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279 Cards in this Set
- Front
- Back
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A short term alternation in behavior due to disordered, synchronous, rhythmic firing of brain neurons?
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Epileptic Seizures
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Environmental stimuli, hypoglycemia, genetic disorders of skeletal muscle tissue, and brain damage due to parasitic infections may cause this?
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Non-epileptic convulsion
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Many patients with epilepsy begin having seizures when?
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In childhood
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Physicians will begin drug therapy for epilepsy after what?
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two unexplained seizures
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What are some common triggers for seizures?
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Alcohol, fatigue, flashing lights
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When a hole is bored through the temple in order to release the demon from inside the person's head, this is called?
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Trephining
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Mutations associated with epilepsy have be identified with these electrolytes and these receptors?
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Electrolytes: Na,K,Ca,Cl
Receptors: nicotinic acetylcholine receptors |
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All abnormal neuronal firing resulting in epileptic seizures originates from?
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Neurons in the brain.
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Causes of epileptic seizures include?
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stroke, trauma, genetic disorders
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Seizure activity begins in a single site within the cortex, what is this type of seizure?
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Partial
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Preservation of consciousness, short duration 20-60 seconds is associated with what type of seizure?
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Simple partial
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The gradual loss of consciousness, 30 sec - 2 min, hallucinations, and automatisms are associated with what type of seizure?
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Complex partial [may begin as a simple partial]
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What test is used to determine which type of seizure is being experienced?
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EEG- electroencephalogram
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If only 1 or 2 electrodes of the EEG display synchronous activity this is what type of seizure?
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Partial
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If all electrodes of the EEG display synchronous activity this is what type of seizure?
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Generalized
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Seizure activity begins simultaneously in both hemispheres of the brain, what type of seizure is it?
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Generalized
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The sudden loss of consciousness, less than 30 seconds in duration. Characterized by staring and blinking (3 blinks/second) when body remains active is what type of seizure?
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Absence generalized
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The sudden loss of consciousness, 1.5-2.5 minutes, with 20 sec of muscle rigidity followed by 1-2 min of rhythmic muscle contractions is what type of seizure?
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Tonic-clonic generalized
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When the whole body or one extremity contracts with a duration less than 1 second, this is what type of seizure?
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Myoclonic generalized
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This starts with a partial seizure then progresses to a generalized seizure, what is this called?
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Secondary generalized seizure
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What structure in the brain is excited by axonal fibers causing synchronous firing in both hemispheres?
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Thalamus
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A repeated low-intensity, brief, electrical stimulation to the amygdale-hippocampus is called what? and is the model for what seizures?
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Kindling
Partial and generalized seizures. |
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Injection of excitatory neurotransmitters/chemoconvulsants is the model for what seizure type?
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Tonic-clonic(generalized)
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The newer anti-epileptic drugs were found by what experiments?
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In vitro
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MOA: for phenytoin, valproic acid, carbamazepine, and oxycarbazepine is?
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Block of voltage gated sodium channels.
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MOA: for ethosuximide, valproic acid is?
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Block of T-type calcium channels located on the postsynaptic membrane
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This drug will increase GABA effects at GABAa postsynaptic receptors?
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Phenobarbital
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Prior to initiating drug therapy for epilepsy; what should be done?
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Identify the correct seizure type or epileptic syndrome.
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What two drugs are used as monotherapy for absence seizures?
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Ethosuximide, valproic acid
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What drugs can exacerbate absence or myoclonic seizures?
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Know: phenytoin, carbamazepine, gabapentin,oxcarbazepine
Others: tiagabine, pregabalin, viagabarin |
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Is Phenobarbital mono or adjunctive therapy?
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Monotherapy
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Phenobarbital is used to treat what seizures?
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Generalized tonic-clonic, partial
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Side effect of phenobarbital is?
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Induction of CYP3A4 resulting in increased drug metabolism of oral contraceptives.
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Is Phenytoin mono or adjuctive therapy?
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Monotherapy
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Phenytoin is used to treat what seizures?
