II Pharm IV Flashcards
What are the most abused drugs in all age groups?
Alcohol and tobacco
4 Factors that increase potential for abuse:
Potency
Rapid onset
Inexpensive
Easy to obtain/distribute
What are “potential” pts?
call office seeking pain meds w/o being seen
In order to give a script:
2 things
pt of record
dental need
Why is a drug “scheduled”
Potential for abuse
Drugs that are used in a manner/amount inconsistent w/ med or social pattern of culture
Drug Abuse
When a drug necessitates continued administration to prevent withdrawal:
Physical dependence
Physical dependence is addiction
False
*chronically dependent opiates for pain = physical dependence but not an addict
You can be physically dependent on a drug and not be addicted to the drug:
True
*but addicts are usually physically dependent
Perceived need or craving for a drug:
Psychological dependence
What is the primary reason for relapse:
Psychological dependence
3 signs of addiction:
Compulsive drug-seeking behavior
Continued use despite serious consequences
ALWAYS psychological dependence (so relapse common)
Physiologic tolerance or psychological dependence short of addiction:
Habituation
4 behaviors associated w/ addiction:
Anal retentive
OCD
Controlling
Manipulative
T/F
Habituation will ALWAYS lead to addiction or dependency
True
With repeated dosing, drug must be increased to produce same effect:
Tolerance
What kind of tolerance to Psychoactive drugs produce?
Central tolerance
*definite decrease in the response of brain tissue to constantly increasing amounts of drug
Is tolerance the same as Metabolic Tolerance?
NO
*it is central tolerance - would need accelerated metabolic rate - not really a factor w/ most psychoactives
Behavior of others associated with user that results in continued drug abuse:
Enabling
The state of being free of drugs:
Abstinence Syndrome
Using opiates for sleeping aid would be considered what?
Misuse
T/F
Nicotine/EtOH are considered “gateway” drugs
True
If pt has Hx of drug abuse, what must you watch out for?
3 things can’t use w/ these pts:
Relapsing disease
opiates, benzodiazepines, nitrous oxides
*ANY substance that can promote relapse
A primary, chronic, progressive, relapsing disease process with genetic, psychosocial, and environmental factors influencing its development and manifestations:
Chemical Dependency
When comparing drugs in the same group, the time required to produce physical dependence is shortest with a rapidly metabolized drug.
True
The time course of withdrawal rxns is related to the half-life of the drug
True
How do we Tx abuse:
3 things
counseling
education
self-help groups
*but person must WANT help
The leading cause of ER visits and accidental overdose among kids (esp in AZ)
Access to stored meds
3 considerations for Drugs and Children:
Increased mem. permeability
Dosing based on weight
Half adult dose
Poison Prevention Act 1970:`
prescriptions must have Child-resistant containers
2 psychological trends in children seeking drugs:
Appearance:
If anxiety - seek downers
Low self esteem - uppers
Appear drunk/intoxicated
Kids are abusing prescription drugs more than cocaine, heroin, hallucinogens, and Ecstasy combined
True
*prescription drugs more popular than recreational drugs
What causes more overdoses in adolescents than cocaine and heroin combined?
Opiates (hydrocodone w/ acetaminophen especially)
2 reasons inhalants are abused:
Huffing/Sniffing very easy
Accessible (markers, glue, white out)
What is difluoroethane?
Why important for Dentistry?
Can lead to what?
Inhalant - halogenated hydrocarbons
Increase heart muscle sensitivity to Epinephrine
Sudden Death
Inhalants known as poppers, snappers?
Amyl nitrite
Butyl nitrite
Whippets are:
Nitrous oxide
T/F
Kids abuse prescription drugs more than street drugs and this is known as “pharming”
True
5 signs of inhalants
*produce similar effects as anesthetics
Intoxication
Slurred speech
Inability to coordinate movements
Euphoria
Dizziness
What is the most abused drug among children?
Vicoden
5 causes of death due to inhalants:
Hepatotoxicity
Suffocation
Resp depression
Sudden sniffing death
Cardiac death (difluoroethane)
What is in Robitussin
Dextromethorphan
What does Dextromethorphan do at low dose?
