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Pharmacology > CNS: Gout, Pain/Spasms, HA/Migraines > Flashcards

CNS: Gout, Pain/Spasms, HA/Migraines Flashcards

1
Q

Gout

A
  1. deposits of monosodium urate crystals in body tissue
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2
Q

Primary vs Secondary GOUT

A

primary = caused by an inborn error of purine metabolism

secondary = caused by hyperuricemia that results from other causes; disease states or drugs

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3
Q

Gout PATHO

A
  1. overproduction of uric acid
  2. under excretion of uric acid

Four phases of disease process:
1. asymptomatic hyperuricemia
2. acute gouty arthritis
3. intercritical period
4. development of chronic tophaceous deposits

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4
Q

Gout Hyperuricemia/Risk factors

A

serum urate level >7mg/dl in men and >6mg/dl in women

Risk factors: men, age >60yo, family hx, med, diet, alcohol consumption, obesity, co-existing medical conditions

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5
Q

Gout Treatment

A
  1. treatment - colchicine, corticosteroids, NSAIDs
  2. Prevention - allopurinol, colchicine, probenecid, pegloticase, febuxostat

patients resistant to conventional tx may require referral to rheumatology

GOAL is PREVENTION

Pretreatment lab

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6
Q

Gout TLC

A

weight loss

review of current meds

reduce, stop alcohol

dietary changes- low purine diet

significant lifestyle changes can reduce or eliminate need for med

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7
Q

Gout: Colchicine MOA/USES

A

Used in acute and post acute stages

MOA: reduces deposition of urate crystals

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8
Q

Gout: Colchicine CONTRA/Administration

A

CONTRA: hypersensitivity, severe renal/GI/hepatic/CV disorders

Onset 12-24 hrs

Dose: initial 0.6-1.2mg, followed by 0.6mg q2hrs until pain relief or diarrhea, max dose 6mg (traditional)

New guidelines: 1.2mg followed in 1hr by 0.6mg = effective and less toxic

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9
Q

Gout: Colchicine AE/INTERACTIONS

A

AE: GI (significant N/V/D, abd pain), alopecia, B12 malabsorption

Interactions: digoxin, antibiotics, antifungals, antiretrovirals, CCBs, fibrates, grapefruit juice, immunosuppressants, statins

All may INC toxicity

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10
Q

Gout: Colchicine Patient education

A
  1. do NOT exceed dose
  2. follow low purine diet
  3. NO ETOH
  4. NO ASA containing meds
  5. STOP and report: severe vomiting, muscle weakness, watery diarrhea, burning in throat, delirium, convulsions
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11
Q

Gout: Allopurinol USES/MOA

A

Used to PREVENT future attacks

MOA: inhibits enzyme that converts xanthine to uric acid

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12
Q

Gout: Allopurinol CAUTION/Administration

A

CAUTION: renal impairment, use of diuretics, ACE inhibitors

Onset 1-2 wks

Dose 200-600mg per day, usual 300mg/day

Adjust for renal clearance

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13
Q

Gout: Allopurinol MONITOR/Patient education

A

administer w/ large glass of water

MONITOR: start of therapy and during - CBC, serum uric acid, hepatic and renal function

  1. adequate hydration
  2. DEC ETOH use
  3. Low purine diet
  4. CAUTION w/ OTC meds and vitamins

REPORT signs of liver dysfunction, rash, hair loss, blood in urine

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14
Q

Gout: Probenecid MOA/USES

A

PREVENTION drug

MOA: inhibit reabsorption of uric acid, promotes excretion and reducing serum uric acid levels

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15
Q

Gout: Probenecid CAUTION/Administration

A

CAUTION: renal disease, high dose ASA therapy, hx PUD

Dosing: 250mg BID for one week, INC by 500mg per week based on serum uric acid levels

MONITOR: uric acid, renal function, CBC

May take 6 months to reach full effect

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16
Q

Gout: Probenecid AE/INTERACTIONS

A

AE: flushing, HA, rash, itching, GI, painful urination, anemia

INTERACTIONS: PCN, salicylates, methotrexate, quinolones, cephalosporins, sulfa, acyclovir, BDZ

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17
Q

Gout: Probenecid Patient education

A
  1. adequate hydration
  2. low purine levels
  3. take w/ food or milk
  4. AVOID NSAIDs, ASA

