Download File - Ms. Walajtys` Pharmacy Tech Class Sidekick

Chapter 6
Anesthetics and
Narcotics
© Paradigm Publishing, Inc.
1
Learning Objectives
• Understand the central and peripheral nervous
systems, their functions, and their relationship to
drugs.
• Recognize different dosage forms and
understand how the drug delivery system works.
• Learn how drugs affect body systems and
where they work in the body.
• Understand the concepts of general and local
anesthesia, and know the functions of these
agents
© Paradigm Publishing, Inc.
2
Learning Objectives
• Define the action of neuromuscular blocking
agents in reducing muscle activity.
• Distinguish between narcotic and nonnarcotic
analgesia.
• Understand the different classes of narcotics
and the role of the technician in monitoring these
drugs.
• Become familiar with the various types of agents
for migraine headaches.
© Paradigm Publishing, Inc.
3
The Nervous System
• Transmits information over vast network
throughout the body
• Neuron: nerve cell that transmits
information
• Neurotransmitter: chemical substance
released from neuron
– Stimulates or inhibits activity in target cells,
especially other neurons
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Neurotransmitters Being
Released from a Neuron
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Divisions of the Nervous
System: CNS
•
Central Nervous System (CNS)
– Brain and spinal cord
– Spinal cord receives information and
sends to brain
– Brain evaluates information and sends
out a response
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Divisions of the Nervous
System: PNS
• Peripheral Nervous System (PNS)
made up of nerves and sense organs
– Afferent system: nerves and sense
organs bring information to CNS
– Efferent system: nerves send
information out from the CNS
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PNS Efferent System
• Autonomic nervous system (ANS)
– Involuntary activities: respiration, circulation,
digestion, body temperature, metabolism,
blood glucose, sweating
• Somatic nervous system
– Voluntary activities: skeletal muscles
– Acetylcholine only neurotransmitter between
CNS and skeletal muscles
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Autonomic Nervous System
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CNS and PNS Primary
Neurotransmitters
• CNS
• PNS
– Acetylcholine (Ach)
– GABA (gammaaminobutyric acid)
– Dopamine
– Norepinephrine
– Serotonin
– Glutamate
– Acetylcholine (Ach)
– Norepinephrine
© Paradigm Publishing, Inc.
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Sympathetic and Parasympathetic
Primary Neurotransmitters
• Sympathetic
System
–
–
–
–
• Parasympathetic
System
Acetylcholine (Ach)
Norepinephrine
Dopamine
Epinephrine
– Acetylcholine (Ach)
© Paradigm Publishing, Inc.
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ACh and GABA
• ACh acts on receptors in smooth and
cardiac muscle, and exocrine glands
• ACh receptors blocked by
anticholinergics
• GABA regulates message delivery
system of the brain
© Paradigm Publishing, Inc.
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Dopamine, Epinephrine, and
Norepinephrine
• Dopamine acts on receptors in the
CNS and kidneys
• Epinephrine acts on cardiac and
bronchodilator receptors
• Norepinephrine acts on alpha and
beta receptors
© Paradigm Publishing, Inc.
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Serotonin and Glutamate
• Serotonin acts on smooth muscle and
gastric mucosa
– Causes vasoconstriction which decreases
blood flow
– Emotional responses: depression, anxiety
• Glutamine may be crucial to some forms of
learning and memory
© Paradigm Publishing, Inc.
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Types of Receptors
• Alpha
– Vasoconstriction, raises blood pressure
• Beta-1
– Increases heart rate and contractive force of
the heart
• Beta-2
– Vasodilation, increases blood flow
– Bronchodilator, relaxes smooth muscles
© Paradigm Publishing, Inc.
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Discussion
What are three important types of
receptors in the study of drugs?
Three important types of receptors
are alpha, beta-1, and beta-2.
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Drug Effects on the Nervous
System
• Two types of effects on receptors
– Stimulating, causing a reaction
– Blocking, preventing a reaction
• Anticholinergics
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Side Effects of
Anticholinergics
•
•
•
•
•
•
Decreased GI motility (constipation)
Decreased sweating
Decreased urination
Dilated pupil and blurred vision
Dry eyes
Dry mouth
© Paradigm Publishing, Inc.