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Generalized tonic-clonic, partial
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Side effects of phenytoin are?
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Induction of CYP3A4 resulting in increased drug metabolism of oral contraceptives. Gingival hyperplasia with chronic therapy. Stevens-Johnson Syndrome
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Stevens-Johnson syndrome is treated by?
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Discontinue use of suspected drug [e.g. phenytoin]
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Is Carbamazepine mono or adjunctive therapy?
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Monotherapy
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Carbamazepine is used to treat what seizures?
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Generalized tonic-clonic and partial
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Side effect of carbamazepine?
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Induction of CYP3A4 resulting in increased drug metabolism of oral contraceptives
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Is oxcarbazepine mono or adjunctive therapy?
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Both. monotherapy for partial seizures in 4-16 year olds.
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Oxcarbazepine treats what seizure type?
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Partial
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Side effect of oxcarbazepine?
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Induction of CYP3A4 resulting in increased drug metabolism of oral contraceptives
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What is the pharmacokinetic difference between oxcarbazepine and carbamazepine?
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Oxcarbazepine does not autoinduce its own metabolism, where carbamazepine does.
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Is ethosuximide mono or adjunctive therapy?
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Monotherapy
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Ethosuximide treats what seizure type?
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Absence seizure
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Is valproic acid mono or adjunctive therapy?
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Monotherapy for absence, myoclonic, partial, tonic-clonic seizures.
Adjunctive therapy for pain. |
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Valproic acid treats what seizure types?
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Absence, myoclonic, partial, tonic-clonic
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The advantage newer AEDs have over the traditional AEDs is?
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lack of serious side effects and they do not induce liver enzymes.
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Newer AEDs are approved mostly for what therapy?
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Adjunctive treatments
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Is gabapentin mono or adjunctive therapy?
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Adjunctive therapy
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Gabapentin is used to treat what seizure types?
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Partial with or without secondary generalized seizure
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This drug is not metabolized, and is excrete unchanged in the urine.
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Gabapentin
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This syndrome has childhood-onset, severe cognitive dysfunction, multiple seizure types, and resistant to drug therapy.
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Lennox-Gustaut Syndrome (LGS)
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Is lamotrigine mono or adjunctive therapy?
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Both.
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Lamotrigine is used to treat what seizure types?
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Partial, generalized tonic-clonic, LGS
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Is Topiramate mono or adjunctive therapy?
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Both
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Topiramate treats what seizure types?
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Partial, generalized tonic-clonic, LGS
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Is Levetiracetam mono or adjunctive therapy?
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Adjunctive
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Levetiracetam is used to treat what seizure types?
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Partial, generalized tonic-clonic in adults. Myoclonic seizures in children.
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What drugs may be given IV to treat status epilepticus?
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Levetiracetam, Phenobarbital, Fosphenytoin [prodrug of phenytoin], valproic acid
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What drugs are considered "broad spectrum" AEDs?
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Topiramate, Lamotrigine, Valproic acid
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Which drug has the highest safety margin in animal studies and can have a rapid dose titration?
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Levetiracetam
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A series of seizures where full recovery from one seizure does not occur before onset of next seizure is?
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Status Epilepticus
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Elderly patients on AEDs should be counseled on?
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Bone health and have bone mineral density checked.
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Women taking oral birth control pills and AEDs have this?
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3x higher failure rate of contraceptive
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To reduce neural birth defects in patients taking AEDs during pregnancy, this should be recommended?
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0.4mg/day Folate. Vitamin K during last month of gestation.
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This drug is teratogenic but there is no substitute so the patient should stay on it.
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Valproic acid
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A strong statement from AAN warns against this for treating epilepsy?
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Against generic substitution
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All AEDs may cause birth defects, this drug is most often associated with them.
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Phenytoin
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There are 4 phases that characterize a migraine attack; what are they?
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1.Premonitory 2. Aura 3.Headache 4. Resolution
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An individual experiencing mood or appetite change hours to days before the migraine attack is this phase.
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Premonitory
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Premonitory features of a migraine attack include?