High dose?
What drug is it similar to and where does it act?
Antitussive
Hallucinogenic
Morphine, centrally
Robotripping involves drinking ____oz’s of DXM (Robitussin) until nausea causes you to ____ and ______
4 ounces
vomit, hallucinate
A lot of cold meds are _______ and considered ________
This means they can’t be used in people that have ______
Adrenergic Agonists
Vasoconstrictors
Hypertension
What cold med doesn’t have Acetominophen but still contains DXM (dextromethorphan)?
Coricidin HBP
What is Coricidin’s street name?
Skittles
T/F
Alcohol use is on the rise, including binge drinking
False
*continues to decline
Alcohol use is decreasing except for what demographic?
College age girls
Roofie:
Rohyponol
Why are women more susceptible to alcohol poisoning?
Don’t make as much Alcohol Dehydrogenase as men
As of _____, cigarette use reached an all-time low due to peer disapproval
2014
More popular among teens: cigarettes or e-cigs?
e-cigs
The FDA regulates e-cigs
True
but, legislation just passed
In 1998 ____% students had tried tobacco
In 2014 ___%
56%
23%
The greatest decline of illicig drug use has been with what drug?
Synthetic marijuana
K-2, spice
Most students recognize synthetic marijuana as a dangerous class of drug:
False
Amphetamine-like stimulant found naturally in the Khat plant:
Bath salts
less than 1% student use
The use of exctasy, salvia, and shrooms have declined
True
10 illicit drugs that have remained unchanged in use:
heroin
crack
meth
ritalin/adderall
LSD
Inhalants
Powder cocaine
tranquilizers
sedatives
anabolic steroids
What receptor does ecstasy bind to in the brain?
NMDA receptors
Most teens get their drugs from a friend/relative
True
3,4 methylenedioxypyrovalerone (MDPV):
aka, drone, meph, meow meow, methylone
Bath Salts
Substance abuse disorders are expected to double by 2020 and the Tx admission for substance abuse has doubled since 1992
True
*baby boomers
1/3 Baby Boomers use Rec. drugs
True
Elderly adults w/ substance abuse put themselves at risk for what 3 things?
Cancer
Infections
Infectious diseases
Newest demographic for HIV
Women over 65
Adults over 65, increasing use of what?
Alcohol
5 diseases Elderly Smokers will die from:
COPD
Heart disease
Stroke
Cancer
Alzheimer’s
Most commonly used recreational drug?
Marijuana
The proportion of older adults seeking Tx for substance abuse is increasing compared to younger adults
True
Alcohol/Rec. drug dependency often come about by what 3 things?
Chronic pain use - initial
Psychological probs - sleeping, anxiety, depression
Loneliness, boredom
4 Recreational and OTC meds abused by older adults:
Opioids
Benzodiazepines
Alcohol
Sleeping preparations
4 substances abused by older adults:
Rx and OTC meds
Alcohol/tobacco
Marijuana
Cocaine/Heroine (diminished after 60)
Most commonly abused CNS depressants?
2 other classes used fairly commonly:
Opioid analgesics
benzodiazepines, barbiturates
What are the 2 most commonly abused CNS stimulants?
Amphetamines
Methylphenidate
5 Examples of depressants:
Alcohol
Benzodiazepines
Opioids
Inhalants
Nitrous oxide
The most frequently abused drug:
Alcohol
Alcohol is oxidized to what in the liver?
Acetaldehyde
Acetaldehyde is metabolized to what?
Excreted where?
CO2 and water
lungs/urine
6 cancers linked to Acetaldehyde:
Oral
Pharyngeal
Gastric
Pancreatic
Liver
Bladder
Alcohol is eliminated from the body via _____ kinetics
What is the rate?
Zero-order
1g/hour
4 signs alcohol intoxication?
