-
Fxn of COX-1:
"TGPS" (travel w/your GPS)
- "Good COX"
- T: Tissues: housekeeping
- G: GI: protects GI mucosa
- P: Platelets: promotes platelet aggregation
- S: Supports Renal Fxn
-
Fxn of COX-2:
"TBBCC"
- "Bad COX"
- T: Tissue: inflammation, pain
- B:
Brain: pain perception, fever - B: Blood Vessels: vasodilation
- C: Kidney: supports renal fxn
- C: Colon: causes colon cancer (CA)
-
Aspirin [ASA]
- COX-1 Inhibitor
- use: RA/OA, ↓Pain, ↓Fever, prevent Clotting, prevent MI/CVA
- ae: GI Bleeding, Bleeding, ↓Renal Fxn, Reye's Syndrome
- intrxn: warfarin(↑anticoag.), glucocorticoid (↑GI ulcer), Alcohol (↑GI bleed), IbuProfen (↓antiplt), ACE/ARB (↓renal fxn)
- DO NOT USE W/CHILDREN
-
Celecoxib [Celebrex]
- COX-2 Inhibitor
- use: RA/OA, ↓Fever, prevent CA
- ae: MI/CVA, GI Ulcer, Renal Impairment
- intrxn: warfarin (↑anticoag), Sulfonamide Allergy
- No cardiovascular Benefit.
- No Risk of Bleeding (like cox-1).
- Don't take with existing MI/CVA, ↓Renal Fxn, Diabetes.
-
Acetaminophen [Tylenol]
- COX Inhibitor
- only works in CNS, not peripherally, so it only works for pain/fever
- use: Analgesia, Antipyretic
- ae: minimal, OD=Liver Injury
- intrxn: Alcohol (↑liver injury), Warfarin (↑risk bleeding)
- Cannot take with Liver Impairment.
- Max Dose 4000 mg/day.
- Antidote: Acetylcysteine [Mucomyst]
-
Hydrocortisone and Prednisone
- Glucocorticoids
- Works with cortisol in the body to ↓immune response and ↓inflammation
- use: prevent rejection of organ transplants, RA, asthma (hydrocortisone only)
- ae: ↑Glucose, Fluid Retention, Risk for Infxn (↓immune response), ↓K+, Osteoporosis
- intrxn: Aspirin (↑risk GI ulcer), K+wasting Diuretics (↑risk hypokalemia)
- DO NOT GIVE if pt has a systemic fungal infxn.
- Discontinue slowly.
- GIVE DOSE IN AM (cortisol is highest in AM).
-
Mu Receptor Activation:
"MU ABCDES"
- M: Misosis: pupils contrict
- U: Urinary Retention + ICP
- A: Analgesia: pain relief
- B: Breathing: respiratory depression
- ---Blood Pressure: orthostatic hypotension
- C: Constipation (+emesis, biliary colic)
- ---Cough Suppression
- D: Dependecy + Tolerance
- E: Euphoria + Dysphoria
- S: Sedation: drowsiness or clouding
-
Kappa Receptor Activation:
"GrAS"
- G: GI: contipation
- r: respiratory depression (little)
- A: Analgesia
- S: Sedation
-
Morphine
- Strong/Pure Opiod Analgesic
- Activate Mu Receptors
- Uses and A/E are relative to indication
- use: Moderate to Severe Pain Relief (modifies pain perception, mimic endogenous opoid peptides)
- intrxn: Alcohol (CNS depr), CNS Depressants, Anti-Cholinergic, Agon-Antag Opoid, Hypotensive, Opoid Antag, MAO Inhbitor, Benzodiazepines (↑sedation)
- Onset of Respiratory Depression:IV: 7 min
- IM: 30 min
- SubQ: 90 min
- Need Baseline BP, Pulse, RR
- Antidote: Nalaxone [Narcan]
-
Pentazocine
- Agonist-Antagonist Opoid
- Activates Kappa Receptors, Blocks Mu Receptors
- use: Mild to Moderate Pain Relief (less powerful analgesic effect)
- ae: usually like Morphine, ↑Cardiac Work (don't take w/MI pain), mild dependence
- intrxn: precipitates withdrawal from Pure AgonistLow Abuse Potential, Less Respiratory Depression
- Antidote: Nalaxone [Narcan]
-
Nalaxone [Narcan]
- Pure Opoid Antagonist
- competitive antagonist at opoid receptors, blocks effects of opoid agonist
- use: Reversal Agent/Antidote (blocks analgesia, euphoria, sedation, resp depr)
- ae: Immediate Withdrawal (Abstinence Syndrome)
- *Titrate*series of small dose to prevent withdrawal
-
Diazepam [Valium]
- Benzodiazepine
- Enhances GABA at receptro sites to depress CBS (insomnia) or limbic system (anxiety)
- use: choice for Insomnia and Anxiety (also seizure, muscle spasms, alcohol withdrawal, induce anesthesia)
- ae: CNS Depression (drowsiness, unable to concentrate), Anterograde Amnesia
- Some Dependence/Withdrawal (discontinue gradually).
- Safer: ↓abuse, ↓tol/dep, ↓drug intrxn
-
Zolpidem [Ambien]
Zoleplon [Sonata]
- Benzodiazepine-Like Drugs
- agonist at Benzodiazepine receptors
- use: Insomnia (not anxiety), SHORT TERM USE ONLY
- ae: drowzy, dizzy, sleep-driving
- Ambien: most widely used
- Sonata: new drug, "Pyrazolopyrimidines"
- Highly effective Hypnotics, Low Abuse Potential
-
Flumazenil [Romazicon]
- Competitive Benzodiazepine Receptor Antagonist
- reverses sedative effects of benzo, but maybe not respiratory depression
- use: Antidote for Benzo Overdose
- ae: Convulsions (can produce the same effects you're trying to stop)
- Effects begin Rapidly and All at Once
|
|