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photophobia, phonophobia, mood/appetite changes
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A migraine without an aura is referred to as a?
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Common migraine
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A migraine with an aura is referred to as a?
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Classic migraine
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The focal neurological symptoms (vision or sensation) that occur in 31% of people with migraines is referred to as?
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Aura
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Migraine headaches progress from a ____ ache to ______. They are usually unilateral or bilateral? Do they get better in time or worsen in time?
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Dull ache to intense pulsations, unilateral, worsen over time.
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Gastrointestinal symptoms such as nausea and vomiting are associated with this migraine attack phase?
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Headache phase
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Migraine attack pain begins in the _______ and may extend to the neck and back of the skull
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Frontotemporal region
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If untreated, migraine headaches may last from?
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4-72 hours
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In this migraine attack phase, patients may feel tired/depressed or refreshed/euphoric
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Resolution phase
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Dull persisting, non pulsating, bilateral pain, not aggravated by physical activity in the absence of N/V or aura; is what headache type?
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Tension type headache - muscle contraction
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Brief episodes of excruciating unilateral pain that occur in clusters with periods of remission are what headache type?
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Cluster headaches
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Migraine headache is thought to result from the?
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inappropraite dilation of intracranial extracerebral blood vessels.
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Depletion of serotonin from tissue stores by reserpine or fenfluramine can induce migraines, what proposed theory is this?
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Serotonergic abnormalities
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This proposed theory suggests health care professionals should attempt to identify and eliminate what?
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Migraine triggers in patients
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If migraine attacks are frequent enough to require acute medication more than twice a week; what therapy should be used?
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Prophylactic therapy
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If a patient has severe N/V, they should be treated with what as part of what therapy?
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Treated with antiemetic in acute therapy
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A clinical problem with abortive therapies in treating migraines is? To avoid the problem they should only be used?
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Rebound headaches. Only use 2 times per week.
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Abortive therapies for treatment of migraine include?
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Combination analgesics, opiates, ergotamine tartrate, and triptans
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What drug is as effective as oral ergotamine tartrate with fewer side effects to treat mild/moderate migraines?
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Midrin
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Gangrenous mummified limbs and spontaneous abortions are associated with?
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Ergotism
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Ergotamine tartrate is available in what dosage forms?
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Oral, sublingual, suppository
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The maximum oral/sublingual dose for ergotamine tartrate is?
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6mg/attack or 10mg/week
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Why is caffeine added to some ergotamine containing products?
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To potentiate vasoconstriction and improve intestinal absorption
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What 3 receptors does ergotamine interact with?
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serotonin, dopamine, adrenergic receptors
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Ergotamine effectiveness for migraine headache is mediated by activation of ______ and _____ it may also reduce ___________.
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Activation of 5HT1b receptors and vasoconstriction. Reduce neurogenic inflammation.
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This drug is contraindicated in patients with peripheral vascular disease and B-blockers potentate vasoconstriction caused by this drug.
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Ergotamine
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Activation of central dopamine receptors in the chemoreceptor trigger zone will cause this?
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GI upset [ nausea, vomiting, anorexia]
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This drug may be given adjunctive with ergotamine therapy to improve oral absorption.
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Metoclopramide
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This antibiotic interferes with the liver metabolism of ergotamine.
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Erythromycin
Note: DHE also is effected by erythromycin. |
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Contraindications for ergotamine are?
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Cardiovascular disease, pregnancy
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This drug used for acute treatment of moderate/severe migraines is incompletely absorbed by the GI tract and is administered parenterally.
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DHE45 Dihydroergotamine [nasal form is available also]
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This drug causes vasoconstriction of dilated intracranial arteries and reduces neurogenic inflammation; it is like ergotamine, what is it?
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Dihydroergotamine
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The difference between ergotamine and dihydroergotamine is?
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Dihydroergotamin there is less vasospasms due to less arterial vasoconstrictor activity and more a-adrenergic blocking activity
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This drug is a derivative of serotonin 5-HT and is metabolized by MAO-A.