REPORT severe HA, rash, bruising, bleeding

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18
Q

Gout: Pegloticase (Krystexxa)

A

Newest drug for gout

would need to refer patient who require this drug

IV only

Patient must fail to reach normal uric acid levels w/ conventional therapy

CONTRA: patient w/ G6PD deficiency

AE: most common anaphylaxis, infusion reaction, gout flares

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19
Q

Gout: Febuxostat USES/MOA

A

Uloric

Newest drug for gout

CHRONIC management of gout

MOA: DEC serum uric acid levels

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20
Q

Gout: Febuxostat Administration/INTERACTIONS

A

Dosing: 40mg/day with goal to 80mg/day

INTERACTIONS: theophylline, mercaptopurine, azathioprine

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21
Q

Gout: Febuxostat CONTRA/AE

A

CONTRA: can INC initial gouty flares

CAUTION: Hx of CV disease, small # of MI experienced

AE: gouty flares, INC LFT, nausea, arthralgias, rash

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22
Q

Gout: Febuxostat MONITOR/Patient education

A

NO High fat meals

Antacids will delay absorption

MONITOR: uric acid levels, liver/kidney functions

  1. low purine diet
  2. DEC or stop ETOH
  3. stay hydrated
  4. report any Hx of CV disease
  5. possible gouty flares at start of therapy
  6. drug is new and still expensive
23
Q

Gout: Clinical Pearls

A
  1. diet and weight loss will help patients
  2. low purine diet
  3. eliminate ETOH
  4. check uric acid levels
  5. check other meds that could precipitate gout attack
  6. have patients check OTC w/ pharmacist first
24
Q

Tramadol MOA/USES

A
  1. Centrally acting non-narcotic agent
  2. useful for patients who CANNOT tolerate NSAIDS and do not want to use opiate drugs

Tx moderate to severe pain
small propensity for abuse

PREG C, NO lactation
NO Children (<18yo)
Adjust dose for elderly

25
Q

Tramadol: CONTRA

A

acute intoxication w/ ETOH, hypnotics, CNS drugs, opiates, psychotropic drugs

May cause CNS depression

26
Q

Tramadol: Interactions/AE

A

Interactions: Carbamazepine, fluoxetine, paroxetine, quinidine, quinine, ritonavir, ETOH, MAOI, SSRI, TCA

AE: flushing, dizziness, HA, insomnia, pruritus, constipation, N/V, dyspepsia, weakness, diaphoresis

27
Q

Tramadol: Administration

A
  1. Immediate release 50-100mg q4-6hr, not exceed 400mg/day
  2. Extended release 100mg QID, titrate up to 300mg/day

Ultracet: 37.5mg tramadol/325mg acetaminophen, 2 tabs q4-6hrs, max 8 tabs/day

28
Q

Opioids: USE/MOA

A
  1. HIGH abuse potential
  2. Dose on fixed dosing intervals

Tx moderate to severe pain

PREG C
CAUTION w/ elderly and children

29
Q

Opioids: AE

A
  1. GI: N/V, constipation, xerostomia
  2. Severe resp depression
  3. circulatory depression, flushing, shock
  4. physical & psychological dependence
  5. sedation, drowsiness
  6. urinary retention
30
Q

Skeletal Muscle Relaxants

A
  1. centrally acting muscle relaxants
  2. work in the CNS
  3. muscle spasms associated w/ low back strain, muscle tenderness, movement disorders
  4. supportive therapy in fibromyalgia
31
Q

Muscle Relaxant DRUGS

A
  1. cyclobenzaprine (Flexeril)
  2. carisoprodol (Soma)
  3. Clorzoxazone (Paraflex, Parafon Forte)
  4. Metaxalone (Skelaxin)
  5. Methocarbamol (Robaxin)
  6. Orphenadrine (Norflex)
32
Q

Cyclobenzaprine (Flexeril) MOA

A

MOA: through central action, brainstem; influences alpha and gamma motor neurons

Onset 1hr, duration 12-24hrs

PREG B
NO w/ ETOH, CNS dep
NO children <16yo
Withdraw slowly if using high doses or over prolong period

33
Q

Cyclobenzaprine CONTRA/AE

A

CONTRA: hyperthyroidism, MAOI use

Overdose: conduction disturbances, death

AE: CNS dep, anticholinergic activity

34
Q

Cyclobenzaprine INTERACTIONS/DOSE

A

Interactions: CNS dep, antimuscarinic meds, tramadol, MAOI, H2 blockers, herbs

35
Q

Carisoprodol MOA/USE

A

Addictive qualities: metabolizes to meprobamate

MOA: blocks interneuronal activity and depresses polysynaptic neuron transmission in the spinal cord and reticular formation of the brain