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Terms to Remember
neuron
neurotransmitter
central nervous system (CNS)
peripheral nervous system (PN)
afferent system
efferent system
© Paradigm Publishing, Inc.
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Terms to Remember
autonomic nervous system (ANS)
somatic nervous system
alpha receptors
beta-1 receptors
beta-2 receptors
© Paradigm Publishing, Inc.
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Anesthesia
• Allows painless and controlled surgical,
obstetric, and diagnostic procedures
• Most potent anesthetics are gases or
vapors
• Two classes of anesthesia: general and
local
• Anesthesiologist oversees administration
of anesthesia during surgery
© Paradigm Publishing, Inc.
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Anesthesia
• One anesthetic may be superior to
another, depends on clinical situation
• Final choice based on drugs and
anesthetic techniques safest for
patient
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Physiologic Effects of
Anesthesia
• Involves many systems
–
–
–
–
–
–
–
Nervous
Respiratory
Endocrine
Cardiovascular
Skeletal muscular
GI
Hepatic
© Paradigm Publishing, Inc.
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Goals of Balanced
Anesthesia
• Amnesia to eliminate patient’s
memory of procedure
• Adequate muscle relaxation, no
contracting of muscles
• Adequate ventilation by maintaining
oxygen concentration
• Pain control
© Paradigm Publishing, Inc.
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Discussion
What are some of the indicators used
to assess general anesthesia?
Some indicators include: blood pressure,
hypervolemia, oxygen level, pulse,
respiratory rate, tissue perfusion, and
urinary output.
© Paradigm Publishing, Inc.
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General Anesthetics
• General anesthesia is the unique condition
of reversible unconsciousness and
absence of response to painful stimuli
• Four reversible actions
–
–
–
–
Unconsciousness
Analgesia (relieving pain)
Skeletal muscle relaxation
Amnesia on recovery
© Paradigm Publishing, Inc.
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General Anesthetics
Preanesthetic medications
– Control sedation
– Reduce postoperative pain
– Provide amnesia
– Decrease anxiety
• Drugs often used: narcotics,
benzodiazepines, phenothiazines
© Paradigm Publishing, Inc.
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General Anesthetics
• Malignant hyperthermia is a serious side
effect of anesthesia
– Fever of 110°F or more
– Life threatening
• Treatment: dantrolene (Dantrium)
Always check
Warning! expiration date
© Paradigm Publishing, Inc.
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Drug List
Inhalant Anesthetics
– desflurane (Suprane)
– enflurane (Ethrane)
– halothane (none)
– isoflurane (Forane)
– nitrous oxide (none)
© Paradigm Publishing, Inc.
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Side Effects of Inhalant
Anesthetics
• Reduce blood pressure
• May cause nausea and vomiting
© Paradigm Publishing, Inc.
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nitrous oxide
• Causes analgesia only
• Given alone or with more powerful
anesthetics to hasten uptake of other
agent(s)
• Commonly used for dental
procedures
• Advantage: rapidly eliminated
© Paradigm Publishing, Inc.
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desflurane (Suprane)
• Easily controllable
• Rapid onset and recovery
• Often used in ambulatory surgery
© Paradigm Publishing, Inc.
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Injectable Anesthetics
• Very lipid soluble
• Most dispensed by IV drip
• Most are controlled substances
© Paradigm Publishing, Inc.
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Drug List
Injectable Anesthetics
– alfentanil (Alfenta)
– etomidate (Amidate)
– fentanyl (Sublimaze)
– fentanyl-droperidol (none)
– ketamine (Ketalar)
© Paradigm Publishing, Inc.
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Drug List
Injectable Anesthetics
– morphine (various)
– propofol (Diprivan)
– remifentanyl (Ultiva)
– sufentanil (Sufenta)
© Paradigm Publishing, Inc.
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Drug List
Injectable Anesthetics
Barbiturates
– methohexital (Brevital)
– thiopental (Pentothal)
Benzodiazepines
– methohexital (Brevital)
– thiopental (Pentothal)
© Paradigm Publishing, Inc.
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Drug List
Injectable Anesthetics
Benzodiazepines
– diazepam (Valium)
– lorazepam (Ativan)
– midazolam (Versed)
© Paradigm Publishing, Inc.
