NR 565 ADVANCED PHARMACOLOGY FUNDAMENTALS<\/p>\n\n\n\n
What are 3 types of acute pain?<\/p>\n\n\n\n
What is referred pain?
Pain that is present in an area removed or distant from its point of origin.<\/p>\n\n\n\n
What is acute somatic pain?
Arises from connective tissue, muscle, bone and skin.
Sharp and localized or dull and non-localized<\/p>\n\n\n\n
What does acute somatic pain respond best to? **7
acetaminophen, corticosteroids, NSAIDs, opiates, local anesthetics, ice, massage<\/p>\n\n\n\n
What is acute visceral pain?
Pain in the internal organs and abdomen
Poorly localized (C-fibers)
Radiates<\/p>\n\n\n\n
What do you use to treat acute visceral pain?
Most responsive to opiates
May also use corticosteroids, NSAIDs<\/p>\n\n\n\n
Heroin, Lysergic Acid Diethylamide (LSD), marijuana (cannabis), 3, 4- Methylenedioxymethamphetamine (ecstasy), Methaqualone, and Peyote are in what drug class?
Schedule I — Substances or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.<\/p>\n\n\n\n
Name some schedule II drugs **
Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), Meperidine (Demerol), Oxycodone (oxycontin) fentanyl, Dexedrine, Adderall and Ritalin.<\/p>\n\n\n\n
Alfentanil
Codeine
Fentanyl
Hydrocodone
Hydromorphone
Levorphanol
Meperidine
Methadone
Morphine
Opium tincture
Oxycodone
Oxymorphone
Remifentanil
Sufentanil
Psychostimulants
Amphetamine
Cocaine
Dextroamphetamine
Methamphetamine
Methylphenidate
Phenmetrazine
Barbiturates
Amobarbital
Pentobarbital
Secobarbital
Miscellaneous Depressants
Glutethimide<\/p>\n\n\n\n
Substances or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence refers to what drug class?
schedule II<\/p>\n\n\n\n
Products containing less than 90 milligrams of codeine per dosage unit (Tylenol and codeine), ketamine, anabolic steroids, testosterone refers to what drug class?
schedule III — Substances or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than schedule I and Schedule II drugs but more than schedule IV.<\/p>\n\n\n\n
Name some schedule IV drugs
Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol<\/p>\n\n\n\n
Substances or chemicals are defined as drugs with a low potential for abuse and low risk of dependence refers to what drug class?
Schedule IV drugs<\/p>\n\n\n\n
Name some Schedule V drugs
Cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Pregabalin (Lyrica), parepectolin<\/p>\n\n\n\n
Schedule V drugs, substances, or chemicals are defined as drugs with a _<\/em><\/strong><\/em><\/strong> __<\/strong><\/em><\/strong><\/em> for abuse than schedule IV and consists of preparations containing limited quantities of certain narcotics. Schedule __<\/em><\/strong> drugs are generally used for antidiarrheal, antitussive and analgesic purposes.<\/p>\n\n\n\n What are examples of pure opioid agonists? Pure opioid agonists produce analgesia, euphoria, __<\/em><\/strong><\/em><\/strong>, respiratory ___<\/em><\/strong><\/em><\/strong>, physical dependence, ____<\/em><\/strong><\/em><\/strong>, and other effects<\/p>\n\n\n\n The pure agonists can be subdivided into two groups: strong opioid agonists and moderate to strong opioid agonists. _____<\/em><\/strong><\/em><\/strong> is the prototype of the strong agonists. _______<\/em><\/strong><\/em><\/strong> is the prototype of the moderate to strong agonists.<\/p>\n\n\n\n What is used to calculate a patient’s overdose risk? Convert each opioid to MMEs by multiplying the daily dosage for each opioid by its conversion factor.<\/p>\n\n\n\n Add all opioid MMEs together.<\/p>\n\n\n\n NIDA-Modified Assist<\/p>\n\n\n\n What are the side effects of opioid agonists? (6) How would you know when to refer someone to a pain specialist for pain management?