Pharma Week 2
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Questions and Answers

What is the primary use of morphine?

  • Anxiety relief
  • Treatment of moderate to severe pain (correct)
  • Allergic reactions
  • Sedative for mild pain

    • Which statement about Dilaudid is true?

  • It is 5-8 times more potent than morphine. (correct)
  • It is primarily used for anxiety treatment.
  • It has no significant analgesic properties.
  • It is less potent than morphine.

    • What is a potential risk associated with the use of morphine?

  • Immediate allergic reactions
  • Prolonged half-life leading to unintentional overdose (correct)
  • Addiction to non-opioid medications
  • Ineffective in relieving pain

    • Which of the following is considered an adjuvant analgesic?

    <p>Antidepressants</p> Signup and view all the answers

    What is fentanyl primarily used for?

    <p>Severe pain management</p> Signup and view all the answers

    What type of pain do hypothalamic systems primarily manage?

    <p>Moderate to severe pain</p> Signup and view all the answers

    What does the three-step ladder of the WHO for pain relief include?

    <p>Non-opioids, weak opioids, then strong opioids</p> Signup and view all the answers

    Which two mild agonists are mentioned in the context of pain management?

    <p>Codeine and hydrocodone</p> Signup and view all the answers

    What role do GABA receptors play in hypothalamic systems?

    <p>They assist in slowing down processes.</p> Signup and view all the answers

    Which of these drugs is often considered a sedative rather than a primary pain reliever?

    <p>Barbiturates</p> Signup and view all the answers

    Which systems are mentioned as being affected by hypothalamic functions?

    <p>Thalamic and limbic systems</p> Signup and view all the answers

    What is one of the indications for using methadone?

    <p>Managing alcohol withdrawal</p> Signup and view all the answers

    In which scenario are other drugs typically referenced?

    <p>When pain levels do not respond to standard treatments</p> Signup and view all the answers

    Which of the following medications is considered a strong opioid agonist?

    <p>Fentanyl</p> Signup and view all the answers

    What is the maximum recommended daily dosage of Tylenol?

    <p>4 g/day</p> Signup and view all the answers

    Which drug is used primarily for neuropathic pain management?

    <p>Amitriptyline</p> Signup and view all the answers

    Which of the following drugs is noted for having a 'hangover' effect causing daytime sleepiness?

    <p>Amitriptyline</p> Signup and view all the answers

    Which opioid is highlighted as the first cause of overdose in California?

    <p>Fentanyl</p> Signup and view all the answers

    Which medication is approximately 50-100 times more potent than morphine?

    <p>Fentanyl</p> Signup and view all the answers

    What is the potency of Carfentanyl compared to morphine?

    <p>about 10,000 times</p> Signup and view all the answers

    Which medication is most commonly associated with tolerance development?

    <p>Fentanyl</p> Signup and view all the answers

    What is a notable adverse effect associated with benzodiazepines?

    <p>Paradoxical excitement</p> Signup and view all the answers

    Which of the following is NOT an adverse effect of opioids?

    <p>Increased alertness</p> Signup and view all the answers

    Why should opioids be taken with food?

    <p>To prevent gastrointestinal upset</p> Signup and view all the answers

    What does a low therapeutic index indicate regarding a medication?

    <p>Increased chance of adverse effects</p> Signup and view all the answers

    Which nursing implication is crucial when administering opioids?

    <p>Assess level of consciousness (LOC)</p> Signup and view all the answers

    What condition can opioids paradoxically lead to despite their primary purpose?

    <p>Opioid-induced hyperalgesia</p> Signup and view all the answers

    Which schedule classification indicates the highest potential for abuse?

    <p>Schedule I</p> Signup and view all the answers

    Which symptom should be monitored closely when administering benzodiazepines?

    <p>Respiratory depression</p> Signup and view all the answers

    What syndrome is contraindicated in children, particularly those with viral illnesses?

    <p>Reye's Syndrome</p> Signup and view all the answers

    Which of the following is a potential effect of salicylate toxicity?

    <p>Vision loss</p> Signup and view all the answers

    What is an unclear mechanism of action related to the use of colchicine?

    <p>Anti-inflammatory effects</p> Signup and view all the answers

    What neurological risk is associated with salicylate use in children?

    <p>Neurological deficits</p> Signup and view all the answers

    Which of the following drugs is noted for its contraindications for use in children?

    <p>Aspirin</p> Signup and view all the answers

    What is the mechanism of action for meloxicam?

    <p>Non-selective COX inhibition</p> Signup and view all the answers

    Which drug is known for better gastrointestinal tolerance than others?

    <p>Nabumetone</p> Signup and view all the answers

    Which of the following is the second most used propionic acid derivative?