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propofol (Diprivan)
• Used for maintenance of anesthesia,
sedation, or treatment of agitation
• Antiemetic properties
• Side effects: drowsiness, respiratory
depression, motor restlessness,
increased blood pressure
© Paradigm Publishing, Inc.
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Dispensing Issues of
Injectable Anesthetics
Warning!
• Diprivan (anesthetic) and Diflucan
(antifungal) may be confused
• A mix-up could be life-threatening
© Paradigm Publishing, Inc.
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fentanyl
• Used extensively for open-heart
surgery due to lack of cardiac
depression
• Analogs used in the operating room
– Alfentanil (Alfenta)
– Sufentanil (Sufenta)
– Reminfentanil (Ultiva)
© Paradigm Publishing, Inc.
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Benzodiazepines
• Used for induction, short procedures, and
dental procedures
• Used in controlling and preventing
seizures induced by local anesthetics
• midozolam (Versed)
– fastest onset of action
– greatest potency
– most rapid elimination
© Paradigm Publishing, Inc.
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Drug List
Antagonist Agents
– flumazenil (Romazicon)
– nalmefene (Revex)
– naloxone (Narcan)
© Paradigm Publishing, Inc.
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Antagonist Agents
• flumazenil (Romazicon) reverses
overdoses of benzodiazepine
• nalmefene (Revex) and naloxone
(Narcan) reverse overdoses of
narcotics
• All operating and emergency rooms
maintain a supply of antagonists
© Paradigm Publishing, Inc.
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Neuromuscular Blocking
Agents
• Causes immediate skeletal muscle
relaxation of short, long, and
extended durations
• Used to facilitate endotracheal
intubation and ensure patient does
not move during surgery
© Paradigm Publishing, Inc.
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Drug List
Neuromuscular Blocking Agents
Short Duration
– succinylcholine (Quelicin)
Long Duration
– atracurium (Tracrium)
– cisatracurium (Nimbex)
– rocuronium (Zemuron)
– vecuronium (Norcuron)
© Paradigm Publishing, Inc.
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Drug List
Neuromuscular Blocking Agents
Extended Duration
– mivacurium (Mivacron)
– pancuronium (none)
© Paradigm Publishing, Inc.
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Neuromuscular Blocking
Agents Dispensing Issues
Warning!
• Be conscious of storage requirements
• Store away from look-alike drugs
© Paradigm Publishing, Inc.
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succinylcholine (Quelicin)
• Often called “sux”
• Only depolarizing agent; all others are
nondepolarizing agents
• Persistent depolarization at motor
endplate. Shorts out electrical signal.
• Result: sustained, brief period of flaccid
skeletal muscle paralysis
© Paradigm Publishing, Inc.
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Reversal of Neuromuscular
Blocking Agents
• Antiacetylcholinesterase agents
increase action of acetylcholine
– Inhibits acetylcholinesterase
– Restores transmission of impulses,
reversing neuromuscular blocking agent
© Paradigm Publishing, Inc.
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Drug List
Anticholinesterase Agents
– edrophonium (Enlon)
– neostigmine (Prostigmin)
– pyridostigmine (Mestinon)
© Paradigm Publishing, Inc.
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Local Anesthesia
• Relieves pain without altering
alertness or mental function
• Affect all types of nervous tissue
• Commonly combined with other
drugs
• Variety of combinations available
© Paradigm Publishing, Inc.
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Dosage Forms of Local
Anesthetics
•
•
•
•
•
•
Topical: drops, sprays, lotions, ointments
Infiltration: superficial injection
Nerve block: injection
IV
Epidural: regional anesthesia
Spinal: blocks afferent pain nerve impulses
from lower part of the body
© Paradigm Publishing, Inc.
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Discussion
What are the two classes of local
anesthetics?
The two classes are esters and amides.
© Paradigm Publishing, Inc.
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Local Anesthetics
• Esters
• Amides
– Short acting
– Metabolized in
plasma and
tissue fluids
– Excreted in
urine
– Longer acting
than esters
– Metabolized by
liver enzymes
– Excreted in
urine
© Paradigm Publishing, Inc.
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Drug List
Local Anesthetics
Esters
– benzocaine (Americaine)
– chloroprocaine (Nesacaine)
– dyclonine (Cēpacol Maximum
Strength)
– procaine (Novocain)
– tetracaine (Cēpacol Viractin,
Pontocaine)
© Paradigm Publishing, Inc.
