Pharmacology, Unit 3- Oppermann

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Terms in this set (...)

Salicylates..
Action?
Indication?
Contraindications/Cautions?
Adverse Effects?
Anti-inflammatory agents, antipyretic, analgesic
Action: inhibit synthesis of prostaglandin

Indication: treatment of mild to moderate pain, fever, & numerous inflammatory conditions including rheumatoid arthritis and osteoarthritis

Contraindications:
Pregnant women- can cross placenta and enter breast milk
bleeding abnormalities
impaired renal function
chicken pox or influenza (risk of Reye syndrome)
surgery/invasive procedures within 1 week

Adverse Effects: direct effects on stomach (nausea, dyspepsia, heartburn, epigastric discomfort) and on clotting systems (blood loss, bleeding abnormalities)
Salicylism
Can occur with high levels of aspirin. Dizziness, ringing in ears (tinnitus), difficulty hearing, nausea, vomiting, diarrhea, mental confusion.
Salicylate toxicity
Hyperpnea, tachypnea, hemorrhage, excitement, confusion, pulmonary edema, convulsions, tetany, metabolic acidosis, fever, coma, and cardiovascular (CV), renal, and respiratory collapse.
Drugs in focus... Salicylates
aspirin (Bayer, Empirin, others)
balsalazide (Colazal)
choline magnesium trisalicylate (Tricosal)
diflunisal (generic)
mesalamine (Pentasa, others)
olsalazine (Dipentum)
salsalate (Argesic, others)
sodium thiosalicylate (generic)
NSAIDS.. Nonsteroidal anti-inflammatory drugs
Action?
Indication?
Contraindications/Cautions?
Adverse Effects?
Anti-inflammatory, analgesic, antipyretic

Action: inhibit prostaglandin synthesis, block enzymes COX-1 which is present in all tissues and involved in many body functions (blood clotting, protecting stomach lining, maintaining sodium/water balance in kidneys) also blocks COX-2 which is thought to act at sites of trauma and injury.. therefore NSAIDS block inflammation before all signs and symptoms can develop

Indication: Relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction.

Contraindications/cautions:
Contraindicated in the presence of any allergy to NSAIDS or salicylate, celecoxib is also contraindicated in the presence of allergy to sulfonamides
CV dysfunction/hypertension
peptic ulcer or known GI bleeding
pregnancy
renal/hepatic dysfunction

Adverse Effects:
Nausea, dyspepsia, GI pain, constipation, diarrhea, or flatulence. GI bleeding (cause of discontinuation) headache, dizziness, somnolence, and fatigue. Bleeding, platelet inhibition, hypertension, and bone marrow depression (reported with chronic use). Rash and mouth sores may occur, and anaphylactic shock has been reported in cases of severe hypersensitivity.
Drugs in focus... NSAIDS
Propionic Acids
fenoprofen (Nalfon)
flurbiprofen (Ansaid)
ibuprofen (Motrin, Advil, Caldolor(IV), others)
ketoprofen (Orudis)
naproxen (Naporsyn)
oxaprozin (Daypro)
Drugs in focus... NSAIDS
Acetic Acids
diclofenac (Voltaren, Cataflam, Flector)
etodolac (Lodine)
indomethacin (Indocin)
ketorolac (Toradol)
nabumetone (Relafen)
sulindac (Clinoril)
tolmetin (Tolectin)
Drugs in focus... NSAIDS
Fenamates
meclofenamate
mefenamic acid
Drugs in focus... NSAIDS
Oxicam Derivative

Cyclooxygenase-2 Inhibitor

Related Agent
meloxicam (Mobic)
piroxicam (Feldene)

celecoxib (Celebrex)

acetaminophen (Tylenol)
Acetaminophen
Action?
Indication?
Contraindications/Cautions?
Adverse Effects?
Used to treat moderate to mild pain and fever, often use in place of NSAIDS or salicylates. Most frequently used drug for managing pain and fever in children. Found in many OTC products, teach patients to avoid overdose.

Action: Acts directly on thermoregulatory cells in the hypothalamus to cause sweating and vasodilation; this causes the release of heat and lowers fever.

