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?

Antidepressants Signup and view all the answers

What is fentanyl primarily used for?

Severe pain management Signup and view all the answers

What type of pain do hypothalamic systems primarily manage?

Moderate to severe pain Signup and view all the answers

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

Non-opioids, weak opioids, then strong opioids Signup and view all the answers

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

Codeine and hydrocodone Signup and view all the answers

What role do GABA receptors play in hypothalamic systems?

They assist in slowing down processes. Signup and view all the answers

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

Barbiturates Signup and view all the answers

Which systems are mentioned as being affected by hypothalamic functions?

Thalamic and limbic systems Signup and view all the answers

What is one of the indications for using methadone?

Managing alcohol withdrawal Signup and view all the answers

In which scenario are other drugs typically referenced?

When pain levels do not respond to standard treatments Signup and view all the answers

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

Fentanyl Signup and view all the answers

What is the maximum recommended daily dosage of Tylenol?

4 g/day Signup and view all the answers

Which drug is used primarily for neuropathic pain management?

Amitriptyline Signup and view all the answers

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

Amitriptyline Signup and view all the answers

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

Fentanyl Signup and view all the answers

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

Fentanyl Signup and view all the answers

What is the potency of Carfentanyl compared to morphine?

about 10,000 times Signup and view all the answers

Which medication is most commonly associated with tolerance development?

Fentanyl Signup and view all the answers

What is a notable adverse effect associated with benzodiazepines?

Paradoxical excitement Signup and view all the answers

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

Increased alertness Signup and view all the answers

Why should opioids be taken with food?

To prevent gastrointestinal upset Signup and view all the answers

What does a low therapeutic index indicate regarding a medication?

Increased chance of adverse effects Signup and view all the answers

Which nursing implication is crucial when administering opioids?

Assess level of consciousness (LOC) Signup and view all the answers

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

Opioid-induced hyperalgesia Signup and view all the answers

Which schedule classification indicates the highest potential for abuse?

Schedule I Signup and view all the answers

Which symptom should be monitored closely when administering benzodiazepines?

Respiratory depression Signup and view all the answers

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

Reye's Syndrome Signup and view all the answers

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

Vision loss Signup and view all the answers

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

Anti-inflammatory effects Signup and view all the answers

What neurological risk is associated with salicylate use in children?

Neurological deficits Signup and view all the answers

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

Aspirin Signup and view all the answers

What is the mechanism of action for meloxicam?

Non-selective COX inhibition Signup and view all the answers

Which drug is known for better gastrointestinal tolerance than others?

Nabumetone Signup and view all the answers

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

Naproxen Signup and view all the answers

Which property best describes ibuprofen compared to other options?

Somewhat better adverse effects Signup and view all the answers

What type of effects do both meloxicam and nabumetone possess?

Analgesic and antipyretic Signup and view all the answers

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

Ibuprofen Signup and view all the answers

Which mechanism of action do propionic acid derivatives primarily utilize?

COX-1 and COX-2 enzyme inhibition Signup and view all the answers

What differentiates nabumetone from other NSAIDs?

Less gastrointestinal side effects Signup and view all the answers

What characteristic of meloxicam can be associated with adverse effects?

Increased likelihood of cardiovascular events Signup and view all the answers

Which of the following statements about naproxen is accurate?

It is a propionic acid derivative. Signup and view all the answers

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

Induce vasodilation Signup and view all the answers

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

Decreased GI mucosal integrity Signup and view all the answers

Which of the following correctly describes COX1?

It is involved in maintaining the GI mucosa. Signup and view all the answers

What is the primary action of non-selective NSAIDs?

Reduce inflammation by blocking the COX enzyme Signup and view all the answers

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

Increased white blood cell migration Signup and view all the answers

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

Increased risk of mucosal lesions Signup and view all the answers

Which of the following is true regarding COX2?

It contributes to inflammation and pain. Signup and view all the answers

What laboratory test is essential to monitor when using NSAIDs?

Creatinine and GFR Signup and view all the answers

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

It protects against GI bleeding. Signup and view all the answers

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

Kidney impairment Signup and view all the answers

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

They primarily attack COX-2 enzyme Signup and view all the answers

Which statement is true regarding the role of NSAIDs?

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

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

It is not safe for patients with sulfa allergies Signup and view all the answers

Which of the following statements about leukotrienes is accurate?

They are produced in response to injury and inflammation. Signup and view all the answers

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

Decreased glomerular filtration rate Signup and view all the answers

Which of the following is a primary use for acetaminophen?

It provides analgesic relief without significant side effects Signup and view all the answers

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

GI ulceration Signup and view all the answers

What significant effect do prostaglandins have on blood vessels?

They cause relaxation and vasodilation. Signup and view all the answers

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

They minimize gastrointestinal side effects Signup and view all the answers

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

Up to one week Signup and view all the answers

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

Moderate to severe acute pain Signup and view all the answers

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

Because these medications can be teratogenic Signup and view all the answers

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

To provide pain relief and reduce inflammation Signup and view all the answers

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

Kidney function Signup and view all the answers

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

Gastrointestinal bleeding Signup and view all the answers

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

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

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

Respiratory depression Signup and view all the answers

What role do prostaglandins play in kidney function?

They are vasodilators contributing to kidney impairment. Signup and view all the answers

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

Gout Signup and view all the answers

What is the first line treatment for hyperuricemia?

Allopurinol Signup and view all the answers

What effect do NSAIDs have on pain management?

They provide analgesia and anti-inflammatory effects. Signup and view all the answers

What is a common contraindication for the use of NSAIDs?

Pregnancy Signup and view all the answers

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

Increased vascular permeability and swelling Signup and view all the answers

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

Ringing in the ears Signup and view all the answers

Which mechanism does probenecid utilize to manage hyperuricemia?

Inhibits the reabsorption of uric acid Signup and view all the answers

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

Increased risk of acute kidney injury (AKI) Signup and view all the answers

What common effect is associated with the inflammatory response?

Increased blood flow and redness Signup and view all the answers

What complication can arise from hyperuricemia if not managed appropriately?

Myocardial infarction Signup and view all the answers

How do leukotrienes contribute to inflammation?

By increasing vascular permeability Signup and view all the answers

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

Inhibits uric acid synthesis 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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