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Drug List
Local Anesthetics
Amides
– bupivacaine (Marcaine)
– levobupivacaine (Chirocaine)
– lidocaine (L-M-X, Solarcaine Aloe
Extra Burn Relief, Xylocaine,
Lidoderm)
© Paradigm Publishing, Inc.
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Drug List
Local Anesthetics
Amides
– lidocaine-epinephrine (Xylocaine with
Epinephrine)
– lidocaine-prilocaine (EMLA)
– mepivacaine (Carbocaine)
© Paradigm Publishing, Inc.
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Discussion
What functions are lost with local
anesthetics?
Functions that are lost include: pain
perception, temperature sensation, touch
sensation, proprioception, and skeletal
muscle tone.
© Paradigm Publishing, Inc.
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Discussion
Under what conditions would a local
anesthetic be used over a general
anesthetic?
It is chosen when a well-defined area of
the body is targeted.
© Paradigm Publishing, Inc.
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Terms to Remember
anesthesiologist
general anesthesia
malignant hyperthermia
neuromuscular blocking
endotracheal intubation
anticholinesterase
© Paradigm Publishing, Inc.
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Terms to Remember
local anesthesia
ester
amide
© Paradigm Publishing, Inc.
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Pain Management
• Pain is protective mechanism to warn
of damage or the presence of
disease
– Part of the normal healing process
– Can be a disease
– Considered the “fifth” vital sign
© Paradigm Publishing, Inc.
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Pain Management
• Acute Pain
– Associated with trauma or surgery
– Warns of a problem
– Easier to manage by treating the cause
– Disappears when body heals
– Has beginning and end
© Paradigm Publishing, Inc.
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Pain Management
• Chronic nonmalignant pain
– Lasts more than 3 months
– Diagnosed or undiagnosed cause
– May respond poorly to treatment
– Depression, sense of helplessness and
hopelessness
– Affects all aspects of life
© Paradigm Publishing, Inc.
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Pain Management
• Chronic malignant pain
– Accompanies malignant disease
– Often increases in severity with disease
progression
© Paradigm Publishing, Inc.
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Major Sources of Pain
• Source: somatic
• Areas: body framework
• Characteristics: throbbing, stabbing,
localized
• Treatment: narcotics, NSAIDs, nerve
blockers
© Paradigm Publishing, Inc.
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Major Sources of Pain
• Source: visceral
• Areas: kidneys, intestines, liver
• Characteristics: aching, throbbing,
sharp, gnawing, crampy
• Treatment: narcotics, NSAIDs, nerve
blockers, antiemetics
© Paradigm Publishing, Inc.
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Major Sources of Pain
• Source: neuropathic
• Areas: nerves
• Characteristics: burning, aching,
numbing, tingling, constant
• Treatment: antidepressants,
anticonvulsants
© Paradigm Publishing, Inc.
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Major Sources of Pain
• Source: sympathetically mediated
• Areas: overactive sympathetic
system
• Characteristics: occurring when no
pain should be felt
• Treatment: nerve blockers
© Paradigm Publishing, Inc.
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Narcotics
• Pain-modulating chemicals that cause
insensibility or stupor
• Opiates
– Derived from opium or synthetic
– Agonists of opioid receptor sites
• Main effects on CNS and GI tract
• Lesser effects on peripheral tissues
© Paradigm Publishing, Inc.
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Natural Opioids
• Endorphins, enkephalins, and dynorphins
• Brain produces in response to pain stimuli
• When receptors are activated
– Causes decreased nerve transmission
– Sensation of pain diminished
• Opioids bind to these same receptors
© Paradigm Publishing, Inc.
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Effects of Narcotics
• Analgesia: reduces pain from most
sources
• Sedation: decrease anxiety and cause
drowsiness
• Euphoria and dysphoria: feelings of wellbeing, disquiet, restlessness
• Narcotics have potential for tolerance and
dependence
© Paradigm Publishing, Inc.
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Patient-Controlled Analgesia
Pump
• PCA pump effective means of
controlling pain
• Patient regulates, within limits,
amount of drug received
• Better pain control with less drug
© Paradigm Publishing, Inc.
