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Pharmacology – Pot-pourri

Pharmacology – Pot-pourri. Peggy Andrews, Instructor Chemeketa CC. Analgesics. Opiates & Opiate Blockers. Buprenex Stadol Vicodin Demerol Morphine sulfate Fentanyl. Nubain Trexan Narcan. We’ll talk about. Buprenex buprenorphine. Class Opioid analgesic (agonist – antagonist)

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Pharmacology – Pot-pourri

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  1. Pharmacology – Pot-pourri Peggy Andrews, Instructor Chemeketa CC

  2. Analgesics

  3. Opiates & Opiate Blockers

  4. Buprenex Stadol Vicodin Demerol Morphine sulfate Fentanyl Nubain Trexan Narcan We’ll talk about

  5. Buprenexbuprenorphine • Class • Opioid analgesic (agonist – antagonist) • Schedule V • Indications • Management of moderate to severe pain

  6. Action • Binds to opiate receptors in CNS (30x morphine and 3x narcan) • Alters perception of and response to pain • Produces generalized CNS depression

  7. Contraindications • Hypersensitivity • Precautions • Increased ICP • Adverse reactions, SE • Nausea/Vomiting • Dizzyness • Headache • Confusion • Dysphoria • Sedation • Sweating

  8. Route & dosage • IV, 0.3 mg q 4-6 h prn • How supplied • 0.3 mg/ml in 1 ml preload

  9. Stadolbutorphanol tartrate • Class • Opioid analgesic (agonist/antagonist) • Indications • Management of moderate to severe pain • Analgesic during labor

  10. Action • Binds to opiate receptors in CNS • Alters perception of response to painful stimuli • Contraindications • Hypersensitivity • Opioid dependency

  11. Precautions • Head trauma • Increased ICP • Adverse reactions, SE • Confusion • Dysphoria • Hallucinations • Sedation • Sweating • Use with extreme precautions in patient on MAO Inhibitors

  12. Route & dosage • 1 mg q 3-4 h prn • How supplied • 1 mg/ml or 2 mg/ml in 1 ml preloads

  13. Vicodin(Anexia)hydrocodone bitartrate w/ acetaminophen • Class • Analgesic • Contains 5 mg narcotic, 500 mg acetaminophen • Schedule III • Indications • Analgesic for moderate to severe pain

  14. Action • Binds to opiate receptors • Acetaminophen produces peripheral and central mechanisms

  15. Contraindications • Hypersensitivity • Precautions • Head injuries • Adverse reactions, SE • Respiratory depression • Sedation • Dizziness • Mental clouding • Acetaminophen overdose may result in potentially fatal hepatic necrosis

  16. Route & dosage • 1 – 2 tablets q 4-6 h prn PO • Total 24-hour dose should not exceed 8 tablets

  17. Demerol meperidine hydrochloride • Class • Opioid analgesic • Schedule II • Indications • Moderate or severe pain • Action • Binds to opiate receptors in CNS

  18. Contraindications • Hypersensitivity • Precautions • Head injury • Increased ICP • Adverse reactions, SE • Seizures • Confusion, sedation • Hypotension • Constipation • N/V

  19. Route & dose • 50 – 100 mg slow IV, SQ, IM • How supplied • 10 mg/ml in 5 ml preload, • 20 mg/ml, or 50 mg/ml in 5 ml preload

  20. MS ContinMorphine Sulfate • Class: Opioid analgesic • Indications • Pulmonary edema • Pain • MI • Action • Acts on opiate receptors to block sensation of pain. Also causes peripheral vasodilation

  21. Contraindications • Head injury • Depressed respiratory drive • Hypotension • Precautions: have intubation equipment and naloxone ready

  22. Adverse reactions, SE • Respiratory depression • hypotension • Confusion • Sedation • constipation

  23. Dosage & Route • 2-10 mg slow IVP q 3 - 5 min. in 2 mg increments, titrated to relief • How supplied • 10 mg/ml in 1 ml tubex