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Sumatriptan
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Sumatriptan is available in these dosage forms?
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Oral, Sub-Q injection, nasal spray
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Is the MOA of sumatriptan like ergotamine and dihydroergotamine or is it different? If different, How?
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It's the same MOA. In addition, helps relieve N/V, photophobia, phonophobia
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Subcutaneous sumatriptan can cause this ? Also a reason why it is never given IV.
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Myocardial infarction
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What drugs should not be used within 24 hours of each other due to vasospastic effect?
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sumatriptan and ergot-type compound
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Chest/throat tightness, difficulty breathing, panic/anxiety, paresthesias, feeling of heaviness are all symptoms of?
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Triptan symptoms from interaction with 5HT1a receptors
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These drugs should not be given with a MAO inhibitor?
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Triptans
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Zolmitriptan is available in these dosage forms?
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oral, disintegrating, nasal
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Zolmitriptan differs from sumatriptan how?
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Zolmitripitan is a 2nd generation triptan. Has greater bioavailability and greater lipid solubility. Acts on central trigeminal nucleus to inhibit pain transmission [ as well as peripheral like sumatriptan]
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This dopamine antagonist is useful for treatment of acute migraines unresponsive to sumatriptan, DHE, or oral analgesics.
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Prochlorperazine
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This drug has both an antiemetic activity as well as provides relief of headache pain.
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Prochlorperazine
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If a patient has recurring migraines that do not respond to acute therapies, then this therapy should be used.
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Prophylaxis migraine therapy
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Methysergide is effective for treatment of?
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Prophylaxis migraines and cluster headaches
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Methysergide is metabolized by the liver to the active metabolite?
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methylergometrine
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Methysergide is a mixed agonist/antagonist; what receptors does it act on?
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Agonist for 5HT1 receptors.
Antagonist for 5HT2 receptors. |
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Why is methysergide not effective for the acute treatment of migraine headaches?
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The protective effect takes 1-2 days to develop due to generation of active metabolite.
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Methysergide should be discontinue for how long? and to prevent what ADR?
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Discontinue for 4 weeks every 6 months to prevent fibrosis or fibrotic complication with long term use
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What drugs are first choice for migraine prophylaxis?
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B-blockers that lack partial agonist activity such as [propanolol, nadolol, timolol, atenolol, metropolol]
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This drug may involve the down regulation of central 5-HT2 and adrenergic receptors. Its side effect is anticholinergic effect.
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Amitriptyline
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Which anticonvulsant drugs are useful for treating migraine prophylaxis?
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Valproic acid, topiramate, gabapentin
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ADRs: paresthesia, fatique, anorexia, diarrhea, weight loss, memory problems, and nausea are associated with this drug?
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Topiramate
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ADRs: somnolence, asthenia, dizziness are associated with this drug?
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Gabapentin
Asthenia is loss of strength. Somnolence is drowsiness. |
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The treatment for acute cluster headaches is?
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Oxygen, ergotamine tartrate, dihydroergotamine, subcutaneous sumatriptan to abort cluster headache
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Treatment for infrequent tension-type headaches include?
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OTC analgesic, relaxation techniques.
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For cluster headaches that do not respond to symptomatic therapy or occur more than 2x daily; use this therapy.
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Prophylaxis therapy: Ergotamine tartrate, methysergide
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For the prophylaxis of tension-type headache use this drug.
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Amitripyline
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What drugs can be used to treat migraines in children?
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B-blockers for prophylaxis. Triptans, ibuprofen, acetaminophen.
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Can metoclopramide be given to a child with nausea and vomiting in a migraine attack?
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No, due to adverse side effects.
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What factors may act as migraine triggers in patients?
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Weather changes, alcohol, chocolate, tyramine[found in cheeses, beer]
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This term means derived from opium
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Opiate
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This term means having properties similar to drugs derived from opium.
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Opioid
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This term means sleep inducing but is commonly taken to mean opioid.
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Narcotic
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This is a dried plant resin obtained from a poppy.
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Opium
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Phenanthrene alkaloids are also referred to as?
