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Hydromorphone (Dilaudid)
-Definition
-Schedule
-Morphine equivalent
very potent opioid analgesic
Schedule II drug
One mg of IV or IM hydromorphone is equivalent to 7 mg of morphine
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Codeine Sulfate
-Define
-Schedule
-Common use
-Side effect
Natural opiate alkaloid with Ceiling effect
(Schedule II)
More commonly used as an antitussive drug (Cough Suppressant)
GI disturbance
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Fentanyl
-Define
- Schedule
- Morphine Equivalent
- Routes
Synthetic opioid
Schedule II
0.1 mg intravenously is equivalent to 10 mg of morphine intravenously
Parenteral injections, transdermal patches (Duragesic), buccal lozenges (Fentora), and buccal lozenges on a stick (Actiq)
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Methadone Hydrochloride (Dolophine)
-Define
-Schedule
-Alternate treatment
-Common OD Cause
Synthetic opioid analgesic
Schedule II
Opioid of choice for treatment of opioid addicts
Renewed interest in the use of methadone for chronic (e.g., neuropathic) and cancer-related pain
Prolonged half-life of the drug: cause of unintentional overdoses and deaths
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Morphine Sulfate
-Define
-Fun Fact
-Schedule
-Routes
Naturally occurring alkaloid derived from the opium poppy
Drug prototype for all opioid drugs
Schedule II controlled substance
Oral, injectable, and rectal dosage forms; also extended-release forms
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Oxycodone
(OxyFast, OxyIR, OxyNorm, Roxicodone)
-Release
-Associated Injury
-with Acetaminophen
-with aspirin
Immediate-release
Associated with hepatotoxicity. (Drug induced liver injury)
(Percocet, Endocet, Roxicet, Tylox)
(Endodan, Oxycodan, Percodan, Roxiprin)
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Oxycodone (OxyContin)
-Release
-Duration
-Best Choice Therapy
Controlled-release
12-hour duration
If a patient is addicted to opiates but still has acute pain, extended release oxycodone should be prescribed.
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Naloxone (Narcan)
-MOA
-Best choice therapy
-Failure of drug
Pure opioid antagonist
Drug of choice for reversal of opioid-induced respiratory depression
Failure of the drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose.
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Naltrexone
-Indications
-MOA
Alcoholism and opiate addiction
Opiate antagonist
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Acetaminophen (Tylenol)
-2 indications
-anti inflammatory?
-Similarity
-Indication
-MOA
-Contraindications
-Overdose warning
-Long term use
-Antidote
-Recommended Max Dose, Adult/Elderly
-Awareness
Analgesic and antipyretic effects
Little to no anti inflammatory effect
Similar to salicylates (acne and psoriasis treatments)
Indicated for Pain, fever
Blocks pain impulses peripherally by inhibiting prostaglandin synthesis
Should not be taken in the presence of:-
-Drug allergy
-Liver dysfunction/failure
-G6PD deficiency.
Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic.
Even though available OTC, lethal when overdosed. Overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity
Long-term ingestion of large doses also causes nephropathy
Recommended antidote: acetylcysteine regimen
Maximum daily dose for healthy adults is being lowered to 3000 mg/day.
2000 mg for older adults and those with liver disease
Be aware of the acetaminophen content of all medications taken by the patient (OTC and prescription).
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Nitrous Oxide “Laughing gas”
-2 Interesting Facts
-Primary Use
Only inhaled gas currently used as a general anesthetic
Weakest of the general anesthetic drugs
Used primarily for dental procedures or as a supplement to other, more potent anesthetics
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Inhalational anesthetics:
-Family Last Name
-Define
-4 Drugs
"Ane" family
Volatile liquids or gases that are vaporized in oxygen and inhaled
ENFLURANE(ETHRANE)
HALOTHANE(FLUOTHANE)
ISOFLURANE(FORANE)
METHOXYFLURANE(PENTHRANE)
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Sevoflurane (Ultane)
-Define
-Onset/elimination
-Useful For
Fluorinated ether
Widely used Inhalational anesthetics
Rapid onset and rapid elimination
Especially useful in outpatient surgery settings
Nonirritating to the airway
Greatly facilitates induction of an unconscious state, especially in pediatric patients
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