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Analgesic Ladder
of Pain Relief
1. Mild to moderate pain
– Acetaminophen or NSAID and an
adjuvant
2. If adequate relief not achieved
– NSAID plus a “weak” opioid (codeine)
3. If adequate relief not achieved
– Strong opioid (morphine) with an
adjuvant analgesic if indicated
© Paradigm Publishing, Inc.
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Transdermal Patch
• Provides pain control
• Allows patient to remain more alert
than with most other methods
© Paradigm Publishing, Inc.
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Analgesic Ladder of Pain Relief
© Paradigm Publishing, Inc.
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Addiction and Dependence
• Chronic opioid therapy has low risk of
addiction when used appropriately
© Paradigm Publishing, Inc.
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Discussion
What is the difference between
addiction and dependence?
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Dependence and Addiction
• Dependence
– Physical and emotional reliance on a
drug
– Withdrawal
• Addiction
– Compulsive disorder
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Signs of Narcotics Addiction
•
•
•
•
•
•
Preoccupation with drugs
Refusal of medication tapers
Strong preference for a specific opioid
Decrease in ability to function
Medication often not taken as prescribed
Tendency to rely on multiple prescribers
and pharmacies to conceal behavior
© Paradigm Publishing, Inc.
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Withdrawal
• Patients more successful overcoming
addiction if withdrawal symptoms are
handled appropriately
• Opioid antagonists have stronger
attraction for receptors than analgesic
agents
• Blocking opioid action may prevent
withdrawal symptoms
© Paradigm Publishing, Inc.
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Drug List
Drugs to Treat Opioid Addiction
– buprenorphine (Buprenex, Subutex)
– buprenorphine-naloxone (Suboxone)
– methadone (Dolophine)
© Paradigm Publishing, Inc.
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Dispensing Issues of
Narcotics
Warning!
• Technicians have a legal and moral
responsibility to alert pharmacist of
suspected abuse and addiction
• Documentation must be in medical record
• Low addiction rate if no history of addiction
© Paradigm Publishing, Inc.
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Narcotic Analgesics
• Analgesic is a drug that alleviates
pain
• Narcotic analgesic is pain medication
containing an opioid
© Paradigm Publishing, Inc.
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Drug List
Narcotic Analgesics
– butorphanol (Stadol)
– codeine (Codeine Contin)
– fentanyl (Actiq, Duragesic, Fentora,
Ionsys)
– hydromorphone (Dilaudid)
– meperidine (Demerol)
© Paradigm Publishing, Inc.
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Drug List
Narcotic Analgesics
– morphine (Astramorph/PF, Avinza,
Duramorph, MS Contin, MSIR)
– oxycodone (OxyContin)
– oxymorphone (Numorphan, Opana,
Opana ER)
– pentazocine (Talwin)
– propoxyphene (Darvon)
© Paradigm Publishing, Inc.
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Narcotic Analgesics
• Dose requirements vary with
– Severity of pain
– Individual response to pain
– Patient’s age and weight
– Presence of concomitant disease
• Morphine is standard against which all
other narcotic analgesics are measured
© Paradigm Publishing, Inc.
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Goal of Narcotic Analgesics
• Narcotic analgesics
– Many dosage forms and strengths
– Delivered by various routes
• Goal: Patient comfort
• Key to reaching goal: Constant
reassessment
© Paradigm Publishing, Inc.
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Dispensing Issues of
morphine
Warning!
• Avinza (morphine) and Invanz
(eratpenem) often confused
• Morphine sulfate (MSO4) and
magnesium sulfate (MgSO4) often
confused
© Paradigm Publishing, Inc.
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Dispensing Issues of
Narcotic Analgesics
Warning!
• Consult policies and procedures of
workplace to use the required check
systems to make sure narcotic counts
are correct.
© Paradigm Publishing, Inc.
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Side Effects of Narcotic
Analgesics
• Side effects anticipated and minimized for
patient comfort
–
–
–
–
–
–
–
Mental confusion
Reduced alertness
Nausea/vomiting
Dry mouth
Constipation
Inflammatory process
Bronchial constriction
© Paradigm Publishing, Inc.
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fentanyl
• Patch (Duragesic)
– Approved for chronic use, not acute
pain after surgery
• Lozenge (Actiq)
– Swabbed on mucosal surfaces inside
the mouth and under the tongue
– Not as effective if swallowed
© Paradigm Publishing, Inc.
