Dosage Calc
How many mcg are in one mg? Mgs in one g?
How many mL in an oz?
1000mcg=1mg
1000mg=1g
30mL=1 oz
What is your prototype drug for each category?
Narcotics:
Narcotic antagonists:
Narcotic agonist/antagonists:
Narcotic-like (ish) pain med:
Ergot:
Triptan:
Narcotics: MORPHINE
Narcotic antagonists: NALOXONE
Narcotic agonist/antagonists: PENTAZOCINE
Narcotic-like (ish) pain med: TRAMADOL
Ergot: ERGOTAMINE
Triptan: SUMATRIPTAN
Chemicals in marijuana
What organ are you concerned with for chronic acetaminophen use? What about for NSAIDS & salicylates?
Acetaminophen= liver
NSAIDS and salicylates= kidneys
Compare and contrast muscle spasm and muscle spasticity
Muscle spasm: sudden, involuntary painful muscle contraction/ often result of injury to the musculoskeletal system
Muscle spasticity: increased muscle tone or contraction, and stiff movements/ result of damage to neurons within the CNS/ muscles stay in continuous state of contraction-neuro diseases, spinal cord damage, CP, MS, CVA
A client weighs 175 lb, 7 oz. What is the client's weight in kg? (round to the tenth)
79.7 kg
What responses are produced by stimulation of mu and kappa receptors?
Explain the differences between morphine, naloxone, and pentazocine regarding how they act on mu and kappa.
Mu responses: analgesia, decreased GI motility, euphoria, physical dependence, respiratory depression, sedation
Kappa responses: analgesia, decreased GI motility, sedation
Morphine stimulates mu and kappa
Naloxone blocks mu and kappa
Pentazocine stimulates kappa and blocks mu
What is the difference in THC and CBD?
THC causes the high; But…it also decreases pain, inflammation, swelling, redness and muscle control problems
CBD has effects without the high and not intoxicating; it reduces pain, inflammation, controls epileptic seizures, possible uses for treating mental illness and addiction.
Give a brief description as to what each of the following are used for:
Acetaminophen:
NSAIDS & ASA:
Steroids:
Acetaminophen: Fever and pain (not inflammation)
NSAIDS & ASA:fever, pain ,inflammation (+antiplatelet effects)
Steroids: Inflammation (not pain)
What is the action of dantrolene and its indications?
Action: skeletal muscle relaxant
Indications: treats spasticity (spinal cord injuries, CVA, CP, and MS) ALSO treatment for malignant hyperthermia (a rare life-threatening rxn to anesthesia-->muscle rigidity, high temp, tachycardia)
Ordered: Amoxicillin 50mg/kg/day PO TID
Patient weight: 10.5 kg
How many mg should be administered per dose?
175 mg per dose
Provide an example for what may fall in each category (C-1 to C-V) of the schedule of controlled substances
l/C-l : high abuse & dependence potential = heroin
ll/C-ll : High abuse & dependence potential = morphine, oxycodone, oxycontin
lll/C-lll : moderate abuse & dependence potential = codeine
lV/C-lV : low abuse and dependence potential =benzodiazepines, tramadol
V/C-V : Limited abuse & dependence potential = lomotil, robitussin AC
How do doctors prescribe medical marijuana?
(*don't get tricked here!)
They don't; doctors do not prescribe the MM but they determine whether a patient qualifies for a MM card; then the pt can file with DHSS for a card which permits them to buy from a legal dispensary
What are the adverse effects of aspirin?
-GI irritation, petechiae, bruising, bleeding, REYE's syndrome (kids w/flu-like symptoms)
Baclofen is a skeletal muscle relaxant used to treat spasticity with MS, CP, & spinal cord injury
Cyclobenzaprine is a skeletal muscle relaxant used to treat local muscle spasms (not as effective with MS, CP, or spinal cord injury)
Ordered: Promethazine 0.5mg/kg IV every 6 hours
Supplied: Promethazine 25mg/mL
Patient weight: 82 lb, 11 oz
How many mL should be administered per dose (round to the hundreth)?
0.75 mL
What makes up the Opioid overdose triad?
How would you treat?
-pinpoint pupils (myosis)
-unconsciousness, comatose
-respiratory depression
Tx: Naloxone
Once someone has a MM card can they buy MM in any state?
No; You cannot take your MM across state lines- even if you have a MM card. Each state has different MM laws, it is NOT legal in all states and the laws will vary per state.
How would you monitor for liver and kidney dysfunction?
Liver:
labs: ALT 8-20, AST 5-40
s/s: jaundice, abdominal pain, n/v
Kidney:
labs: BUN 10-20, Creatnine 0.5-1.5
s/s: decreased UOP (<30ml.hr)
Thinking of the CNS effects/sedation risks with muscle relaxants, what education would you provide your patient with?
-caution with driving, use of other cns depressants, old & young, monitor coordination(fall risk), teach non-pharm methods
-warn against alcohol/depressant use
-abruptly stopping may result in seizures
Ordered: Ampicillin 400mg every 6 hours
Patient weight: 16 kg
Recommended dosage: 100 to 200 mg/kg/day
What is the safe dosage range for this patient? Is the ordered dose safe?
Range: 1,600 to 3,300 mg/day
Yes, the ordered dose is a safe dose
What causes migraines and how are they different from tension headaches?
Is sumatriptan and ergotamine used to prevent or abort migraines?
Migraines are caused by VASODILATION (why the meds promote vasoconstriction)
Migraines -severe, throbbing headaches typically on one side of the head
-may be proceeded by aura
-often causes nausea and emesis
-have triggers that can be avoided
Tension headaches -usually occur at times of stress; dull band of pain around the entire head
-self-limiting annoyance rather than emergency
Sumatriptan and ergotamine are abortive
How does the DEA classify marijuana in the schedule of controlled substances? How does this affect hospitals with federal funding?
Schedule 1 controlled substance, with no medical use.
Since the Medical marijuana amendment conflicts with federal government; hospitals are worried that allowing doctors to "qualify or certify" patients to get a card from DHSS will cause them to lose their federal funding.
What is the max daily dose for acetaminophen? And the acetaminophen antidote?
4 grams from ALL sources
acetylcysteine
What does dantrolene's BBW state? What about dantrolene drug interactions?
BBW: liver damage (greater in females over age 35 & over 3 month use)
many drug interactions
-no OTC cold/cough meds
-estrogen
-neuromuscular junction blockers