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narcotic analgesics
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This drug is 10% opium by weight.
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morphine
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This drug is 0.5% opium by weight.
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codeine
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Pain is a complex experience that consists of what 2 components?
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Physiological sensation and emotional/psychological reaction
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Which component of pain is most important because it represents suffering?
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Emotional/psychological reaction
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Which component of pain is produced by the excitation of functionally distinct pain receptors or nociceptors?
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Physiological sensation
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This component of pain involves the reticular activating system, limbic system, and frontal cortex.
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Emotional/psychological component
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This component of pain involves the cerebral cortex, reticular formation, and limbic system.
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Physiological sensation
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In most situations morphine acts primarily in the _____ system. It also acts in the ______and ____ to modify physiological sensation.
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Limbic, spinal cord, thalamus
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Is morphine more effective against dull, constant, visceral pain or sharp,intermittent somatic pain?
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Dull, constant, visceral pain
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Morphine acts as an ____ at receptors for endogenous opioid peptides.
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agonist
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When an agonist binds to the opioid receptors what gets inhibited?
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Substance P release is inhibited thus numbing the action potentials being sent to the thalamus.
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MOP/u receptors are located where?
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brainstem, spinal cord, limbic areas. Also, periphery and modulate sensitivity of nociceptors.
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KOP/k receptors are located where?
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brainstem, spinal cord, lesser extent limbic system
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Which receptors mediate supraspinal analgesia, some spinal analgesia, sedation, respiratory depression, euphoria, dependence?
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MOP/u receptors
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Which receptors mediate spinal analgesia, some supraspinal analgesia, miosis, sedation, dysphoria?
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KOP/k receptors
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Morphine acts as a what at MOP/u receptors and a what at KOP/k receptors?
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Strong agonist at MOP/u receptor
Moderate agoinst at KOP/k receptors |
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Pentazocine acts as a what at MOP/u receptors and a what at KOP/k receptors?
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Strong agonist at KOP/k receptors. Partial agonist/antagonist at MOP/u receptors.
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Naloxone acts as a what at MOP/u receptors and a what at KOP/k receptors?
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Antagonist at all types of opioid receptors
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Therapeutic doses of this drug produce a floating, dream-like state from which the patient normally can be aroused.
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Morphine
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Overdose situations of morphine or other opioids follow this depression of cortical function:
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Mental clouding/sedation to hypnosis/stupor to coma to death
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Relief of anxiety and apprehension are associated with this drug?
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Morphine
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Euphoria is usually the action of this drug but it can occasionally cause dysphoria.
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Morphine
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This side effect is due to opioids stimulating the CRTZ in the medulla.
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Nausea
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What is the usual cause of death in opioid poisoning?
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Respiration depression
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The benefit of respiratory depression caused by morphine is the treatment of?
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Treatment of pulmonary edema
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What is a tell-tell sign of opioid poisoning?
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pin-point pupils
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Codeine and its analogs particularly are used to treat this? [not pain]
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Depression of cough center in medulla- antitussive
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Asthma or obstructive pulmonary disease may be aggravated by morphine and opioids, why?
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Morphine and other opioids cause the systemic release of histamine and bronchoconstriction.
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What drug may be useful after spinal morphine administration, when the patient has severe itching on the trunk and face?
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Naloxone
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Why should morphine be used with caution in seizure-prone patients?
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Morphine lowers the seizure threshold.
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Chronic opioid users may develop what endocrine disturbances?
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Decrease secretion in gonadotropins, corticosteriods, prolactin. Menstrual problems in females and impotence in males.
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What effect does morphine have on smooth muscle?
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Morphine will increase tone of circular smooth muscle and decrease in propulsive movements of longitudinal muscle.
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Does morphine cause increase or decrease in motility?
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Decrease - constipation
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Does morphine cause urine retention or urine incontinence?
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Urine retention
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Does morphine cause bronchodilation or bronchoconstriction?
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Bronchoconstriction
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Does morphine cause an increase or decrease in biliary pressure?