    <p>Naproxen</p> Signup and view all the answers

    Which property best describes ibuprofen compared to other options?

    <p>Somewhat better adverse effects</p> Signup and view all the answers

    What type of effects do both meloxicam and nabumetone possess?

    <p>Analgesic and antipyretic</p> Signup and view all the answers

    Which of the following drugs is considered most common among NSAIDs?

    <p>Ibuprofen</p> Signup and view all the answers

    Which mechanism of action do propionic acid derivatives primarily utilize?

    <p>COX-1 and COX-2 enzyme inhibition</p> Signup and view all the answers

    What differentiates nabumetone from other NSAIDs?

    <p>Less gastrointestinal side effects</p> Signup and view all the answers

    What characteristic of meloxicam can be associated with adverse effects?

    <p>Increased likelihood of cardiovascular events</p> Signup and view all the answers

    Which of the following statements about naproxen is accurate?

    <p>It is a propionic acid derivative.</p> Signup and view all the answers

    What is the primary function of leukotrienes and prostaglandins in inflammation?

    <p>Induce vasodilation</p> Signup and view all the answers

    What adverse effect can result from the inhibition of COX enzymes?

    <p>Decreased GI mucosal integrity</p> Signup and view all the answers

    Which of the following correctly describes COX1?

    <p>It is involved in maintaining the GI mucosa.</p> Signup and view all the answers

    What is the primary action of non-selective NSAIDs?

    <p>Reduce inflammation by blocking the COX enzyme</p> Signup and view all the answers

    Which effect is caused by the action of leukotrienes during inflammation?

    <p>Increased white blood cell migration</p> Signup and view all the answers

    What is a risk of using NSAIDs on the gastrointestinal system?

    <p>Increased risk of mucosal lesions</p> Signup and view all the answers

    Which of the following is true regarding COX2?

    <p>It contributes to inflammation and pain.</p> Signup and view all the answers

    What laboratory test is essential to monitor when using NSAIDs?

    <p>Creatinine and GFR</p> Signup and view all the answers

    What is a common misconception about the effects of COX1 inhibition?

    <p>It protects against GI bleeding.</p> Signup and view all the answers

    What is a notable adverse effect associated with the short-term use of ketorolac (Toradol)?

    <p>Kidney impairment</p> Signup and view all the answers

    What is the main feature that differentiates COX-2 inhibitors from traditional NSAIDs?

    <p>They primarily attack COX-2 enzyme</p> Signup and view all the answers

    Which statement is true regarding the role of NSAIDs?

    <p>They target both COX1 and COX2 to relieve pain and inflammation.</p> Signup and view all the answers

    What is a crucial consideration when prescribing celecoxib (Celebrex)?

    <p>It is not safe for patients with sulfa allergies</p> Signup and view all the answers

    Which of the following statements about leukotrienes is accurate?

    <p>They are produced in response to injury and inflammation.</p> Signup and view all the answers

    What is a potential result of COX enzyme inhibition in relation to kidney function?

    <p>Decreased glomerular filtration rate</p> Signup and view all the answers

    Which of the following is a primary use for acetaminophen?

    <p>It provides analgesic relief without significant side effects</p> Signup and view all the answers

    What is one of the risks associated with the nonsteroidal anti-inflammatory drug piroxicam?

    <p>GI ulceration</p> Signup and view all the answers

    What significant effect do prostaglandins have on blood vessels?

    <p>They cause relaxation and vasodilation.</p> Signup and view all the answers

    What is a primary advantage of using COX-2 inhibitors over traditional NSAIDs?

    <p>They minimize gastrointestinal side effects</p> Signup and view all the answers

    What is the recommended duration for the short-term use of ketorolac (Toradol)?

    <p>Up to one week</p> Signup and view all the answers

    What type of pain is primarily managed by the medication enolic acid derivatives like piroxicam?

    <p>Moderate to severe acute pain</p> Signup and view all the answers

    Why should healthcare workers use gloves and masks when handling patients receiving certain medications?

    <p>Because these medications can be teratogenic</p> Signup and view all the answers

    What is the therapeutic goal of using nonsteroidal anti-inflammatory drugs (NSAIDs)?

    <p>To provide pain relief and reduce inflammation</p> Signup and view all the answers

    What should be closely monitored when administering medications with potential nephrotoxic effects?

    <p>Kidney function</p> Signup and view all the answers

    What consequence might arise from long-term use of NSAIDs?

    <p>Gastrointestinal bleeding</p> Signup and view all the answers

    Which of the following statements about celecoxib (Celebrex) is accurate?

    <p>It aims to reduce pain without significant GI side effects</p> Signup and view all the answers

    What is an expected outcome when using opioid analgesics in patients?