<\/p>\n\n\n\n What is a Prescription Drug Monitoring Program (PDMP) and why is it important? How renal and hepatic function impact medication levels in the body? How do you assess someone for possible drug diversion? In general, the medicine being prescribed, should be in the urine. If it is not in the urine, there should be a clear reason why it is not. Additionally, UDT allow for providers to see if there are illicit drugs present as well that could complicate treatment and would need to be discussed.<\/p>\n\n\n\n *** Black box warning for methadone<\/p>\n\n\n\n Methadone prolongs the _ __<\/em><\/strong> and hence may pose a risk for potentially fatal ____<\/em><\/strong><\/em><\/strong>. __<\/em><\/strong><\/em><\/strong> _ ___<\/em><\/strong> has developed in patients taking 65 to 400\u202fmg\/day. To reduce risk, methadone should be used with great caution\u2014if at all\u2014in patients with existing QT prolongation or a family history of long QT syndrome and in those taking other QT-prolonging drugs. In addition, methadone causes severe respiratory depression that can be potentially fatal.<\/p>\n\n\n\n Benefits of METHADONE in opioid use disorder By taking methadone, the addict avoids both withdrawal and the need to procure illegal drugs.<\/p>\n\n\n\n Suppressive therapy is done to prevent the reinforcing effects of opioid-induced euphoria. After the patient is tolerant to methadone, taking street drugs, even in high doses, cannot produce significant desirable effects. As a result, individuals made tolerant with methadone will be less likely to seek out illicit opioids.<\/p>\n\n\n\n Buprenorphine (Suboxone) and Naloxone — Benefit of using this combination When should naloxone be prescribed for a patient? risk factors for opioid use disorder \u00b7 Guiding principles for prescribers (6)\n
Morphine, codeine, meperidine, and others<\/p>\n\n\n\n\n
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Calculating MME\/ day Determine the total daily amount of each opioid the patient takes.<\/p>\n\n\n\n
Sedation, respiratory depression, constipation, GI upset, hypotension, urinary retention<\/p>\n\n\n\n
These electronic databases enable providers to access information regarding a patient’s prescription history of controlled substances. Nearly all states have implemented PDMPs, and some states require providers to check the PDMP before prescribing controlled substances. According to the CDC (2020), PDMPs have shown promising results in changing prescribing behaviors, decreasing the use of multiple providers by patients, and decreasing substance abuse treatment admissions.<\/p>\n\n\n\n
Patients with renal or hepatic insufficiency can experience greater peak effect and longer duration of action for medications, thereby reducing the dose at which respiratory depression and overdose may occur. Similarly, for patients ages 65 years and older, reduced renal function and medication clearance due to age can result in a smaller therapeutic window between safe dosages and dosages associated with respiratory depression and overdose.<\/p>\n\n\n\n
Routine urine drug tests<\/p>\n\n\n\n\n
In addition to its role in facilitating opioid withdrawal, methadone (Methadose, Diskets) can be used for maintenance therapy and suppressive therapy. These strategies are used to modify drug-using behavior in patients who are not ready to try withdrawal.<\/p>\n\n\n\n
The naloxone in Suboxone is there to discourage IV abuse. If taken intravenously, the naloxone in Suboxone will precipitate withdrawal. However, with sublingual administration, very little naloxone is absorbed, and hence when the drug is administered as intended, the risk for withdrawal is low.<\/p>\n\n\n\n
history of overdose
history of substance use disorder, higher opioid dosages (\u226550 MME\/day)
concurrent benzodiazepine use<\/p>\n\n\n\n
a pattern of use that leads to significant impairment or distress. Typically, this disorder is marked by unsuccessful efforts to reduce or control use resulting in the inability to fulfill work, school, or home responsibilities.<\/p>\n\n\n\n
Using opioids only after nonopioid analgesics or more conservative methods have failed<\/p>\n\n\n\n