects?
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respiratory depression (fatal in overdose)
8-12 resp per min is the minimum in the average pt |
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what are non-dose limiting side effects?
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constipation
euphoria, rash/itching |
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non-dose limiting side effects regarding constipation...
can occur when? why does constipation occur with narcotics? how do you try to fix it? |
after a single dose
narc's slow the gi tract, not remove water must use stimulant laxatives |
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is a rash an allergy?
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no
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__ is adaptation to a drug class noted by a specific withdrawal syndrome that can be produced by abrupt d/c or admin of an antagonist
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physical dependence
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__ pt's have impaired control over drug use, compulsive use, continued use despite harm and craving for more.
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addiction
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__is the need to increase the dose of opioid to achieve the same level of analgesia
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tolerance
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__is the use of any chemical for non-therapeutic purposes
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substance abuse
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__is a pattern of drug-seeking behavior in pt's who are receiving inadequate pain control (can be mistaken for addiction)
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pseudoaddiction
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what is MOA of NSAIDS?
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cox mediates conversion of arachidonic acid to prostaglandins and thromboxane A2
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the MOA of ___ is prostaglandins that mediate pain, inflammation, fever, etc.
cox 1 cox 2 |
cox 2
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the MOA of __ is prostaglandins that protect GI mucosa and participate in hemostasis, renal perfusion, platelet aggregation,
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cox 1
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asa inhibits...
cox 1 cox 2 both |
both
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does ibuprofen inhibit...
cox 1 cox 2 both |
both
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__ is only for tx of gout and pericarditis, and the s/e are slightly worse than IB for GI s/e.
asa toradol indocin |
indocin
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when choosing an nsaid how do you choose?
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pick the one you want, and that can be tolerated
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what is a good use for nsaids, what is not a good use for nsaids?
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good for metastatic pain
not so much for OA |
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what are common s/e to most nsaids?
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mild/moderate GI effects
serious GI s/e |
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what are common renal effects of nsaid's?
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renal bld flow needs prostaglandins
too much inhibition will lead to renal failure |
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what are platelet effects of nsaids?
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antiplatelet effects
promotes bleeding in GI and everywhere else |
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why should a pregnant woman not take nsaid's?
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could cause premature closure of the pda
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which drug is basically the only cox 2 inhibitor?
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celebrex
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what differs between celebrex and traditional nsaid's?
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more specific
little risk almost like placebo less inhibition of cox 1 asa and celebrex is good combo between naproxen and placebo for gi risks |
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what is the MOA of tylenol?
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inhibits cox 1 and 2, that only works in CNS
analgesic but not anti-inflammatory |
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t/f
should not give tylenol with nsaids due to reactions |
false; it's all good
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what is the maximum dose of tylenol qd for adults and children?
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adult 4g/qd
kids 10-15mg/kg/dose |
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what is the drug of choice in the treatment of OA?
-asa -tylenol -celebrex |
TYLENOL
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what are the 3 uses of tylenol?
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fever
pain OA |
