Pharm Exam 4 2024 complete update A+
graded study guide
MOA acetaminophen - not clear
- weak COX1/COX2 inhibitor
- activation of descending serotonergic inhibitory pathways
- antipyretic effects via inhibitory effects on hypothalamic "thermostat"
adverse effects tylenol- skin rash/allergy
- hemolytic uremia
- methemoglobinemia
- hepatotoxicity (>4g/day, >15g lethal)
early signs hepatotoxicity tylenol nausea, vomiting, diarrhea, abdominal pain, dizziness,
excitement, disorientation
contraindications acetaminophen? - long term use during pregnancy associated with ADHD
- severe inflammatory pain (not best to give)
- severe hepatic disease
MOA salicylates (acetylsalicylic acid, aspirin) inhibits COX which inhibits the synthesis of
prostaglandins
- antipyretic, analgesic, anti-platelet properties
side effects salicylates- CNS: tinnitus, aseptic meningitis, HA, dizziness
- CV: fluid retention, HTN, edema, MI, CHF
- GI: abdominal pain, dyspepsia
- hematologic: thrombocytopenia, neutropenia, aplastic anemia
- hepatic: abnormal LFTs, liver failure
- pulm: asthma
- skin: rash, pruritis
- renal: renal failure/insufficiency, hyperkalemia, proteinuria
indications salicylates - pain relief, anti-inflammatory
- rheumatic disease arthritis
, - primary prevention of atherosclerotic CV disease
contraindiciations salicylates - pregnancy
- allergy
- children (Reyes syndrome)
- hemophilia/bleeding disorders
MOA NSAIDs inhibits prostaglandin biosynthesis via inhibition of COX isoenzymes
(COX1/COX2)
side effects NSAIDs - similar to aspirin
- can precipitate asthma/anaphylactoid reactions
- reversible platelet inhibition
- hepatotoxicity
- CV risk
- people with PUD history should be tested for H.Pylori
- monitor renal function
indications NSAIDs? - pain (more effective than tylenol)
- fever
- colon cancer prevention
- PDA closure
- stabilize menstrual bleeding
contraindications NSAIDs? - hx of PUD
- renal insufficiency
- CHF
opioids MOA?** depends on receptor type **
inhibits dorsal horn pain transmission neurons
- inhibits release of excitatory NTs inhibition of pain processing in dorsal horn of the spinal cord
side effects opioids? analgesia, cough suppression, diarrhea, dyspnea, opioid abuse disorder
biliary colic, urinary retention, renal impairment, prolonged labor, hypogonadism, pruritis,
impaired immunity, tooth decay
contraindications opioids? - renal impairment (be careful)
- drug interactions! (codeine, 3A4 substrates, 2D6 substrates)
MOA TCAs? block the reuptake of serotonin/norepi
block peripheral sodium channels, histamine, alpha 1 receptors, muscarinic receptors
side effects TCAs dry. mouth, weight gain, dizziness, tremor, urinary retention, confusion,
sedation
graded study guide
MOA acetaminophen - not clear
- weak COX1/COX2 inhibitor
- activation of descending serotonergic inhibitory pathways
- antipyretic effects via inhibitory effects on hypothalamic "thermostat"
adverse effects tylenol- skin rash/allergy
- hemolytic uremia
- methemoglobinemia
- hepatotoxicity (>4g/day, >15g lethal)
early signs hepatotoxicity tylenol nausea, vomiting, diarrhea, abdominal pain, dizziness,
excitement, disorientation
contraindications acetaminophen? - long term use during pregnancy associated with ADHD
- severe inflammatory pain (not best to give)
- severe hepatic disease
MOA salicylates (acetylsalicylic acid, aspirin) inhibits COX which inhibits the synthesis of
prostaglandins
- antipyretic, analgesic, anti-platelet properties
side effects salicylates- CNS: tinnitus, aseptic meningitis, HA, dizziness
- CV: fluid retention, HTN, edema, MI, CHF
- GI: abdominal pain, dyspepsia
- hematologic: thrombocytopenia, neutropenia, aplastic anemia
- hepatic: abnormal LFTs, liver failure
- pulm: asthma
- skin: rash, pruritis
- renal: renal failure/insufficiency, hyperkalemia, proteinuria
indications salicylates - pain relief, anti-inflammatory
- rheumatic disease arthritis
, - primary prevention of atherosclerotic CV disease
contraindiciations salicylates - pregnancy
- allergy
- children (Reyes syndrome)
- hemophilia/bleeding disorders
MOA NSAIDs inhibits prostaglandin biosynthesis via inhibition of COX isoenzymes
(COX1/COX2)
side effects NSAIDs - similar to aspirin
- can precipitate asthma/anaphylactoid reactions
- reversible platelet inhibition
- hepatotoxicity
- CV risk
- people with PUD history should be tested for H.Pylori
- monitor renal function
indications NSAIDs? - pain (more effective than tylenol)
- fever
- colon cancer prevention
- PDA closure
- stabilize menstrual bleeding
contraindications NSAIDs? - hx of PUD
- renal insufficiency
- CHF
opioids MOA?** depends on receptor type **
inhibits dorsal horn pain transmission neurons
- inhibits release of excitatory NTs inhibition of pain processing in dorsal horn of the spinal cord
side effects opioids? analgesia, cough suppression, diarrhea, dyspnea, opioid abuse disorder
biliary colic, urinary retention, renal impairment, prolonged labor, hypogonadism, pruritis,
impaired immunity, tooth decay
contraindications opioids? - renal impairment (be careful)
- drug interactions! (codeine, 3A4 substrates, 2D6 substrates)
MOA TCAs? block the reuptake of serotonin/norepi
block peripheral sodium channels, histamine, alpha 1 receptors, muscarinic receptors
side effects TCAs dry. mouth, weight gain, dizziness, tremor, urinary retention, confusion,
sedation