  24. fentanyl • Class • Opioid analgesic • Schedule II • Indications • Analgesia • Action • Binds to opiate receptors in CNS, altering response to and perception of pain

  25. Contraindications • Hypersensitivity • Precautions • Geriatrics • Diabetes • CNS tumors • alcoholism

  26. Adverse reactions, SE • Apnea • Laryngospasm • Route & dosage • 50-100 mcg (0.05 – 1.0 mg) • How supplied • 0.05 mg/ml in one ml preload or tubex

  27. Nubainnalbuphine • Class • Opioid analgesic (Agonist/antagonist) • Indication • Moderate to severe pain • Action • Binds to opiate receptors • Alters perception of and response to pain

  28. Contraindications • Hypersensitivity • Opioid dependency • Precautions • Head trauma • Increased ICP

  29. Adverse reactions, SE • Dizziness • Headache • Sedation • Dry mouth • N/V • Clammy feeling, sweating

  30. Route & dosage • 10 mg g 3-6 h (not to exceed 20 mg) IV • How supplied • 10 mg/ml in 1 and 10 ml vials or • 20 mg/ml in 1 and 10 ml vials • 1 ml preloads

  31. Trexannaltrexone • Class • Opiate receptor agonist • Indications • Alcoholics to decrease compulsive consumption • Detoxified addicts to stay opiate-free

  32. Action • Competes for opiate receptors • Contraindications • None noted • Precautions • None noted • Adverse reactions, SE • Abdominal cramps, • H/A • Depression • irritability

  33. Route & dosage • 25 mg tablets, PO; repeat if no withdrawal sx in one hour • Alcohol dependence; 50 mg qd PO

  34. Narcannaloxone • Class • Opioid antagonist • Indication • Reversal of CNS depression and respiratory depression 2ndary to opiate overdose

  35. Contraindications • Hypersensitivity • Precautions • Cardiovascular disease • Pregnancy • Adverse reactions, SE • None in emergent setting

  36. Route & dosage • 2 mg IV, SQ, IM, ET, SL injection • Repeat prn

  37. Nitronoxnitrous oxide • Class • Analgesic • Indications • Moderate to severe pain • Action • Alters perception of pain • Decreases hypoxia

  38. Contraindications • Do not administer for abdominal pain • Severe head injury • Precautions • Must be self-administered • N/V

  39. Route & dosage • Inhaled, blended mixture of 50% nitrous oxide and 50% oxygen • Effects dissipate within 2-5 min. after cessation of administ. • Unit consists of oxygen & nitrous oxide cylinders, fed into blender; delivered to modified demand valve

  40. Benzodiazepines And a Benzodiazepine Antagonist

  41. Valium Versed Lorazepam & Flumazanil We’ll talk about

  42. Valiumdiazepam • Class • Anticonvulsant • Sedative hypnotic agent • Skeletal muscle relaxant • Schedule IV • Indications • seizures • Anxiety • Pre-paralytic • Pre-cardioversion • Alcohol withdrawal

  43. Action • Depresses CNS • Produces anterograde amnesia • Has anticonvulsant properties

  44. Contraindications • Hypersensitivity • Comatose patients • Pre-existing CNS depression • Precautions • Hepatic dysfunction

  45. Adverse reactions, SE • Dizziness • Drowsiness • Lethargy

  46. Dosage & route • Seizures • 5 – 10 mg IV; may repeat q 10 – 15 min. to total dose of 30 mg • Precardioversion • 5 – 15 mg IV; 5 min. before • Sedation • 5 – 15 mg IV slowly

  47. Versedmidazolam • Class • Sedative/hypnotic (benzodiazepine) • Schedule IV • Indications • Used to produce sedation preoperatively • Antegrade & retrograde amnesia • Provides conscious sedation

  48. Action • Acts at many levels of the CNS to produce generalized CNS depression; produces short-term sedation

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