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Increased biliary pressure
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What cardiovascular effects occur with morphine use?
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orthostatic hypotension, cutaneous vasodilation, increase CSF pressure
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Can an immunocompromised patient take morphine?
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In chronic use, morphine can act as an immunosuppressant, it may contribute to the pathogenesis of immune disorders.
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When opioids are used as adjuncts for surgical anesthesia at high doses what side effect may occur?
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Skeletal muscle rigidity
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By what route is morphine given?
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IM,SC,spinal, oral
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Why is morphine considered less potent when given orally?
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It undergoes significant first pass effect.
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How long does it take for maximal analgesic action to occur after morphine injection? What is the duration?
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1 hour maximal, 4-6hours duration
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What is the standard therapeutic dose of morphine?
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Morphine 10mg SC or IM
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What is the characteristic triad for opioid poisoning?
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CNS depression, Depressed depth/rate of respiration, pin-point pupils
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What drug can be given to treat opioid poisoning?
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Naloxone- narcotic antagonist
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What interaction do opioids have with other CNS depressants?
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Additive effects
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What interaction do opioids have with MAO inhibitors?
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Severe hyperpyrexia(high fever), coma.
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A mixture called speedball is composed of?
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morphine, amphetamine and cocaine abuse
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What interaction occurs between opioids and other analgesics such as aspirin,acetaminophen, and ibuprofen?
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Drugs in combination produce enhanced analgesic effects
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What interaction occurs between opioids and tricyclic antidepressants?
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Enhance analgesic effects.
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Three important developments in how opioids have changed are?
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1. Infusion/autoinjector system
2.PCA 3. spinal analgesia |
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This drug is 1/12 potency of morphine.
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Codeine
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This drug is 10 times more potent than morphine.
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Hydromorphone
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This drug is a cross between morphine and codeine.
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Oxycodone
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These drugs may be used in combination with acetaminophen, aspirin, or ibuprofen?
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Hydrocodone, oxycodone, codeine
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This drug is 1/10th the potency of morphine.
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Meperidine
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What are the problems with Meperidine?
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Short acting, build up of toxin resulting in seizure, interactions with MAO,SSRI. not useful for chronic pain.
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This drug is more potent and more euphoric than morphine with a duration of 4-6hours.
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Heroin
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This drug is orally effective, less eurphoric and longer duration(12-24h) than heroin or morphine.
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Methadone
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These drugs are used to treat opioid addictions
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Methadone, Naltrexone, Buprenorphine
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This drug is 100x more potent than morphine.
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Fentanyl.
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Treatment of breakthrough pain use this drug in lozenges.
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Fentanyl
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Neuroleptic analgesia can be induced by the use of droperidol with?
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Fentanyl
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Neuroleptic anesthesia can be induced by the use of droperidol with? (2)
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Fentanyl and nitrous oxide
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Opium extracts in an old medication were used for the treatment of?
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diarrhea
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What drug is an agonist at KOP/k receptors, and partial agonist at MOP/u receptors?
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Pentazocine
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At high doses, Pentazocine acts as what?
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MOP/u receptor antagonist
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Is pentazocine more or less effective than morphine for severe pain?
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Less effective.
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What drug is similar to pentazocine and can be given intranasally?
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Butorphanol
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This drug acts as only a partial agonist at MOP/u receptors and at very high doses MOP/u antagonist.
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Buprenorphine
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What agent is used for office based treatment of opioid addiction?
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Buprenorphine
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This drug is a weak MOP/u agonist. It also inhibits reuptake of NE and serotonin.
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Tramadol
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This drug is given in combination with other oral narcotic analgesics to prevent abuse.
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Naloxone
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This drug is an orally effective, long acting antagonist. It may be useful in treating alcoholism.
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Naltrexone
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This quaternary salt is used to treat/prevent opioid-induce constipation.
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Methylnaltrexone
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|
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Name some Acute withdrawal syndrome characteristics?