Indication: treatment of pain and fever associated with a variety of conditions including influenza,and for relief of musculoskeletal pain associated with arthritis

Contraindications/cautions:
Pregnancy- potential adverse effects on baby
Hepatic dysfunction or chronic alcoholism- (toxic effects on liver)

Adverse Effects:
Headache, hemolytic anemia, renal dysfunction,skin, rash, and fever.
Hepatotoxicity- potentially fatal and associated with chronic use or overdose related to the direct toxic effects on the liver

*when overdose occurs acetylcysteine can be used as an antidote
Anti arthritis Agents
Action?
Indication?
Contraindications/Cautions?
Adverse Effects?
Antiarthritis agents include gold compounds which are used to prevent and suppress arthritis in selected patients with rheumatoid arthritis. Other anti arthritis drugs are specifically used to block the inflammation and tissue damage of rheumatoid arthritis.

Action: Chrysotherapy (treatment with gold salts) results in the inhibition of phagocytosis, since this is blocked the release of lysosomal enzymes in inhibited and tissue destruction is decreased. This action allows gold salts to suppress and prevent some arthritis and synovitis.

Indication: Treat selected cases of rheumatoid and juvenile rheumatoid arthritis in patients whose disease has been unresponsive to standard therapy. These drugs do not repair therapy, they prevent further damage and are most effective if used early in the disease.

Contraindications/cautions:
Can be toxic, contraindicated in the presence of..
known allergy to gold, severe diabetes, congestive heart failure, severe debilitation, renal/hepatic impairment, hypertension, blood dycrasias, recent radiation treatment, history of toxic levels of heavy metals, pregnancy/ lactation.

Adverse Effects:
Stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, and other GI inflammation. Gold bronchitis, and interstitial pneumonitis, bone marrow depression, vaginitis, nephrotic syndrome, dermatitis, pruritus, exfoliative dermatitis, and allergic reactions ranging from flushing, fainting, and dizziness, to anaphylactic shock.
Drugs in focus..
Antiarthritis agents
Gold compounds & other anti arthritis drugs
auranofin (Ridaura)
gold sodium thiomalate (Aurolate)

anakinra (Kineret)
etanercept (Enbrel)
hyaluronidase derivatives (hylan G-F 20, Synvisc)
leflunomide (Arava)
penicillamine (Depen)
sodium hyaluronate (Hyalgan)
Benzodiazepines
Action?
Indication?
Contraindications/Cautions?
Adverse Effects?
Prevent anxiety without causing much associated sedation. Less likely to cause physical dependence

Action: Act in limbic system and the RAS to make GABA more effective causing interference with neuron firing. GABA stabilizes the postsynaptic cell which leads to an anxiolytic effect at doses lower than those required to induce sedation.

Indication: treatment of anxiety disorders, alcohol withdrawal, hyper excitability, agitation, preoperative relief of anxiety and tension to aid in balanced anesthesia.

Contraindications:
allergy, acute narrow angle glaucoma, shock, coma, acute alcoholic intoxication, pregnancy, elderly patients use with caution, hepatic/renal dysfunction