PREG C, NO lactation, NO children <16yo

36
Q

Carisoprodol CONTRA

A

CONTRA: CNS dep, Hx of drug or ETOH dependence, seizure disorder

Risk of idiosyncratic reaction: weakness, visual or motor disturbances, confusion, euphoria

37
Q

Carisoprodol Administration/AE/Interactions

A

Onset 30 min, duration 4-6hrs
Dose: 350mg TID or QID

use only for SHORT periods, 2-3 wks

AE: drowsiness, dizziness, HA
Interactions: ETOH

38
Q

Chlorzoxazone MOA

A

MOA: acts on spinal cord and subcortical levels by depressing polysynaptic reflexes

PREG C

39
Q

Chlorzoxazone CONTRA/INTERACTIONS

A

CONTRA: impaired liver function

Interactions: CNS dep, INH, disulfiram, azoles, ETOH

40
Q

Chlorzoxazone AE/Administration

A

AE: dizziness, drowsiness, lightheaded, paradoxical stimulation, GI

Onset 1hr, duration 6-12hrs
taper dose

Adults: 250-500mg TID or QID
Peds: 20mg/kg/day
Elderly: half of adult dose

41
Q

Metaxalone MOA/CONTRA/Interactions

A

Central muscle relaxant

CONTRA: hepatic or renal dysfunction

NO pregnancy, NO lactation, NO children <12yo

Interactions: CNS dep, benzos, ETOH, TCA

42
Q

Metaxalone AE/CAUTION

A

AE: dizziness, HA, nausea, rash, itching, jaundice

elderly more at risk for CNS effects and CNS depression

Death from overdose and w/ ETOH

43
Q

Metaxalone Administration

A

dose: 800mg TID to QID

Onset 1hr, duration 4-6hrs

less sedating that other muscle relaxants

44
Q

Methocarbamol MOA/CONTRA

A

MOA: causes skeletal muscle relaxation by general CNS depression

CONTRA: renal impairment, seizure disorder, liver impairment

NO children <16yo, PREG C

Supportive therapy in TETANUS
May discolor urine

45
Q

Methocarbamol AE/INTERACTIONS

A

AE: drowsiness, dizziness, GI upset, blurred vision, HA

Interactions: CNS dep, ETOH, herbs

46
Q

Methocarbamol Administration

A

Onset 30 min, duration 8hrs

Dose: 1.5g BID or TID, max 8g in 24hrs

IV for spasms: 1g q8hrs, no longer than 3 days

47
Q

Orphenadrine MOA/USE

A

MOA: centrally acting CNS

Anti-Parkinson’s agent, Anticholinergic agent

PREG C, Adults and children >12yo

48
Q

Orphenadrine CONTRA/CAUTION

A

CONTRA: glaucoma, achalasia, GU/GI obstruction, MG

CAUTION: CAD, arrhythmias, asthma

Interactions: haloperidol, amantadine, phenothiazines, MAOI, anticholinergic meds

49
Q

Orphenadrine AE/Administration

A

AE: tachycardia, dizziness, syncope, weakness, INC intraocular pressure, urinary retention, blurred vision, dry mouth, GI upset

Dose: 200-250mg/day, usually BID

Onset 1-2hrs, duration 4-6hrs

50
Q

Pain/Spasms: Adjuvant therapies for PAIN

A
  1. TCA - neuropathic pain and chronic pain
  2. other antidepressants - neuropathic pain and depression
  3. anti-epilepsy (Gabapentin) - neuropathic pain
  4. Benzos - skeletal muscle spasms and akathisia
  5. Anesthetics - Lidoderm patch
51
Q

Mild to Moderate migraine tx

A

OTC meds: Excedrin, Tylenol
NSAIDS

52
Q

Mild to Moderate migraine tx

A

OTC meds: Excedrin, Tylenol
NSAIDS

53
Q

Moderate to Severe migraine tx

A
  1. Migraine specific: triptans, ergots
  2. Non-specific narcotics/analgesics:
    fioricet, opioids, butalbitals
54
Q

Triptans MOA

Pharmacology (12 decks)

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