Dilated pupils
Slurred speech
Nystagmus (involuntary eye movement)
Incoordination
3 severe, centrally mediated signs of intoxication:
seizures
coma
death
4 physiologic considerations of Alcohol Use in older adults:
Decreased body water/body mass (higher conc. alcohol)
Decline liver/kidney
Malnutrition/Weight loss
Injuries/Falls
4 reasons the Elderly are more sensitive to Alcohol:
*this is why older people develop problems with alcohol even if drinking habits have not changed
Metabolize more slowly
Stays in body longer
Decrease body water
Lower body’s tolerance
Alcohol induced changes in the Elderly Brain that is often misdiagnosed as dimentia:
Biological Brain Disorder
Biological Brian Disorder: withdrawal, Seizures, Organic hallucinations, Psychosis, Dementia, and _______
Delirium tremens (DT’s)
4 consequences of Chronic Alcoholism in the Elderly:
Systemic (neuropathies)
Fatigue/weight loss
Existing conditions worsen (HTN, diabetes, etc)
Psychological (isolation, depression, anxiety, suicide)
Mixing alcohol with what can cause GI bleeding?
Aspirin/NSAIDS
Alcohol plus what can cause liver damage?
Acetaminophen
Cold/allergy meds + antihistamines + alcohol = 4 things
Drowsiness
Impaired judgement
Reaction time
Decreased coordination
CNS drugs + alcohol = 5 things
Sleepiness
Poor coordination
Dyspnea
Tachycardia
Memory problems
Alcohol withdrawal occurs in stages and includes what 4 things?
Paranoid behavior
Disorientation
Grand mal seizures
DT’s (delirium tremens), shaky tremor movements
Chronic signs of alcoholism, watch what 4 things:
Bleeding
Oropharyngeal cancer
Liver cancer
Peripheral neuropathy
Mothers that drink:
Fetal Alcohol Syndrome
2 features of Fetal Alcohol Syndrome:
Intellectual disabilities
Craniofacial probs
What drug inhibits the metabolism of Aldehyde Dehydrogenase, increasing serum levels of Acetaldehyde?
disulfiram (Antabuse )
disulfiram is used for what?
Tx alcoholism
If you drink while taking disulfiram you will _____
vomit
Other than alcohol, what is a contraindication when taking disulfiram (Antabuse)
Alcohol containing mouth rinses
For an Alcoholic, 5 Dental Tx Considerations:
Poor OH
Bilateral Parotid gland enlargement
Liver failure (bleeding)
Ascites
Difficulty metabolizing drugs
7 oral complications of Alcoholism
*must know
Glossitis
No Tongue Papillae
Angular Cheilitis
Fungal infections
Bleeding
Oral cancer (squamous cell)
leukoplakia, ulceration of lateral borders of tongue
If you’re Tx an alcoholic, examine the tongue carefully for what?
Precancerous lesions
4 abused opioids:
Heroin
Methadone
Morphine
Oxydodone
*oxycontin widely abused by dentists
Why are opioids typically abused?
Produce complete satiation for all drives of body
*only in absence of pain
What drug is widely abused by dentists?
Oxycontin
*brand that is oxycodone only
T/F
Physical dependency increases motivation to obtain the drug and fear of withdrawal overrides motivation to stop using
True
*addicts often resort to criminal activity to obtain drug
Oxycodone, when asked by name, should be a Red Flag?
Roxicet
*most concentrated part of oxy in middle of tablet
T/F
Oxycodone can be smoked,
True
What pain meds are included in REMS program?
Risk Eval and Mitigation Strategy (FDA)
Extended-release, oral-dosage forms of opioids
*potential for abuse very high
Number of women dying from opioid painkiller overdose increased how much between 1999 and 2010?
*deaths up ____%
Fivefold
*deaths up 400%
T/F
In 2007 it was the first tome in 100 yrs that drug induced death exceeded death from motor vehicles
True
3 reasons women have more opioid overdoses?
Chronic pain
More likely to get a prescription
Engage in doctor shopping
Abuse of prescription (Rx) painkillers by pregnant women can affect the infant how?
This increased by ____% between 2000 and 2009
Neonatal abstinence syndrome
300%
CDC Opoid recommendations for Rx’s
5
follow responsible guidelines
Use states’ Rx drug monitoring programs
Discuss pain Tx options
Discuss risks/benefits
Avoid prescribing combos of Rx painkillers and benzodiazepines
2 Things clinicians must avoid when prescribing pain meds (and other controlled substances)
Overprescribing
Big quantities (always limit quantity)
Why injecting heroin is a problem:
3 consequences
HIV
Hep
Heart valve damage
If a pt has heart valve damage secondary to heroin use, what would they need prior to dental Tx?
Antibiotic premedication
The heroin death rate has increased by how much across 28 states?
2x
7 signs of Acute Opioid Overdose
*must KNOW
Pinpoint pupils
Depressed respiration
Hypotension
Shock
Slow/absent reflexes
Drowsiness
Coma
What is the drug to use if you overdose on an opioid?
naloxone (Narcan)
*used for acute narcotic overdose
What is used to treat opioid withdrawal?
Methadone
2 reasons Methadone is used to Tx opioid withdrawal:
Physiologically equivalent to heroin
Replace heroin and gradually withdrawn
Dental implication to Opioid-tolerant pts?
Require more pain meds
- asking for more pain meds may be sign of addiction
- use NSAIDS
diazepam (Valim), lorazepam (Ativan), alprozolam (Xanax) are what class of drugs?
Benzodiazepans
BDZ’s
Unavailability of BDZ (unavailability due to hospitalization/other med problem):
Benzo-abstinence syndrome
*go through withdrawal
3 indications for BDZ’s
*significant physical dependence/addiction
Chronic anxiety
Depression
Sleep disturbance
BDZ’s have significant ______ effect with other sedatives.
Never combine BDZ’s with what?
Additive
Alcohol
BDZ’s have a prolonged ______, which predisposes to easy intoxication
BDZ withdrawal is similar to what kind of withdrawal?
Half life
Alcohol
Dangerous DDI with BDZ’s
Alcohol
When giving a BDZ Rx teach pts to do what?
Avoid Alcohol
!!
Consequence of long half life of BDZ’s:
Linger days after - alcohol can still be dangerous
What is the Antidote to BDZ overdose?
flumazenil
*generic only
Flumazenil used for BDZ overdose WON’T block _____ effects from alcohol, barbiturates, general anesthetics, or opiates (won’t block other depressants)
may not reverse what?
may cause what?
CNS
respiratory depression/hypoventilation
seizures
3 uses for BDZ’s in dentistry:
Anxiety
Sedation
Pre-anesthetic (amnesiac)
What are 2 the most commonly abused Legal stimulants?
2 Illegal?
Caffeine, Nicotine
Cocaine, methamphetamine
Most potent vasoconstrictor in all of medicine?
Cocaine
Only reason cocaine is used medically?
Eye surgery
Profound sense of euphoria, produces intense psychological dependency but no tolerance or withdrawal
Cocaine
If over-use cocaine, euphoria stays but what increases?
Paranoia
4 signs of Cocaine use:
*know these!
Nasal bleeding/necrosis
Dilated pupils
Hypertension
Localized gingival recession/bleeding and alveolar bone necrosis in maxillary premolar area
What should a dentist never do within 24 hrs of cocaine use?
(b/c hypertension)
give Epinephrine
What is the most commonly abused form of amphetamines?
Methamphetamine (crystal meth)
What produces LONGER effects, cocaine or meth?
Methamphetamine
Amphetamines are considered what?
Sympathomimetics
dextroamphetamine (Dexadrine) is used for what?
What does it inhibit?
ADHD (stimulant)
Monamine oxidase
A selective norepinephrine reuptake inhibitor used for ADHD?
Is this an amphetamine?
atomoxetine (Straterra)
no
Main drug for ADHD
methylphenidate (Ritalin)
Stimulant psychedelic, first used as an appetite suppressant?
Ecstasy
Ecstasy side effects include: Anorexia, nausea, muscle stiffness, ataxia, sweating, tachycardia, hypertension _______ and ______
Trismus
Bruxism
6 side effects of Ecstasy:
Trismus/Bruxism
Fatigue, insomnia
Tolerance
Hepatotoxic
Long term psychiatric
Fatal
Meth is a stimulant where?
CNS
What form of meth is used for ADHD, narcolepsy, and obesity?
*medical form
dextromethamphetamine (Desoxyn)
*know both names
Meth is dangerous b/c it uses multiple pathways in the brain and downregulates ______
*brain structure/function become altered with chronic use
dopamine
1st time on meth:
surge of dopamine
and norepinephrine and serotonin
Sensation of insects crawling beneath the skin, seen in meth use (crank bugs)
formication
Meth is especially neurotoxic to what?
dopaminergic neurons
Degradation of dopamine produces what?
*secondary to Meth use
ROS - reactive oxygen species
*likely what kills neurons after meth use
What are 4 manifestations of Amphetamine Psychosis?
Hallucinations
Paranoia
Delusions
Thought disorders
T/F
Parents often miss meth withdrawal signs, b/c they include prolonged sleep moodiness, and depression
True
Depression with Meth is often longer/deeper than with Cocaine, which is why _____ is common
relapse
What is the antidote to meth?
None
*nothing comparable to heroin addicts
2 most common routes of taking meth?
oral
smoking
Who uses meth?
increasing in college and young professionals
Meth OD is heart failure, and long term physical damage to kidneys, liver, and lungs
True
Meth Use
*know these 7 signs!!
Dilated pupils
HTN/tachycardia
Anorexia
increased sweating
moodiness
xerostomia
bruxism
T/F
Like cocaine, there is no tolerance effect to prolonged use of Meth
False
*tolerance develops
Erosion, poor OH, caries, perio infection, bruxism, tissue damage, oral ulcerations/infections, oral burns:
Meth Mouth
Signs of Acute OD of CNS stimulants
*know these 8
dilated pupils
HTN
elevated pulse
arrhythmias
extreme sweating
hyperthermia
hyperactivity
tremors
Withdrawal rxns to CNS stimulants in a Modest Abuser:
Heavy Abuser:
fatigue, prolonged sleep
Prolonged sleep, depression, suicidal tendency
Consequences of smoking: lung cancer, oral cancer, lowered ______, heart disease, periodontal disease
estrogen levels
osteoporosis
Nicotine turns on what cytokine?
function?
IL-6
turns on osteoclasts - leads to osteoporosis/rapid bone loss in perio disease
When burned, how many chemicals are in cigarette smoke?
4000
2 reasons nicotine is especially detrimental to women?
Estrogen gone as protective barrier - increase in IL-6 (normally suppressed by estrogen)
IL-6 increases osteoclastic activity
Orally, in smokers, where will you most often see narrow, deep, perio defects with fibrotic tissue.
Around anterior
What is a secondary reason meth users will have bad teeth?
Meth users crave sugar
Irritability, HTN, increased pulse, nausea/vomiting, dizzy, coronary artery disease, lung and oral cancer:
Nicotine
8 notable chemicals in cigarettes:
Tar
hydrogen cyanide-genocidal agent WWII
Benzene
Acetone
Formaldehyde
Ammonia
CO
nicotine
Erosion, poor OH, Caries, perio infection, bruxism, tissue damage, oral ulcerations, oral burns:
Meth Mouth
Anxiety, irritability, difficulty concentrating, headaches, drowsiness, increased apetite, sleep disturbances, and craving
Nicotine (tobacco) withdrawal
T/F
Cigars are safer than cigarettes
False
*and more nicotine
Major cause of esophageal cancer:
Cigarettes
3 ways smoking contributes to cancer:
3 types of cancer
Esophageal cancer
Mouth cancer
Oral cavity/pharynx cancer
T/F
Girls smoke more than boys
True
*boys do it to look cool, girls establish at younger age
What are “light” cigarettes?
Are they less dangerous?
Less tar
No
E-cig nicotine can help people to quit long term
True
What is the only cancer that hasn’t had any statistical changes for a 5 year prognosis?
Oral cancer
Why are women more likely to be successful when attempting to stop smoking?
more likely to use support group
Ask, Advise, Refer:
Program to assist dental professionals with helping pts to quit smoking
4 hallucinogens:
LSD
PCP
Mescaline
Marijuana
Why must pts completely stop smoking before initiating smoking cessation therapy?
Nicotine is a vasoconstrictor
*raises CV risk - can’t smoke and take nic patches at same time
T/F
The safety and efficacy of nicotine therapy are not established in children
True
People require how many attempts on average to stop smoking?
5-8
7-12 weeks (3 months) less dosage than through smoking, designed to decrease nicotine craving:
Step-down approach
3 risks to bupropion (Zyban) for smoking cessation:
seizures
HTN
psycho
Dopamine reuptake inhibitor used as an antidepressant and for smoking cessation:
bupropion (Zyban)
***wellbutrin if antidepressant
smoking cessation drug that is a partial neuronal alpha4 B2 nicotinic receptor agonist (occupies nicotine receptor sites in brain)
varenicline (Chantix)
varenicline (Chantix) mechanism:
stimulates dopamine activity
*but less than nicotine - decreases craving/withdrawal symptoms
Some people have a higher chance of relapse at certain times of day
True
What drug used for smoking cessation has the highest success rate?
verenicline (Chantix)
2 contraindications to nicotine replacements:
Pregnancy
CV
Hallucinogens (psychodelics) foster _____ dependence
_____ develops quickly
psychological
tolerance
3 consequences of long-term use of hallucinogens:
depression
panic disorders
schizo
Hallucinogens are powerful _______ and ______
stimulants
sympathomimetics
2 major psychoactive chemicals in marijuana:
delta-9-tetrahydrocannabinol (THC)
Cannibidiol (CBD)
What marijuana chemical is an appetite stimulant?
Which is neuroprotective?
THC
CBD
What does long-term chronic use of marijuana cause?
physical dependence
Withdrawal
psychological dependence
addiction
Teens with genetic predisposition for depression, schizophrenia, and psychotic disorders are at increased risk for these if they use marijuana
True
4 oral complications to marijuana use:
xerostomia
gingivitis
leukoplakia
hyperkeratinized tissues
What herbal mixture produces the same effect as marijuana and acts on same receptors as THC?
K2/spice
K2/spice has what type of effects?
sympathetic
What is the synthetic version of marijuana?
Schedule ____ drug
Approved for what 2 things?
dronabinol (Marinol)
III
nausea, appetite stimulation
4 predatory drugs:
ecstasy
gamma hydroxy-butyrate
ketamine
rohypnol
Another name for Rohypnol:
it is a _______
flunitrazepam
benzodiazepine
What euphoric sedative (anabolic) drug is associated with sexual assualt cases?
analogue found in industrial solvents:
GHB - gamma hydroxy-butyrate
sodium oxybate (Xyrem)
A sedative hyptnotic drug, analgesic and hallucinogenic
also used as general anesthetic in vetrinary medicine
Ketamine
nightmares
suicidal thoughts
adverse cardiac events
xerostomia
headache
nausea
verenicline (Chantix)
*side effects
The high of marijuana:
medical effects:
THC
CBD
What molecule is implicated in a lot of psychiatric disorders such as anxiety, depression, OCD, and schizophrenia?
Serotonin (5-HT)
Headaches and migraines involve a disregulation of what?
serotonin
What receptors are important for pain modulation in descending pathways, especially chronic pain?
Serotonin (5-HT) - stimulation produced analgesia
Data supports that migraines are caused by what?
Chronic 5-HT dysregulation
What family of drugs is a vasoconstrictor that inhibits depolarization of Dural blood vessel-associated nociceptors and possibly blocks neurogenic inflammation?
Ergot derivatives
2 examples of Ergot derivatives used to “abort” a migraine?
ergotamine
ergotamine + caffeine
Timing is an important factor for migraine drugs, and taking them at the beginning of the episode will be more effective
True
What ergot derivative is used for chronic, protracted migraine in a hospital setting?
dihydroergotamine (Migranal)
3 families of drugs that can be used to treat migraines:
Ergot derivatives
Triptans
Antiemetics
What anti-emetic is used for migraines?
isometheptene (Midrin)
Family of drugs that cause vasoconstriction and reduce neurogenic inflammation and provide relief from nausea (antiemetic)?
Triptans
First drug in the class of Triptans?
vasoconstrictor, reduces neurogenic inflammation
sumatriptan (Imitrex)
2 examples of Triptans?
sumatriptan
zolmitriptan
Acetaminophen + sedative that helps migraines and tension headaches?
isometheptene
2 components of isometheptene and what they do:
acetaminophen - analgesic
dichrolalphenazone - tranquilizing
Why are anti-emetics used to treat migraines?
Control nausea/gastric irritation
Because antiemetics are also antipsychotics, they cause _______ effects in the brain and result in ______
extrapyramidal
movement disorders
3 antiemetics:
prochloroperazine
metoclopramide
promethazine
8 classes of drugs that can be used for migraine prophylaxis:
tricyclic antidepressants
SSRI’s
Selective 5-HT and NE reuptake inhibitor
Beta blockers
Antiseizure meds
Ca ++ channel blockers
NSAIDS
Corticosteroids
NSAID used for migraine prophylaxis:
indomethacin (Indocin)
Intractable migraine, only drug to use after hasn’t responded to other interventions?
corticosteroids
4 corticosteroid mechanisms:
migraine specific
GABA receptor modulators
Suppress neurogenic inflammaiton
Block neurogenic extravasation
Block high-voltage activated Ca++ currents by blocking Ca++ channels
A form of arthritis caused by accumulation of uric acid crystals in joints:
Gout
Overload of uric acid in Gout leads to what?
Formation of tiny crystals of urate
Gout is considered a chronic and progressive disease
True
Gout affects joints, but does not affect organs
False
*decreases kidney function
Gout can be inherited
True
Gout, uric acid is a breakdown product of ______, resulting in overload of uric acid in the body that produces painful ______ attacks and deposits of lumps of crystals in body tissue
purines
arthritic
Where is gout usually found?
Extremities, esp big toe
Elevated levels of Uric Acid w/o symptoms:
Asymptomatic hyperuricemia
2 types of Gout:
Excessive production of uric acid
Reduced excretion of uric acid
With gout, what foods should you avoid?
Purine-rich
5 things that predispose to Gout:
Dehydration
Fever
Infection
After surgery
Injury to joint
5 foods that are protective against Gout:
Cherry juice
Veggies
Dairy
Dark pure chocolate
Pineapple
Pts with longstanding hyperuricemia can have uric acid crystal deposits called what?
*this is in other tissue
Tophi
4 distinct stages of Gout:
Asymptomatic
Acute phase
Intercritical phase
Chronic
Drug used to treat Acute attack of Gout (only use for drug)
*inhibits neutrophil migration/phagocytic activity of inflamed joints
colchicine (Colcrys)
Original drug on the market for gout?
colchicine
4 side effects for colchicine (for gout)
GI toxicity
bone marrow depression
myopathy
alopecia
Drug of choice for pts that make too much uric acid
*works by inhibitying synth of uric acid
allopurinol (Zyloprim)
Drug used for management of Chronic Gout
*also used during chemo and radiation
allopurinol
4 side effects of allopurinol:
hepatotoxic
pruritic rash
allergic skin
blood rxns
What drug for Gout works by increasing the excretion of uric acid?
*Uricosuric Agent
probenecid (Bememid)
probenecid (Bememid) is indicated for what?
*2 things
Chronic gout
Acute gout w/ increased severity/frequency
What drug interferes with the Uricosuric action of probenecid?
Aspirin
*only at LOW DOSE
probenecid can be combined with what antibiotic to delay the excretion of the antibiotic?
penicillin
*allows you to keep penicillin in body for longer
What is the purpose of NSAIDS to treat Gout?
Relieves pain, tenderness, swelling of Joint
*no mechanism against gout itself