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Craving for drug, anxiety, insomnia, yawning, hyperventilation, hostility, rhinorrhea, dilation of pupils, GI hypermotility, hypertension, tachycardia, chills, sweating, hyperalgesia, muscle aches, GI pain
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If the patient was on a short acting drug such as heroin or morphine (4-6 hours) what would the duration and intensity of an acute withdraw be?
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Duration: 3-7 days
Intense symptoms |
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If a patient has been on a long acting drug such as methadone, what would the duration and intensity of an acute withdraw be?
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Duration: 1-2 weeks
Moderate symptoms |
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The physical dependence to opioids is thought to result from?
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compensatory changes in opioid receptors
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|
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What would you use in treating dependence on opioids?
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Wean off drug, Methadone, buphenorphine, naltexone,clonidine
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|
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What does clonidine do in treating dependence on opioids?
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Helps to decrease craving for the drug and reduce the severity of withdrawal symptoms.
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Patients who become dependent while chronically receiving opioids of pure drug occur in this setting.
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Hospital setting dependence
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Health hazards, questionable drug purity, and socioeconomic problems occur in this setting
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Street setting dependence
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This form of arthritis is triggered by deposition of monosodium urate crystals in joints.
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Gout
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A familial disorder as a result of genetically determined errors in purine metabolism or uric acid excretion is called?
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Primary Gout
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This results from exogenous factors such as drugs, diet, disease states that increase circulating levels of uric acid.
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Secondary gout
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|
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Does uric acid serve any physiologic function?
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No. It is the end product of purine metabolism.
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How is uric acid removed from the body?
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Excreted by the kidneys[ primarily filtration at glomerulus, reabsorbed in proximal tubule]
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|
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What is the normal value for plasma urate/uric acid?
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2-7mg/dL or 0.2-0.7g/L
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|
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What factors contribute to the development of hyperuricemia and gout?
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Heredity, diet, alcohol, low fluid intake, cancer, radiation therapy, drugs, problem with excretion.
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Do all patients with gout have elevated levels of uric acid?
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No. Some may have high levels of uric acid and never experience attacks. Some may have low levels of uric acid and experience gout attacks.
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|
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Is uric acid soluble or insoluble?
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Not very soluble and will precipitate as sodium urate crystals.
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|
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Why do crystals form in the toes, feet, ankles, fingers, and hands?
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These areas of the body are cooler than the core body temperature.
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|
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What are the four stages of gout?
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1. asymptomatic hyperuricemia
2. acute gouty attack 3. intercritical gout 4. chronic tophaceous gout with or without renal failure. |
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In what stage of gout does the deposition of urate crystals in the kidney and renal calculi occur?
|
Chronic tophaceous gout stage
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Place these steps in the correct order for a gout attack. A.Phagocytosis by neutrophils and macrophages. B.Sodium urate crystals form in the joint. C. Neutrophil activation and release of inflammatory mediators.
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B.A.C
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Severe pain, redness, swelling, fever, increased sedimentation rate are all symptoms of?
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acute inflammation
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|
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These drugs suppress an acute gout attack.
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Indomethacin, ibuprofen, ketorolac, colchicine, prednisone, methylprednisolone.
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|
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This drug increases the excretion of uric acid.
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Probenecid
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|
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These drugs inhibit the formation of uric acid.
|
Allopurinol, Febuxostat
|
|
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This drug used to treat acute gout attacks causes CNS side effects.
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Indomethacin
|
|
|
These drugs inhibit prostaglandin synthesis.
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NSAIDS; indomethacin, ibuprofen, ketorolac, aspirin
|
|
|
This drug should be avoided in gout patients.
|
Aspirin
|
|
|
What side effect do NSAIDS have?
|
GI irritation
|
|
|
This drug has a unique antiinflammatory activity that is specific for gout.
|
Colchicine
|
|
|
This drug binds to tubulin and prevents its polymerization to microtubules.
|
Colchicine
|
|
|
Side effects of Colchicine are?
|
GI upset; diarrhea, nausea, vomiting
|
|
|
Can colchicine be used to prevent recurrence of attacks?
|
Yes, at lower, less frequent doses.
