MEMORIZE TEST 2

Question 1

Drugs for gout that decrease uric acid levels

Answer 1

In gout, serum uric acid is usually increased above 6 mg/dL.

The gold standard for diagnosis of gout is synovial fluid aspiration.
Affected fluid contains needle-like monosodium urate crystals.
This procedure is done in only a small number of patients because diagnosis
can typically be made on clinical symptoms alone.

Gout
Attack Prevention
Xanthine oxidase inhibitor
Allopurinol (Zyloprim, Aloprim)–most common
Decreases the production of uric acid
SE: Bone marrow suppression, vomiting, abdominal pain
Uricosuric agent
Probenecid (Benemid)
Increases urinary excretion of uric acid
Ineffective if creatinine clearance is reduced
Avoid aspirin: Decreases drug effects, increases SE risk

Question 2

Drugs for gout that treat acute inflammation

Answer 2

Collaborative Care (acute attack)
Medications for inflammation
Colchicine (anti-inflammatory but no analgesic effect)
Corticosteroids (Prednisone)
Used instead of colchicine if renal impairment or adverse SE

Question 3

Drugs for gout that treat pain

Answer 3

Medications for pain
NSAIDs or opioids for pain

Question 4

Side effects of muscle relaxants

Answer 4

Drowsiness
Lassitude (A state or feeling of weariness, diminished energy, or listlessness. synonym: lethargy.The state of having the energies weakened; weakness; weariness; languor of body or mind.)
Headache
Weakness and fatigue
Blurred vision
Ataxia
Gastrointestinal upset

Question 5

name the 3 muscle relaxers used in pts with fractures

Answer 5

Carisoprodol (Soma), Cyclobenzaprine (Flexeril), Methocarbamol (Robaxin)

Question 6

what meds do you use for phantom limb pain

Answer 6

Gabapentin, SSRIs

Mirror therapy (looking in the mirror at the residual limb)The mirror is thought to give visual information to the brain,
replacing sensory feedback expected from the missing limb.
The practice consists of placing the intact limb in front of a mirror while the residual
limb is placed behind the mirror in a similar position; the patient then practices
repetitive movements with both limbs and has the visual perception that the
amputated limb is intact and obeying commands sent from the brain.

Question 7

Rheumatoid Arthritis-
Drug Therapy

Answer 7

Disease-modifying antirheumatic drugs (DMARDs)
Cornerstone of RA treatment
Slows disease progression
Examples: Methotrexate and hydroxychloroquine (Plaquenil)
Risk of toxicity and some not safe in pregnancy

Biologic/Targeted therapy
Slows disease progression for patients who haven’t responded to DMARDs by inhibiting inflammation.
Examples: etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira)

Corticosteroids
To treat exacerbations
Oral or intraarticular injections
Do not affect disease progression
Complications include osteoporosis and avascular necrosis.
NSAIDs and salicylates
For pain and inflammation
Aspirin may be used in dosages of 3 to 4 g/day in 3 to 4 doses.
NSAIDs have anti-inflammatory and analgesic effects.

Question 8

OA- Drug Therapy

Answer 8

Mild to Moderate pain
Acetaminophen
OTC topical products
Topical capsaicin (Zostrix)*also available in prescription-strengthCapsaicin blocks pain by locally interfering with substance P.
It is responsible for the transmission of pain impulses.

Products w/ camphor, eucalyptus oil, and menthol (e.g. BenGay, Arthricare)

Topical salicylates (Aspercreme)

If pain persists, NSAIDs NSAIDs: If the patient is at risk for or develops gastrointestinal (GI) side effects with
an NSAID, adding a protective agent, such as misoprostol (Cytotec), may be needed. Diclofenac gel may be applied to the affected joint.
Teach the patient who is taking an oral NSAID to avoid use of a topical NSAID
because of increased risk for adverse effects.
Long-term NSAID use for osteoarthritis of the knee may worsen inflammation of the joint

Question 9

Clostridium difficle (C. Diff) MED

Answer 9

Treated w/ IV or oral metronidazole (flagyl) and/or oral vancomycin

Question 10

Incontinence (Drug Therapy)

Answer 10

Muscarinic Receptor Antagonists and Anticholinergics
Reduce overactive bladder contractions
Used for urge incontinence and overactive bladder
Oxybutynin (Ditropan)
Tolterodine (Detrol)
Solifenacin (VESIcare)
Dicyclomine (Bentyl)

α-Adrenergic Antagonists
5α-Reductase Inhibitors
Used when incontinence is related to BPH

Question 11

BPH: Alpha Blockers

Answer 11

-Blocks the α1-adrenergic receptors in the prostate smooth muscle to improve urinary flow

-May cause orthostatic hypotension

Examples:
Silodosin (Rapaflo)
Alfuzosin (Uroxatral)
Terazosin (Hytrin)
- Doxazosin (Cardura)
Tamsulosin (Flomax)
Prazosin (Minipress)

Improvement in days to 2-3 weeks (50-60%)

Other SE: Retrograde ejaculation (semen is redirected to urinary bladder—bladder sphincter doesn’t contract before ejaculation), nasal congestion, and dizziness

Also used for HTN

The medications do not treat hyperplasia (helps w/ symptom mgmt.)

Question 12

BPH: 5alpha reductase inhibitors:

Answer 12

5alpha reductase inhibitors:
*5 alpha-Reducatase Inhibitors:

Finasteride (Proscar)
Reduces the size of the prostate gland to improve urine flow
Blocks the 5α-reductase isoenzyme (type 2), which is needed to convert testosterone to dihydroxytestosterone
Takes 4-6 months to be effective

Dutasteride (Avodart)
Same effect, dual inhibitor of 5α-reductase isoenzyme 1 and 2
SE: decreased libido, decreased volume of ejaculate, ED
Monitor liver function tests

Finasteride: (Proscar) to shrink the prostate and improve urine flow. Lowers levels of dihydrotestosterone (DHT) which is a major cause of prostate growth.

Risk of orthostasis w/ ED drugs

Can increase liver function tests

Women who may be or are pregnant should not handle tablets due to potential risk to male fetus (anomaly).