Adverse Effects: sedation, drowsiness, depression, lethargy, blurred vision, headaches, apathy, light-headedness, amnesia, and confusion. GI effects- Dry mouth, constipation, nausea, vomiting, elevated liver enzymes. CV problems hypotension, hypertension, arrhythmias, palpitations, respiratory difficulties.
What is the prototype for benzodiazepines?
diazepam
Patients taking benzodiazepines, especially elderly patients, are at high risk for:
falls
Sedatives and hypnotics are used to primarily to treat:
insomnia
An elderly patient is administered a sedative for the treatment of insomnia. Which sign should the nurse look for in the patient when monitoring the effects of the administered drug?
confusion
A patient's medication regimen for treatment of anxiety has been changed from a benzodiazepine to buspirone (BuSpar). The patient asks the nurse what makes this medication safer than the benzodiazepine he has taken. What is the nurse's best response?
"It will not produce sedation like benzodiazepines."
A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for:
respiratory disturbances and partial airway obstruction.
A patient who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by:
increasing the effects of the neurotransmitter GABA.
Medication reconciliation of an 82-year-old man who has recently moved to a long-term care facility reveals that the man takes 1 to 2 mg of lorazepam bid prn. The nurse should recognize what consequence of this aspect of the resident's drug regimen?
Increased risk for falls
After reviewing the various drugs that are classified as barbiturates, a student demonstrates understanding when identifying which as the prototype?
phenobarbital (Luminal)
A client is prescribed an anxiolytic agent. What would be most important for the nurse to include in the teaching?
"Be sure not to stop the drug abruptly."
A client with a high-pressure job temporarily requires an anxiolytic that has no sedative properties. What medication is most likely to meet this client's needs?
Zaleplon
Buspirone
Diphenhydramine
Meprobamate
Buspirone
A patient has been administered flumazenil (Romazicon) because of the toxic effects of benzodiazepines. The patient should be observed for acute benzodiazepine withdrawal symptoms. Which of the following symptoms is indicative of acute benzodiazepine withdrawal?
Tachycardia
Seizures
Lethargy
Coma
Seizures
A patient receiving halcion 0.25 mg PO at bedtime appears very drowsy and is difficult to rouse when the nurse enters the room. Based on these findings, what would be the best nursing diagnosis for this patient?
Risk for altered elimination
Ineffective individual coping
Risk for injury
Risk for skin breakdown
Risk for injury
A client is receiving a barbiturate intravenously. The nurse would monitor the client for:
hypertension.
bradycardia.
tachypnea.
bleeding.
Bradycardia
A 70-year-old male client asks why he is receiving a lower dose of zaleplon than his son. As part of the nurse's teaching plan, which explanation will the nurse give this client?
"Older adults metabolize the drug more quickly, but due to renal dysfunction, the medication must be reduced."

"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults."

"Older adults metabolize the drug at the same speed as younger adults; I will check the dosage with your physician."

"Older adults do not need as much of the medication for the desired effect as a younger adult does."
"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults."
A client has received a benzodiazepine for sedation before a diagnostic procedure. Which agent would the nurse expect the client to receive to reverse the sedative effects?
Temazepam
Triazolam
Flumazenil
Promethazine
flumazenil
A client with a high-pressure job temporarily requires an anxiolytic that has no sedative properties. What medication is most likely to meet this client's needs?

Buspirone
Zaleplon
Meprobamate
Diphenhydramine
buspirone
Barbiturates
Action?
Indication?
Contraindications/Cautions?
Adverse Effects?
Used to be the sedative-hypnotic drugs of choice, but are not any longer because adverse effects and risk of addiction are greater with barbiturates than new drugs.

Action: CNS depressants that inhibit neuronal impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, and depress motor output.

Indication: the relief of symptoms and signs of anxiety and for sedation, insomnia, pre anesthesia, and the treatment of seizures.

Contraindications:
allergy, previous addiction to sedative-hypnotic drugs, porphyria, hepatic impairment or nephritis, respiratory distress, pregnancy, use with caution in patients with acute or chronic pain (can cause paradoxical excitement, masking other symptoms)

Adverse Effects:
More severe than with newer sedative-hypnotics, also the development of physical and psychological dependence is more likely.
CNS effects- drowsiness, ataxia, vertigo, "hangover" feeling, thinking abnormalities, paradoxical excitement, anxiety, hallucinations.
GI effects- nausea, vomiting, constipation, diarrhea, epigastric pain.
CV effects- bradycardia, hypotension (especially with IV administration), syncope.
Hypoventilation, respiratory depression
Hypersensitivity reactions- rash, serum sickness, Stevens-Johnson syndrome
Drugs in focus...
Barbiturates

Name the prototype
amobarbital (Amytal sodium)
butabarbital (Butisol)
mephobarbital (Mebaral)
pentobarbital (Nembutal)
phenoarbital (Luminal)- prototype
secobarbital (Seconal)
Drugs in focus...
Benzodiazepines

Name the prototype
alprazolam (Xanax)
chlordiazepoxide (Librium)
clonazepam (Klonopin)
clorazepate (Tranxene)
diazepam (Valium)- prototype
estazolam (ProSom)
flurazepam (Dalmane)
lorazepam (Ativan)
midazolam
oxazepam (Serax)
quazepam (Doral)
temazepam (Restoril)
triazolam (Halcion)
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