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Combination Drugs for
Managing Pain
• Combinations of narcotics and
nonnarcotics are common
– Increases pain relief
– Allows use of lower doses
– Limits intake of addictive substances
– Decreases side effects
© Paradigm Publishing, Inc.
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Drug List
Combination Drugs for Pain Control
– acetaminophen-codeine (Phenaphen
with Codeine, Tylenol with Codeine)
– hydrocodone-acetaminophen
(Lortab, Vicodin, Lorcet)
– meperidine-promethazine
(Mepergan)
– oxycodone-acetaminophen (Endocet,
Perocet, Tylox)
© Paradigm Publishing, Inc.
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Drug List
Combination Drugs for Pain Control
– oxycodone-aspirin (Endodan,
Percodan)
– oxycodone-ibuprofen (Combunox)
– pentazocine-naloxone (Talwin NX)
– propoxyphene-acetaminophen
(Darvocet-N 100)
© Paradigm Publishing, Inc.
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Dispensing Issues of Analgesic
Combinations
Warning!
• Serious risk of aspirin or acetaminophen
toxicity if dose is overlooked
• Technicians—check that patient is not
getting more than 4 grams of aspirin or
acetaminophen per day
© Paradigm Publishing, Inc.
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Dispensing Issues of Analgesic
Combinations
Warning!
• Pharmacy technicians should check C-III,
CIV, and C-V drugs
– Refills no more than 5 times
– Refills good for no more than 6 months
• C-II drugs have NO refills
© Paradigm Publishing, Inc.
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meperidine-promethazine
• Produces less nausea than similar
drugs
– Promethazine controls nausea
• Very sedating
• Used for patients who develop
nausea from opioid use
© Paradigm Publishing, Inc.
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Terms to Remember
pain
narcotic
opiate
opioid
patient-controlled analgesia (PCA)
nonsteroidal anti-inflammatory drugs
(NSAIDs)
© Paradigm Publishing, Inc.
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Terms to Remember
analgesic ladder
dependence
addiction
analgesic
narcotic analgesic
© Paradigm Publishing, Inc.
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Migraine Headaches
• Migraine Headache
– Severe, throbbing, vascular headache
– Recurrent unilateral head pain
– Accompanied by neurologic and GI
disturbances
• 90% of migraine sufferers report nausea
• Sensitivity to light, sound, and stimulation
also common
© Paradigm Publishing, Inc.
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Components of Migraine
• Classic migraine components (all five
not experienced by everyone)
– Prodrome
– Aura
– Headache
– Headache relief
– Postdrome
© Paradigm Publishing, Inc.
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Components of Migraine
• Prodrome: Symptom indicating onset
• Aura: Subjective sensation or motor
phenomenon that precedes onset
–
–
–
–
–
Flashing lights
Shimmering heat waves
Bright lights
Dark holes in visual fields
Vision blurred, cloudy transient or loss of
© Paradigm Publishing, Inc.
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Components of Migraine
• Headache and Headache Relief
– Generally dissipates in 6 hours, but may
last 1 to 2 days
• Postdrome
– Knowing headache is gone
© Paradigm Publishing, Inc.
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Cause of Migraine
Headaches
• Serotonin appears involved in cause
• Decreased levels causes excessive
vasodilation in cranial arteries and
migraine occurs
• By stimulating serotonin receptors
vasoconstriction occurs, alleviating
migraine
© Paradigm Publishing, Inc.
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Causative Factors of
Migraine Headaches
•
•
•
•
•
Diet
Stress
Depression
Sleep habits
Certain
medications
• Hormonal
fluctuations
• Atmospheric
changes
• Environmental
irritants
© Paradigm Publishing, Inc.
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Initial Treatment of Migraine
Headaches
• At first hint of migraine, identify and
eliminate triggers
– Quiet environment and sleep may help
– Lying down in a dark room
• For severe or debilitating and frequent
attacks, drug therapy may be indicated
– Sedative, antiemetic, and narcotic
agents
© Paradigm Publishing, Inc.
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Discussion
What are the two classes of
migraine drug therapy?
The two classes are prophylactic
therapy and abortive therapy.
© Paradigm Publishing, Inc.
