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

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

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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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
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
Tramadol: CONTRA
acute intoxication w/ ETOH, hypnotics, CNS drugs, opiates, psychotropic drugs May cause CNS depression
26
Tramadol: Interactions/AE
Interactions: Carbamazepine, fluoxetine, paroxetine, quinidine, quinine, ritonavir, ETOH, MAOI, SSRI, TCA AE: flushing, dizziness, HA, insomnia, pruritus, constipation, N/V, dyspepsia, weakness, diaphoresis
27
Tramadol: Administration
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
Opioids: USE/MOA
1. HIGH abuse potential 2. Dose on fixed dosing intervals Tx moderate to severe pain PREG C CAUTION w/ elderly and children
29
Opioids: AE
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
Skeletal Muscle Relaxants
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
Muscle Relaxant DRUGS
1. cyclobenzaprine (Flexeril) 2. carisoprodol (Soma) 3. Clorzoxazone (Paraflex, Parafon Forte) 4. Metaxalone (Skelaxin) 5. Methocarbamol (Robaxin) 6. Orphenadrine (Norflex)
32
Cyclobenzaprine (Flexeril) MOA
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
Cyclobenzaprine CONTRA/AE
CONTRA: hyperthyroidism, MAOI use Overdose: conduction disturbances, death AE: CNS dep, anticholinergic activity
34
Cyclobenzaprine INTERACTIONS/DOSE
Interactions: CNS dep, antimuscarinic meds, tramadol, MAOI, H2 blockers, herbs
35
Carisoprodol MOA/USE
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
Carisoprodol CONTRA
CONTRA: CNS dep, Hx of drug or ETOH dependence, seizure disorder Risk of idiosyncratic reaction: weakness, visual or motor disturbances, confusion, euphoria
37
Carisoprodol Administration/AE/Interactions
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
Chlorzoxazone MOA
MOA: acts on spinal cord and subcortical levels by depressing polysynaptic reflexes PREG C
39
Chlorzoxazone CONTRA/INTERACTIONS
CONTRA: impaired liver function Interactions: CNS dep, INH, disulfiram, azoles, ETOH
40
Chlorzoxazone AE/Administration
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
Metaxalone MOA/CONTRA/Interactions
Central muscle relaxant CONTRA: hepatic or renal dysfunction NO pregnancy, NO lactation, NO children <12yo Interactions: CNS dep, benzos, ETOH, TCA
42
Metaxalone AE/CAUTION
AE: dizziness, HA, nausea, rash, itching, jaundice elderly more at risk for CNS effects and CNS depression Death from overdose and w/ ETOH
43
Metaxalone Administration
dose: 800mg TID to QID Onset 1hr, duration 4-6hrs less sedating that other muscle relaxants
44
Methocarbamol MOA/CONTRA
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
Methocarbamol AE/INTERACTIONS
AE: drowsiness, dizziness, GI upset, blurred vision, HA Interactions: CNS dep, ETOH, herbs
46
Methocarbamol Administration
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
Orphenadrine MOA/USE
MOA: centrally acting CNS Anti-Parkinson's agent, Anticholinergic agent PREG C, Adults and children >12yo
48
Orphenadrine CONTRA/CAUTION
CONTRA: glaucoma, achalasia, GU/GI obstruction, MG CAUTION: CAD, arrhythmias, asthma Interactions: haloperidol, amantadine, phenothiazines, MAOI, anticholinergic meds
49
Orphenadrine AE/Administration
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
Pain/Spasms: Adjuvant therapies for PAIN
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
Mild to Moderate migraine tx
OTC meds: Excedrin, Tylenol NSAIDS
52
Mild to Moderate migraine tx
OTC meds: Excedrin, Tylenol NSAIDS
53
Moderate to Severe migraine tx
1. Migraine specific: triptans, ergots 2. Non-specific narcotics/analgesics: fioricet, opioids, butalbitals
54
Triptans MOA

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