-
Methadone
Prototype
Classification
Indications for Use
Special qualities
- Severe Chronic Pain
- Detoxification-has a more natural tapering effect so less withdrawl.Methadone
- maintenance- Switch heroin addiction to methadone so pt can still
- function and get opiate fix.-oral liquid so no use of needles.
-
Hydromorphone
Prototype
Classification
Indications for Use
Special Qualities
- For severe Chronic Pain
- 5x more potent than MS but shorter acting; used as push frequently
-
Meperidine
Prototype
Classification
Indications for Use
Special Qualities
- Moderate to Sever Pain treatment
- Shorter acting; Less respiratory depression; Not good for long term use
- (>48hrs) due to build up and CNS toxicity resulting in adverse mood
- effects such as restlessness, anger, sadness, apprehenshion. So not for
- older adults and those with renal dysfunction
-
Hydrocodone & Acetaminophen
Prototype
Classification
Indications for Use
Special Qualities
- Moderate to severe pain
- Used when oral narcotic analgesic needed; Dosage 1-2 tabs q4-6h prn po
-
Codeine
Prototype
Classification
Indications for Use
Special Qualities
- Mild Pain, Cough Suppression
- Weak analgesic alone but used in combination therapy with
- Tylenol(Percocet) watch for acetominophen toxicity and with ASA
- (Percodan)
-
Naloxone
Prototype
Classification
Indications for Use
Special Qualities
- Anitidote to Narcotic Analgesic (reverses the depressant effects)
- Also antidote to Pertazocine. Shorter acting than many narcotics so
- monitor for 24hrs after aparent recovery. May cause withdrawl symptoms
- to manifest fast. Doesn't get absorbed well orally. Dose: 0.4 mg IV if necessary repeat q2-3 minutes
-
Pentazocine
Prototype
Classification
Indication for Use
Special Qualities
- Pain Management
- Causes vasoconstriction (unlike morphine) and psychotomimetic
- (halucination) Talwin Nx (oral) no longer can be made into injectable
- because manufacturers added Naloxone to cancel the affects when injected
- (since naloxone isn't absorbed well orally, Talwin Nx still effective
- pain reliever)
-
Acetaminophen
Prototype
Classification
Indications for Use
Special Qualities
- Pain Reliever and Fever Reducer
- Careful of liver toxicity- cannot exceed 4g/day. (2g/day for alcoholics
- and fasting pts.) No anti-platelet effects like aspirin so use instead
- of aspirin for: mylosuppressed pt, blood dyscrasia, pt on anticoagulant
- therapy, ulcer, aspirin allergy
-
Pharmacological Effects of Barbiturates (5)
- Sedation
- Hypnosis
- Anticonvulsant
- Anesthesia
- Tolerance & Dependence
-
Adverse Effects of Barbiturates (6)
- Drowsiness and ataxia
- Hangover (nausea, depression, listlessness)
- Allergic Reactions
- REM rebound
- Repiratory Depression (High doses)
- Tolerance and Addiction
-
Phenobarbital
Prototype
Classification
Indications for Use
Special Qualities
- Anticonvulsant (seizures), sedative
- Long Acting
-
Secobarbital
Prototype
Classification
Indications for Use
Special Qualities
- hypnotic for insomnia, sedative for pre-anesthesia
- short acting, "downer"- highly abused as (red-devils) so use is highly restricted
-
Special Pharmacology for Benzodiazepines
- High therapeutic index so relatively safe but most abused drug in US and can be fatal with combination meds
- sedative-hypnotic
- antianxiety
- anticonvulsant
-
Flurazepam
Prototype
Classification
Indications for Use
Special Qualities
- Hypnotic, Longest acting
- Little or no REM rebound, low physical addiction, active metabolite causes hangover effects (especially in older males so use 1/2 dose.)
-
Temazepam
Prototype
Classification
Indications for Use
Special Qualities
- Intemediate acting hypnotic
- No active metabolite so less hangover effect, elderly still unable to
- metabolize well so use 1/2 dose or 1/4 dose with kidney dysfuntion
-
Triazolam
Prototype
Classification
Indications for Use
Special Qualities
- Short acting hypnotic (for those having trouble falling asleep but not staying asleep)
- Least hangover effect, Only for temporary use, used as antianxiety but
- has phyiscal withdrawl manifesting in psychiatric disturbances-paranoia,
- rage, violence
-
Fumazenil
Prototype
Classification
Indications for Use
Special Qualities
- Reverse the sedative effects of benzodiazepines but not the respiratory depression and amnesia
- Used for OD and to bring patients out of sedation. [adverse effects: Seizure, HA, visual disturbances, anxiety]
-
Advantages of "Z" hypnotics (4)
- Lacks next day hangover effect
- Less amnesic effects
- Less potentiation with alcohol (still should avoid)
- Less Tolerance
-
Adverse Effects of "Z" Hypnotics
- dizziness, drowsiness, loss of concentration
- nausea, vomiting, diarrhea
-
Zolpidem
Prototype
Classification
Indications for Use
Special Qualities
- Non-benzodiazepine selective for omega-1 receptors aka Z hypnotic
- Short term treatment of insomnia
-
Zaleplon
Prototype
Classification
Indications for Use
Special Qualities
- Non-benzodiazepine selective for omega 1 receptors aka Z hypnotics
- Short term treatment of insomniaPrecaution because it contains tatrazine dye (Yellow #5)
-
Diphenhydramine
Prototype
Classification
Indications for Use
Special Qualities
- none
- Sedative Hypnotic, antihistamine
-
Alternative Medicines for Sedative Hypnotics (5)
- B vitamins
- lavender
- chamomile
- valerian (liver caution)
- kava kava (liver toxicity)
-
Pharmacologic Effects of Narcotic Analgesic (13)
- Analgesia
- CNS Depression
- Behaviorial-euphoria, mental clouding, drowsiness
- Repiratory Depression- less responsice to [CO2]
- Nausea and Vomiting
- Cough supression
- Pupil constriction (miosis)
- Postural hypotension
- Vasodilation
- Constipation
- Urinary retention
- Pruritis and Sweating
- Addiction and Tolerance
-
Clinical Uses of Narcotic Analgesics (5)
- Analgesia-MI, APE
- CNS depression-preop/preanesthesia medication
- Cough suppression (Codeine, hydrocodone)
- Vasodilation -MI, APE
- Constipation- to treat diarrhea (Lomotil)
-
Adverse Effects of Narcotic Analgesics (11)
- CNS depression-sedation, lethargy
- Behaviorial-mental clouding, restlessness, mood changes
- Respriatory Depression
- Nausea and Vomiting
- Cough Supression (if productive cough)
- Postural Hypotension- fainting, dizziness
- Vasodilation-fainting, dizziness
- Constipation
- Urinary Retention
- Pruritis and Sweating
- Addiction and Tolerance
-
Contraindication and Precautions of using Narcotic Analgesics (4)
- Increased intracranial pressure- look for mydriasis (pupil dilation)
- Respiratory disease- asthma, COPD, emphysema
- Prostatic Hypertrophy-enlarged prostate (added pressure to the urinary tract)
- Drug interactions- any other drugs that supress Resp or CNS (alcohol, sedative, hypnotics, antihistamines)
-
Morphine
Prototype
Classification
Indications for Use
Special Qualities
- Severe pain
- Dose:10 mg IM q4h prn (5-20 mg)
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