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Therapy for Migraine
Headaches
• Prophylactic Therapy
– Attempts to prevent or reduce
recurrence
• Abortive Therapy
– Taken after acute migraine occurs
– Taken at first sign of a migraine, such
as aura or headache
© Paradigm Publishing, Inc.
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Prophylactic Therapy
•
•
•
•
•
•
•
•
Anticonvulsants
Beta blockers
Calcium channel blockers
Estrogen
Feverfew
NSAIDs
SSRIs
Tricyclic antidepressants
© Paradigm Publishing, Inc.
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Abortive Therapy
•
•
•
•
Simple analgesics
NSAIDs
Ergotamine-containing medications
Serotonin-containing medications
© Paradigm Publishing, Inc.
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Drug List
Migraine Headache Agents
Triptans—Selective 5-HT Receptor
Agonists
–
–
–
–
–
–
–
almotriptan (Axert)
eletriptan (Relpax)
frovatriptan (Frova)
naratriptan (Amerge)
rizatriptan (Maxalt, Maxalt-MLT)
sumatriptan (Imitrex)
zolmitriptan (Zomig)
© Paradigm Publishing, Inc.
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rizatriptan (Maxalt-MLT)
• Sublingual tablet, quickly absorbed
• Most rapid onset of action of all oral
migraine therapies
• May receive relief after 30 minutes
• Maxalt not absorbed as quickly as
Maxalt-MLT
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sumatriptan (Imitrex)
• Causes vasoconstriction of blood vessels
• Use at first sign of headache
• If brings partial relief, patient may receive
second dose at least 1 hour after first
• Available in injection, nasal spray, and
tablet
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Drug List
Migraine Headache Agents
Ergot Preparations
– dihydroergotamine (D.H.E. 45,
Migranal)
– ergotamine (Ergomar)
– ergotamine-caffeine (Cafergot)
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Drug List
Migraine Headache Agents
Antiemetic Agents
– chlorpromazine (Thorazine)
– metoclopramide (Reglan)
– prochlorperazine (Compazine)
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metoclopramide (Reglan)
• Reduces nausea and vomiting
• Enhances absorption of other
antimigraine products
• Metoclopramide and aspirin
prescribed together in place of
sumatriptan (Imitrex) due to fewer
side effects
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Drug List
Migraine Headache Agents
Opioid Analgesic
– butorphanol (Stadol, Stadol NS)
Beta Blocker
– propranolol (Inderal)
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butorphanol (Stadol,
Stadol NS)
• Nasal spray used more commonly
than injection
• Used for moderate-to-severe pain
• Can be addictive
• C-IV controlled substance
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Drug List
Migraine Headache Agents: Other
– acetaminophen, aspirin, caffeine
(Excedrin Migraine)
– butalbital-acetaminophen-caffeine
(Fioricet)
– butalbital-aspirin-caffeine (Fiorinal)
– isometheptene-dichloralphenazoneacetaminophen (Midrin)
– tramadol (Ultram)
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tramadol (Ultram)
• High success rate when given with
NSAIDs (ibuprofen)
• Slow onset of action
• Not a controlled substance, but has
shown potential for addiction
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Dispensing Issues of
Migraine Agents
Warning!
• Tramadol and Toradol could be
confused
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isometheptene-dichloralphenazineacetaminophen (Midrin)
• Fewer side effects than ergotamines
• Combination of analgesic, sedative, and
vasoconstrictor
• For mild to moderate headaches
• Take 2 capsules at onset of headache,
then 1 every 1 to 2 hours until pain stops,
up to 5 capsules in 12 hours
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acetaminophen, aspirin,
caffeine (Excedrin Migraine)
• Combination reported to give very
good results in migraine pain
• Many common headaches, including
migraines, respond to this
combination
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Discussion
What are some of the issues facing
migraine sufferers and the medication
that is used?
Some issues are nausea and
vomiting, 0.5 to 2 hour onset of
action, and side effects.
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Terms to Remember
migraine headache
a severe, throbbing, unilateral headache,
usually accompanied by nausea, photophobia,
phonophobia, and hyperesthesia
aura
a subjective sensation or motor phenomenon
that precedes and marks the onset of a
migraine headache
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Assignments
• Complete Chapter Review activities
• Answer questions in Study Notes
document
• Study Partner
– Quiz in review mode
– Matching activities
– Drug tables
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