Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BHM II > Pharm 19 > Flashcards

Pharm 19 Flashcards

1
Q

Identify where opioids act within the neurological pathway of pain transmission

A
  • Opioids influence pain signals where peripheral nerve connects to the dorsal horn in the spine
  • When activated opioid receptors generally create an inhibitory effect upon the neuron to which they are attached.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute pain

A
  • 3-6 mos

- best treated with opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic pain

A
  • persist after normal healing process

- Fentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nociceptive pain

A
  • Usually related to tissue damage, requires pain receptor activation
  • normal opioid tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nociceptive pain: somatic

A

injury to body tissue, well localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Nociceptive pain: Visceral

A

viscera mediated by stretch receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neuropathic pain

A
  • Abnormal neural activity secondary to disease, injury, or dysfunction of CNS.
  • Tramadol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cancer pain

A

-Best treated with opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List opioid drugs that are receptor agonist

A

Morphine

Hydromorphone

Codeine

Hydrocodone

Oxycodone

Meperidine (Demerol)

Fentanyl

Methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List opioid drugs that are receptor partial agonist

A
  • Buprenophine

- Tramadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List opioid drugs that are receptor antagonist

A
  • Naloxone (Narcan)
  • Naltrexone
  • Methylnaltrexone
  • Naloxegol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MC COD from opioid overdose

A
  • Respiratory depression:
  • Decreased sensitivity of chemoreceptors that sense high levels of CO2 in blood and decrease respiratory volume and rate
  • Essentially brain stops realizing the pts need to breathe.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mu receptors are found where

A

brainstem and medial thalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Kappa receptors are found where

A

limbic and other diencephalic areas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Delta receptors are found where?

A

largely in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PK of opioids

A
  • PK properties determine their analgesic and side effects
  • bioavailability is about 75-85%
  • highly water soluble, rapid onset of action
  • duration of action if related to their t 1/2
  • flow dependent hepatic clearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Max morphine dose in Washington state

A

120 mg PO per day

18
Q

What actions need to betaken to exceed morphine dose?

A
  • If above 120 pt required to consult a pain specialist

- Pain specialist can be considered a DO, MD, ARNP, pediatric physician

19
Q

Key drugs used for opioid addiction treatment:

A
  • Buprenorphine + Naloxone

- Methadone

20
Q

Why is Buprenorphine + Naloxone used for opioid addiction tx?

A
  • Natural ceiling effect of buprenorphine plus taper proofing of naloxone
  • partial agonist at mu opioid receptor
  • Once daily, easy to adhere to
21
Q

Why is Methadone used for opioid addiction tx?

A
  • Longer duration of action, can be given under medial supervision, not allowed to be “prescribed”.
  • Less euphoria effect
22
Q

Steps required for a Physician Assistant to qualify to prescribe medications for opioid addiction treatment?

A
  • Need to apply for a separate DEA registration (X as first letter of DEA)
  • Take and record no less than 24 hrs of certified training
  • Apply for a DATA waiver from SAMSHA-skips CSAT approval stat.
23
Q

Prescriptive limitations of a Physician Assistant compared to a MD or DO, in regards to prescribing for opioid addiction treatment

A
  • PAs are allowed to care up to 30 pts for purposes of opioid addiction tx

VS MD OR DO:

  • Initial limit: 30-100, petition for 275 pts.
24
Q

List sedative/hypnotic drugs: benzodiazepine

A
  • Alprazolam (Xanax)
  • Chlordiazepoxide
  • Clonazepam
  • Diazepam
  • Lorazepam (Ativan)
  • Midazolam
  • Triazolam
  • Flumazenil—benzodiazepine overdose antidote
25
Q

List sedative/hypnotic drugs: barbiturates

A
  • Pentobarbital

- Phenobarbital

26
Q

List sedative/hypnotic drugs: others

A
  • Diphenhydramine—antihistamine
  • Doxepin—tricyclic antidepressant
  • Ramelteon—melatonin receptor agonist
  • Buspirone—non-benzodiazepine anti-anxiety medication.
27
Q

unique pharmacokinetic properties of the benzodiazepines

A
  • Lipid solubility, big difference in onset and duration and extensively metabolized by the liver
28
Q

Alprazolam best fit for?

A
  • Anxiety, GAD, panic disorder.

- Short duration

29
Q

Chlordiazepoxide best fit for?

A
  • Alcohol withdrawal, anxiety.

- Long duration.

30
Q

Clonazepam best fit for?

A
  • Certain kind of seizures and panic disorder.

- Moderate duration.

31
Q

Diazepam best fit for?

A
  • Alcohol withdrawal, anxiety, drug induced seizure tx, muscle spasms, sedation induction.
  • Long duration.
32
Q

Lorazepam best fit for?

A
  • Anxiety, insomnia, sedation induction, status epilepticus.
  • Short – to – medium duration.
33
Q

Midazolam best fit for?

A
  • General anesthesia induction an maintenance, sedation maintenance (hospital use only-not anxiety).
  • Very short duration
34
Q

Triazolam best fit for?

A
  • Insomnia only!

- Short duration.

35
Q

Flumazenil (overdose antidote) best fit for?

A
  • Reversal of sedation expected to be caused by benzo tox.
  • Very short duration
  • keep redosing every 20 minutes.
36
Q

Non benzo tx: Zolpidem best tx for?

A
  • Various types of insomnia, individual formulation have diff. Indications, fast onset, but morning grogginess occurs.
37
Q

Non benzo tx: Zaleplon best tx for?

A
  • Short term tx for insomnia, best used for pts not able to stay asleep, avoid next morning effects
38
Q

Non benzo tx: Eszopiclon best tx for?

A
  • “treatment of insomnia”, flexible usage based on indication, not a great idea for mid-night waking tx.
39
Q

Non benzo tx: Pentobarbital best tx for?

A
  • Pre-anesthetic sedation, various antiseizures, technically indicated for short term tx for insomnia, used longer than 2 wks pt will develop tolerance and no longer effective for insomnia. “hits hard and fast”
40
Q

Non benzo tx: Phenobarbital best tx for?

A
  • Many kind of seizures (main use), short term insomnia, sedation, anxiety, apprehension. Slower and longer oral compared to pentobarbiral.
41
Q

Why is combining opioids and benzodiazepines so dangerous?

A

Can result in extreme generalized CNS depression, including respiratory depression.

42
Q

What is methylnaltrexone?

A

Used for opioid induced constipation

BHM II (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions