NSG 533 - Advanced Pharmacology
Exam 2
Question:
NSAID use
Answer:
Nonselective COX-1 and COX-2 inhibitors (COX-2 does anti-inflammation)
Precaution: GI issues, renal toxicity, antiplatelet effect
No NSAID is better than others- but vary from patient to patient
Best for: RA, menstrual cramps, postsurgical pain, bony metastasis
Flat-dose curve response: higher doses aren't more effective than moderate
doses but do increase ADRs
ADRS: sodium retention, platelet inhibition, GI irritation, hepatic
dysfunction, renal insufficiency, CNS dysfunction
Caution: Diuretics, lithium, warfarin, nephrotoxicity, low creatinine
clearance, antihypertensives, reduced cardiac capacity
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Question:
APAP
Answer:
Inhibit prostaglandin synthesis in CNS and block pain impulses in the periphery
Indication: mild-moderate pain including low back pain and osteoarthritis
Limits: hepatotoxicity don't go over 4000 mg/day, caution with alcohol use,
binge drinking
Renal dysfunction: 50-75% dose reduction and for those with excessive
ETOH use
Question:
Adjunctive pain medications
Answer:
Fibromyalgia: Duloxetine
Diabetic peripheral nerve pain (DPN): duloxetine, pregabalin (lyrica)
Post-herpetic neuralgia (PHN) (shingles): gabapentin, pregabalin, lidocaine
patch
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Question:
Opioids
Answer:
Opioids act by stimulating opioid receptors in CNS
ADRs: Sedation, hallucinations, constipation, nausea, vomiting, urinary
retention, myoclonus, respiratory depression
Question:
Opioids ADR management
Answer:
Excessive sedation: reduce dose by 25% or change interval
Constipation: docusate at bedtime or BID, senna, bisacodyl, miralax,
methylnaltrexone, naloxegol N/V: prevention: hydroxyzine, diphenhydramine, treatment: prochlorperazine, ondansetron
Gastroparesis: metoclopramide
Vertigo: meclizine
Urticaria/itching: hydroxyzine, diphenhydramine
Respiratory depression: mild: reduce by 25%, moderate-severe: naloxone
CNS irritability: d/c opioid, treat with benzo
Patients with CYP450 may respond differently to opioids: drug
unresponsiveness - elevated toxic serum levels Tolerance to respiratory depression develops quickly
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Question:
Opioid allergy
Answer:
Cross-sensitivity is unlikely
patient is truly allergic to one chemical class within the opioid family such as morphine-like agents they may try a different one such as meperidine-like or methadone-like agents
Mixed agonist/antagonist agents are treated as if they are morphine-like agents
Question:
Opioid conversion
Answer:
Opioid potency is compared using a reference standard of 10 mg parenteral morphine Current total daily dose is calculated (for 24 hours including any rescue dosages) and the total of the new dosage form is determined using a ratio of equianalgesic doses Sustained-release options may decrease by 25% due to oversedation concern Methadone is more potent than once believed and may need to be reduced after calculation as well as for elderly
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