Pharm related to Pain migraines and anesthesia

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Pharm related to Pain migraines and anesthesia
2016-06-27 00:53:52
1st Year Nursing Pharm
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  1. Morphine Sulfate
    Pharm-opiate receptor agonist
    • Therapeutic effects: Opioid analgesic
    • Preg Cat: B
    • MOA: Binds with both Mu and Kappa receptor sites to cause profound analgesia.
    • Indications: Treat severe pain that cannot be controlled with other forms of analgesia.
    • Contraindications: Can mask the pain of some abdominal/visceral pain, respiratory depression, orthostatic hypotension, ALOC, constipation.
    • Alerts:Caution with hypotensive patients.
    • Adverse effects:*potential test question: due to constipation the patients are usually on a bowel program (colace/senna) mush and the push.
    • Interactions: concurrent use of CNS depressants such as alcohol or other opioids potentiates the effects of morphine causing severe respiratory depression or death.
  2. Tramadol (Ultram)
    Pharm-Non-opioid analgesic
    • Therapeutic class: Non-opioid analgesic
    • Preg Cat: C
    • MOA: Centrally acting synthetic opioid analgesic that exerts it's effect through binding of parent drug (M1) that binds to mu receptor and through weak inhibition of norepinephrine and serotonin reuptake(limits transmission of pain)
    • Indications: Pain
    • Contraindications: Concurrent use with antidepressants can cause seizures, respiratory depression.
    • Adverse effects: vertigo, dizziness, headache, nausea, constipation and lethargy. CNS stimulation such as nervousness, tremor, anxiety, agitation, confusion, and hallucinations are possible.
  3. Adjuvant Analgesic
    Pharm-CNS muscle relaxant
    ex-Methocarbamol (Robaxin)
    • Adjuvant analgesics used to enhance analgesia of opioids and can also be used for neuropathic pain.
    • All centrally acting muscle relaxants cause sedation, they may also cause urinary retention, dizziness, dry mouth, hypotension and bradicardia
  4. Anti-seizure
    ex Gabapentin (neurontin)
    Helpful with neuropathic pain
  5. Naloxone (Narcan)
    Pharm: opioid receptor antagonist
    • Therapeutic class:Treatment Acute opioid overdose and misuse
    • MOA: Blocks Mu and kappa receptors.
    • Indications: Opiate reversal
    • Contraindications: non
    • Alerts: IV onset 1 minutes, IM onset 2-5 min, half-life 20-60 min
    • May be administered if respirations drop below 10 breaths per minute-

    Administer slowly, may need to dilute. Post-op narcotic depression dose will start at 0.1 ti 0.2 mg, every 2-3 minutes. For a Narcotic overdose start with 0.4 mg - 2 mg every 2-3 minutes.
  6. Sumatriptan (imitrex)
    Pharm: Triptan; 5-HT (serotonin) receptor drug; vasoconstrictor of intracranial arteries.
    • Therapeutic: Antimigraine drug
    • Preg. Cat: C
    • MOA:Triptans act by causing vasoconstriction of cranial arteries; this vasoconstriction is moderately selective.
    • Indications: Migraines 
    • Contraindications: 
    • Alerts: synergistic effects with naproxen, multiple routes (PO, SQ, Nasal), may be repeated in 60 min, 
    • Adverse effects: GI upset, May cause cardiac ischemia, dysrhythmias and potential for ALOC, Observe for seizures.
    • Interactions: MAOI, SSRIs.
  7. Propofol (Diprivan)
    Pharm: Sedative-hypnotic
    • Therapeutic class: Anesthesia
    • Preg Cat: B
    • MOA: Short-acting hypnotic-Widely UNK MOA.
    • onset: 40-60 seconds, peak: 3-5 mins, duration: 10-15 minutes
    • It is a milky white liquid and became "famous" when it was implicated in the death of Michael Jackson. 
    • Indications: General anesthesia/conscious sedation, migraine, used to facilitate ET tube.
