Advanced Pharmacology Exam 1 Review

Advanced Pharmacology Exam 1 Review PAIN MEDICATIONS AND MANAGEMENT Types of Pain - Nociceptive o Caused by damage to body tissue o Secondary to noxious stimuli - Neuropathic/Functional o Pain that is disengaged from noxious stimuli or healing o Described in terms of chronic pain o Result of nerve damage (neuropathic) or abnormal operation of the nervous system o Ie postherpetic neuralgia, diabetic neuropathy, fibromyalgia, irritable bowel syndrome, tension-type headache Partial Agonist: A drug that can activate an opioid receptor to affect a submaximal response. Opioid Antagonist: A drug that blocks some or all opioid receptor subtypes. Acetaminophen (Tylenol) - Mechanism of Action: Believed to inhibit the synthesis of prostaglandins in the CNS / block pain impulse. - Dose: 325-650mg Q4h or 1000mg Q6h o MAX: 4 Grams/ Day (If you have Liver impairment of alcoholism can only have MAX 2 Grams/Day) - Forms: PR/ PO/ Intravenous - U.S. Box Warning: Acetaminophen may cause severe hepatoxicity, potentially requiring liver transplant or resulting in death; hepatoxicity is associated with excess acetaminophen use. Aspirin (Salicylates) - Mechanism of Action: IRREVERSIBLY binds to COX-1 & COX-2 enzymes - Properties: Analgesia, Anti-inflammatory, antipyretic, Antiplatelet (irreversible) o Prevents the synthesis of thromboxane A (vasoconstrictor & induces of platelet aggregation) - Adverse Effects: o GI discomfort or bleeding o Dizziness o Reye’s Syndrome (Occurs in children w/ viral infections) - AVOID USE WITH RECENT SURGERY NSAIDs Adverse Effects: - Cardio = Fluid retention, hypertension, edema - GI = Irritation, ulcers, bleeding, and perforation - Respiratory = Bronchospasm - Skin = Rash, Renal = Insufficiency or Failure - AVOID with other nephrotoxic drugs (Diuretics like furosemide, hydrochlorothiazide, ACE inhibitors) - BLACK BOX Warning o Potential or serious adverse cardiovascular thrombotic events including MI & Stroke o Serious and potential GI bleeding and Ulceration o Treatment of perioperative pain in the setting of CABG. Ketorolac (Toradol) - Available parenterally (IV or IM) and PO - Indication: Short-term management of moderate to severe pain. - Adverse Effects: o Severe bleeding post-operatively o Renal failure monitor: Bleeding, liver enzymes, serum creatinine - LIMIT TO MAX 5 DAY THERAPY! Celecoxib (Celebrix):