    <p>Respiratory depression</p> Signup and view all the answers

    What role do prostaglandins play in kidney function?

    <p>They are vasodilators contributing to kidney impairment.</p> Signup and view all the answers

    What condition is primarily characterized by the deposition of uric acid crystals in tissues?

    <p>Gout</p> Signup and view all the answers

    What is the first line treatment for hyperuricemia?

    <p>Allopurinol</p> Signup and view all the answers

    What effect do NSAIDs have on pain management?

    <p>They provide analgesia and anti-inflammatory effects.</p> Signup and view all the answers

    What is a common contraindication for the use of NSAIDs?

    <p>Pregnancy</p> Signup and view all the answers

    What physiological effect is linked to inflammation caused by uric acid crystals?

    <p>Increased vascular permeability and swelling</p> Signup and view all the answers

    What condition can result from chronic use of aspirin leading to salicylism?

    <p>Ringing in the ears</p> Signup and view all the answers

    Which mechanism does probenecid utilize to manage hyperuricemia?

    <p>Inhibits the reabsorption of uric acid</p> Signup and view all the answers

    What is a potential consequence of COX1 inhibition in kidney function?

    <p>Increased risk of acute kidney injury (AKI)</p> Signup and view all the answers

    What common effect is associated with the inflammatory response?

    <p>Increased blood flow and redness</p> Signup and view all the answers

    What complication can arise from hyperuricemia if not managed appropriately?

    <p>Myocardial infarction</p> Signup and view all the answers

    How do leukotrienes contribute to inflammation?

    <p>By increasing vascular permeability</p> Signup and view all the answers

    What is the primary mechanism of action for allopurinol in gout management?

    <p>Inhibits uric acid synthesis</p> Signup and view all the answers

    Study Notes

    Opioid Analgesics

    • Opioids are used to manage moderate-severe pain.
    • They are classified into mild and strong agonists.
    • Mild agonists include codeine and hydrocodone and are used for mild pain.
    • Strong agonists include morphine, dilaudid, fentanyl, and methadone and are used for moderate-severe pain.
    • Morphine is a Schedule II drug that is 5-8x more potent than morphine.
    • Dilaudid is a Schedule II drug with a prolonged half-life which increases compliance, but also increases the risk of unintentional overdose.
    • Methadone is a Schedule II drug that is 5-10x more potent than morphine and can cause a "hangover" effect or daytime sleepiness.
    • Fentanyl is a Schedule II drug that is 50-100x more potent than morphine and is the leading cause of overdose in California.
    • Carfentanyl is the most potent opioid, approximately 10,000x more potent than morphine.
    • Tolerance develops over time, meaning that the effects of the drug decrease, and higher doses are required to achieve the same effect.

    Opioid Adverse Effects

    • Respiratory depression is a major concern, especially with strong agonists.
    • Constipation is a common side effect.
    • Urinary incontinence can also occur, but is less common.
    • Opioids can also cause paradoxical excitement or nervousness.
    • Opioid-induced hyperalgesia is a condition where the patient becomes more sensitive to pain.
    • Habit forming and low therapeutic index are key concerns with opioid use.
    • Opioid adverse effects should be monitored, especially in high-risk patients.

    Nursing Implications

    • Take opioids with food.
    • Monitor level of consciousness (LOC).
    • Monitor respiratory rate (RR).
    • Assess for risk factors for overdose.
    • Educate patients on the risks and benefits of opioid use.
    • Provide patients with resources for addiction treatment.
    • Use the WHO 3-step pain ladder to guide opioid use.

    Other Pain Management Strategies

    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Corticosteroids
    • Antidepressants
    • Anticonvulsants
    • Adjuvant analgesics - used in conjunction with traditional pain relievers to enhance pain relief or address specific pain mechanisms.

    Additional Information

    • GABA receptors help slow things down.
    • Benzodiazepines and barbiturates are typically used for anxiety and alcohol withdrawal.

    NSAIDs

    • Nonsteroidal anti-inflammatory Drugs (NSAIDs) are used to treat pain and inflammation
    • They are not steroids
    • Examples: ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin
    • Use with caution as they may cause gastrointestinal bleeding, kidney problems, and cardiovascular risks
    • Aspirin is a special case, and should not be given to children due to the risk of Reye's syndrome (encephalitis and liver damage)
    • Aspirin is teratogenic, meaning it can harm a developing fetus
    • General NSAID mechanisms include blocking prostaglandin synthesis (creation)
    • Aspirin inhibits platelet aggregation and therefore should not be used before or after heart surgery

    Acetic Acid Derivatives

    • Examples: ketorolac (Toradol)
    • Short-term use (up to a week) for moderate to severe acute pain
    • Adverse effects: kidney impairment, edema, GI pain, dyspepsia, and nausea
    • Newer, costly, prescription-only drugs

    COX-2 Inhibitors

    • Developed to minimize GI adverse effects of NSAIDs
    • Traditional NSAIDs target both COX1 and COX2 enzymes, whereas COX-2 inhibitors only target COX2
    • This selectivity results in fewer adverse effects
    • Examples: celecoxib (Celebrex)

    Enolic Acid Derivatives

    • Examples: piroxicam
    • Used for mild to moderate pain from conditions like osteoarthritis, rheumatoid arthritis, and gouty arthritis
    • Celecoxib should not be used in patients with a sulfa allergy### Non-selective NSAIDs
    • NSAIDs target COX1 and COX2 enzymes
    • Non-selective NSAIDs are referred to as "non selective" because they block both COX1 and COX2 enzymes
    • NSAIDs decrease the production of prostaglandins and leukotrienes
    • COX1 and COX2 enzymes contribute to inflammation, pain, and fever
    • COX1 also contributes to the maintenance of the gastrointestinal mucosa and renal blood flow
    • COX2 is the primary enzyme that contributes to inflammation, pain and fever

    ### Propionic Acid Derivatives

    • Ibuprofen (Motrin, Advil) is the most common propionic acid derivative used
    • Ibuprofen has better adverse effect profiles and less drug interactions compared to other non-selective NSAIDs
    • Naproxen is the second most used propionic acid derivative

    Other Non-selective NSAIDs

    • Meloxicam (Mobic) is a common non-selective NSAID
    • Nabumetone has a better tolerance profile with regard to gastrointestinal adverse effects
    • Meloxicam, nabumetone, ibuprofen and naproxen are indicated for the treatment of pain and fever
    • Meloxicam, Nabumetone, ibuprofen and naproxen are also indicated for the treatment of chronic inflammatory conditions

    Adverse Effects of Non-selective NSAIDs

    • Adverse effects are a significant concern when using NSAIDs
    • Common adverse effects are:
      • Gastrointestinal intolerance
      • Bleeding, which can range from heartburn, to mucosal lesions (ulcerations), and severe GI bleeding
    • Lab monitoring includes assessment of creatinine and glomerular filtration rate (GFR)
    • Non-selective NSAIDs should be used cautiously in patients with gastrointestinal or renal impairment

    Kidney Impairment

    • Prostaglandins are vasodilators and their inhibition can lead to acute kidney injury (AKI).
    • Some NSAIDs can cause gastrointestinal bleeding due to COX-1 inhibition.
    • NSAIDs are contraindicated in patients with allergy to them, those at risk for bleeding, and pregnant women.

    Inflammation

    • Inflammation is mediated by endogenous compounds, including prostaglandins and leukotrienes.
    • It leads to: vascular dilation, increased permeability, pain, fever, loss of function, redness, and swelling.
    • Increased risk of thrombosis, including fatal myocardial infarction (MI) and stroke, except for aspirin.

    Hyperuricemia

    • Hyperuricemia is caused by either overproduction or underexcretion of uric acid.
    • It leads to uric acid crystal deposition in tissues and joints, triggering inflammatory responses.

    Gout

    • Gout is a painful inflammatory condition caused by hyperuricemia.

    Anti-Inflammatory & Antigout Drugs

    • NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are the most commonly prescribed drug class for inflammation and gout.
    • Common uses of NSAIDs include analgesia, anti-inflammatory, and antipyretic effects.
    • Aspirin is a unique NSAID that also has platelet inhibition effects.
    • NSAIDs should be taken with food and patient education is crucial.

    Allopurinol

    • Allopurinol inhibits the production of uric acid.
    • It is a first-line treatment for gout.

    Probenecid

    • Probenecid inhibits the reabsorption of uric acid, increasing its excretion.
    • It increases the excretion of uric acid

    Colchicine

    • Colchicine has an unclear mechanism of action (MOA).
    • It is a treatment for gout.

    Salicylates - Aspirin

    • Aspirin is in the salicylates class of NSAIDs.
    • It is commonly used as analgesia and anti-inflammatory.
    • It has platelet inhibition effects.
    • Salicylism (toxicity) can occur with chronic aspirin use.
    • Symptoms include: increased heart rate, tinnitus, hearing loss, and visual disturbances.
    • Salicylates can lead to neurological deficits.
    • Aspirin is contraindicated in children with viral illnesses due to risk of Reye's syndrome.

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    Pharma W2 Part 1 Pain Drugs PDF
    Pharma W2 Part II: Anti-inflammatory & Antigout Drugs PDF

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