    • Contraindications: Hemodynamicaly unstable patients use caution. Normally few side effects.
    • adverse effects: Respiratory depression have BVM ready as a caution.
  8. idocaine (xylocaine)
    Local anesthetic
    Primary use: for brief medical or dental procedures, occasionally to treat dysrhythmiasMechanism of action: blocks sodium channelsAlerts: check bottle for preservatives and/or epinephrine, prior to procedureAdverse effects: uncommonInteractions: none significantCan be given subcutaneous, IM, IV, or topical via a patch.
  9. Spinal anesthesia
    • Injected into CSF
    • Affects large, regional areas such as lower abdomen and legsImmediate, less medication than epidural
  10. Epidural
    • Injected into epidural space of CSF
    • used most often in labor/delivery
    • Catheter for continuous medication
    • takes longer to work due to diffusion
  11. Nitrous oxide
    This is an odorless, nonirritating, inorganic gas used for a large number of medical and surgical procedures. It is one of the least potent anesthetics, and is unable to produce deep anesthesia at therapeutic doses. It is used most frequently for dental procedures (mask placed over the nose) It has strong analgesic properties. Effects of the drug diminish quickly after the gas is discontinued
  12. Cyclooxygenase
    Enzyme responsible for the formation of prostaglandins. Prostaglandins responsible for inflammation (Cox-1) and (Cox-2). Cox-2 is more specific for the synthesis of inflammatory prostaglandins.
  13. Aspirin (ASA)
    Pharm: Salicylate; cyclooxygenase inhibitor/Antiplatelate
    • Therapeutic class: nonopioid analgesic; NSAID; antipyretic
    • Preg. cat: D
    • MOA: inhibits prostaglandin synthesis involved in the processes of pain and inflammation and produces mild to moderate relief of fever. 
    • Indications: Pain/fever, also used for CAD
    • Contraindications: GI bleeding, Ulcers,
    • Alerts: Max dose of 2-3g/day. should be discontinued 1 week prior to elective surgery.
    • Adverse effects: GI distress/ can cause bleeding.
  14. Tylenol (acetaminophen)
    • Therapeutic class: Analgesic/ antipyretic
    • Preg. Cat: C
    • MOA: centrally acting analgesic and antipyretic with minimal to non anti-inflammatory properties. inhibits prostaglandin in the CNS and by preventing pyrogens  at the hypothalamic thermoregulator center.
    • Indications: Fever, pain
    • Contraindications: severe hepatic impairment
    • Adverse effects: Nausea, vomiting, number one cause of liver failure
    • ALERT: Max of 4g in healthy individual, 2g or less for hepatic deficiency
  15. COX-1
    Has gastro-protective effects causes increased platelet aggregation, renal protective effects, vasodilation and bronchodilation
  16. COX-2
    Enzyme is responsible for inflammation, pain, fever and decreased platelet aggregation
  17. Ibuprofen, Naproxen, Aspirin
    Pharm class: NSAID
    • Therapeutic class: Antipyretic/ Anti-inflammatory
    • Preg cat: C/D
    • MOA:Inhibits prostaglandin synthesis-Non-selective, blocks COX 1&2.
    • Indications: Fever, headache, migraine, osteoarthritis, pain, primary dysmenorrhea, RA.
    • Contraindications: Asthma, urticaria, potential for anaphylaxis.
  18. Naproxen
    • Therapeutic class: anti-inflammatory/ antipyretic.
    • Preg cat: C
    • MOA: UNK, but believed to be similar to other prostaglandin inhibitors. Longer lasting than others.
    • Indications: ankylosing spondylitis, bursitis, gout, osteoarthritis, pain, RA.
    • Contraindications: Asthma, urticaria allergic reactions similar to other NSAID. Can cause GI upset/ulcers.
    • Adverse effects: toxic to kidneys if taken in high doses-provider approval for daily use over 10days.
  19. Conscious sedation meds
    • Midazolam(versed)
    • Propofol used as well