|
|
|
When a patient has an acute gout attack what do physicians typically try first?
|
NSAIDS and corticosteroids
|
|
|
These drugs work by inhibiting the enzyme xanthine oxidase and reduce the formation of uric acid.
|
Allopurinol, Febuxostat
|
|
|
These drugs do not stop an acute gout attack but over time can reduce potential for future attacks.
|
Allopurinol, Febuxostat
|
|
|
These drugs cause elevation of liver enzymes.
|
Allopurinol, Febuxostat
|
|
|
Between allopurinol and febuxostat, which drug is less likely to cause allergic reactions?
|
febuxostat
|
|
|
This drug works by inhibiting the anion exchange transporter.
|
Probenecid
|
|
|
By inhibiting both the secretion and reabsorption of organic acids, this drug's effect is to increase uric acid excretion.
|
Probenecid
|
|
|
Which drug causes an increased risk of stone formation in the kidneys?
|
Probenecid
|
|
|
To treat hyperuricemia of chronic gout, recommendations are?
|
Diet modification. Probenecid, allopurinol
|
|
|
This drug is preferred in treatment of patients with existing kidney stones with hyperuricemia.
|
Allopurinol
|
|
|
What is one of the most basic tasks of any health care professional?
|
alleviate pain and suffering
|
|
|
To manage pain, what approaches should be used?
|
Remove cause, Decrease inflammation/irritation, Block pain impulses, Modify pain processing.
|
|
|
This drug is an injectable NSAID useful as an alternative to opioids for pain.
|
Ketorolac
|
|
|
This drug is a selective COX-2 inhibitor
|
celocoxib[celebrex]
|
|
|
COX-2 inhibitors are problematic because?
|
They predispose patients to heart attacks. Increase prostacyclin [inhibits platelet activation and is also an effective vasodilator]
|
|
|
These block sodium channels in nerve endings/axons and stop generation/conduction of action potentials.
|
Local anesthetics
|
|
|
This is a physiologic state resulting from chronic exposure to a drug.
|
Drug dependence
|
|
|
This is a pattern of behavior in which the use of a drug assumes a central role in a person's life.
|
Drug addiction
|
|
|
These act as agoinsts at receptors for endorphins and enkephalins.
|
opioids
|
|
|
What are the adjuvant drugs for pain management?
|
Corticosteroids, DMARDS, immunomodulators, muscle relaxants, amitriptyline, carbamazepine, valproic acid, gabapentin, pregabalin, clonidine
|
|
|
What is appropriate drug selection for mild pain?
|
acetaminophen, aspirin, ibuprofen
|
|
|
What is appropriate drug selection for moderate pain?
|
NSAIDS, intermediate potency opioids in combination w/ acetaminophen or aspirin.
|
|
|
What is appropriate drug selection for severe pain?
|
Strong opioids, NSAIDS, adjuvant drug [amitriptyline,carbamazepine,valproic acid, gabapentin]
|
|
|
This is generalized physiological and psychological response to noxious stimuli.
|
Pain
|
|
|
What group of patients did not receive pain management until recently during surgeries?
|
Children
|
|
|
Are NSAIDs given at higher doses for pain or antiinflammatory relief?
|
Antiinflammatory, also provides pain relief at these higher doses.
|
|
|
How does COX1 inhibitation cause GI irritation?
|
Increases acid, decreases mucus.
|
|
|
This inhibits prostaglandin synthesis in nerve endings in CNS, but not in periphery.
|
Acetaminophen
|
|
|
This drug should only be used for 1-2 days, not for chronic use due to GI irritation.
|
Ketorolac
|
|
|
These protocols provide more selective pain relief without affecting other functions in local anesthetics.
|
New, low dose protocols
|
|
|
What are the keys to effective use of opioids without abuse?
|
1. Healthcare provider maintains control.
2. Define outcomes/develop therapeutic plan. 3. Monitor patient. 4.patient contracts and drug screenings |
|
|
These drugs can be used to precipitate withdrawal syndrome in opioid addicts.
|
Pentazocine, Naloxone
|
