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Flashcards in II Pharm IV Deck (266):
1

What are the most abused drugs in all age groups?

Alcohol and tobacco

2

4 Factors that increase potential for abuse:

Potency

Rapid onset

Inexpensive

Easy to obtain/distribute

3

What are "potential" pts?

call office seeking pain meds w/o being seen

4

In order to give a script:

2 things

pt of record

dental need

5

Why is a drug "scheduled"

Potential for abuse

6

Drugs that are used in a manner/amount inconsistent w/ med or social pattern of culture

Drug Abuse

7

When a drug necessitates continued administration to prevent withdrawal:

Physical dependence

8

Physical dependence is addiction

False

*chronically dependent opiates for pain = physical dependence but not an addict

9

You can be physically dependent on a drug and not be addicted to the drug:

True

*but addicts are usually physically dependent

10

Perceived need or craving for a drug:

Psychological dependence

11

What is the primary reason for relapse:

Psychological dependence

12

3 signs of addiction:

Compulsive drug-seeking behavior

Continued use despite serious consequences

ALWAYS psychological dependence (so relapse common)

13

Physiologic tolerance or psychological dependence short of addiction:

Habituation

14

4 behaviors associated w/ addiction:

Anal retentive

OCD

Controlling

Manipulative

15

T/F
Habituation will ALWAYS lead to addiction or dependency

True

16

With repeated dosing, drug must be increased to produce same effect:

Tolerance

17

What kind of tolerance to Psychoactive drugs produce?

Central tolerance

*definite decrease in the response of brain tissue to constantly increasing amounts of drug

18

Is tolerance the same as Metabolic Tolerance?

NO

*it is central tolerance - would need accelerated metabolic rate - not really a factor w/ most psychoactives

19

Behavior of others associated with user that results in continued drug abuse:

Enabling

20

The state of being free of drugs:

Abstinence Syndrome

21

Using opiates for sleeping aid would be considered what?

Misuse

22

T/F
Nicotine/EtOH are considered "gateway" drugs

True

23

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

24

A primary, chronic, progressive, relapsing disease process with genetic, psychosocial, and environmental factors influencing its development and manifestations:

Chemical Dependency

25

When comparing drugs in the same group, the time required to produce physical dependence is shortest with a rapidly metabolized drug.

True

26

The time course of withdrawal rxns is related to the half-life of the drug

True

27

How do we Tx abuse:

3 things

counseling

education

self-help groups

*but person must WANT help

28

The leading cause of ER visits and accidental overdose among kids (esp in AZ)

Access to stored meds

29

3 considerations for Drugs and Children:

Increased mem. permeability

Dosing based on weight

Half adult dose

30

Poison Prevention Act 1970:`

prescriptions must have Child-resistant containers

31

2 psychological trends in children seeking drugs:

Appearance:

If anxiety - seek downers

Low self esteem - uppers

Appear drunk/intoxicated

32

Kids are abusing prescription drugs more than cocaine, heroin, hallucinogens, and Ecstasy combined

True

*prescription drugs more popular than recreational drugs

33

What causes more overdoses in adolescents than cocaine and heroin combined?

Opiates (hydrocodone w/ acetaminophen especially)

34

2 reasons inhalants are abused:

Huffing/Sniffing very easy

Accessible (markers, glue, white out)

35

What is difluoroethane?

Why important for Dentistry?

Can lead to what?

Inhalant - halogenated hydrocarbons

Increase heart muscle sensitivity to Epinephrine

Sudden Death

36

Inhalants known as poppers, snappers?

Amyl nitrite

Butyl nitrite

37

Whippets are:

Nitrous oxide

38

T/F
Kids abuse prescription drugs more than street drugs and this is known as "pharming"

True

39

5 signs of inhalants

*produce similar effects as anesthetics

Intoxication

Slurred speech

Inability to coordinate movements

Euphoria

Dizziness

40

What is the most abused drug among children?

Vicoden

41

5 causes of death due to inhalants:

Hepatotoxicity

Suffocation

Resp depression

Sudden sniffing death

Cardiac death (difluoroethane)

42

What is in Robitussin

Dextromethorphan

43

What does Dextromethorphan do at low dose?

High dose?

What drug is it similar to and where does it act?

Antitussive

Hallucinogenic

Morphine, centrally

44

Robotripping involves drinking ____oz's of DXM (Robitussin) until nausea causes you to ____ and ______

4 ounces

vomit, hallucinate

45

A lot of cold meds are _______ and considered ________

This means they can't be used in people that have ______

Adrenergic Agonists

Vasoconstrictors

Hypertension

46

What cold med doesn't have Acetominophen but still contains DXM (dextromethorphan)?

Coricidin HBP

47

What is Coricidin's street name?

Skittles

48

T/F
Alcohol use is on the rise, including binge drinking

False

*continues to decline

49

Alcohol use is decreasing except for what demographic?

College age girls

50

Roofie:

Rohyponol

51

Why are women more susceptible to alcohol poisoning?

Don't make as much Alcohol Dehydrogenase as men

52

As of _____, cigarette use reached an all-time low due to peer disapproval

2014

53

More popular among teens: cigarettes or e-cigs?

e-cigs

54

The FDA regulates e-cigs

True

but, legislation just passed

55

In 1998 ____% students had tried tobacco

In 2014 ___%

56%

23%

56

The greatest decline of illicig drug use has been with what drug?

Synthetic marijuana

(K-2, spice)

57

Most students recognize synthetic marijuana as a dangerous class of drug:

False

58

Amphetamine-like stimulant found naturally in the Khat plant:

Bath salts

(less than 1% student use)

59

The use of exctasy, salvia, and shrooms have declined

True

60

10 illicit drugs that have remained unchanged in use:

heroin

crack

meth

ritalin/adderall

LSD

Inhalants

Powder cocaine

tranquilizers

sedatives

anabolic steroids

61

What receptor does ecstasy bind to in the brain?

NMDA receptors

62

Most teens get their drugs from a friend/relative

True

63

3,4 methylenedioxypyrovalerone (MDPV):

aka, drone, meph, meow meow, methylone

Bath Salts

64

Substance abuse disorders are expected to double by 2020 and the Tx admission for substance abuse has doubled since 1992

True

*baby boomers

65

1/3 Baby Boomers use Rec. drugs

True

66

Elderly adults w/ substance abuse put themselves at risk for what 3 things?

Cancer

Infections

Infectious diseases

67

Newest demographic for HIV

Women over 65

68

Adults over 65, increasing use of what?

Alcohol

69

5 diseases Elderly Smokers will die from:

COPD

Heart disease

Stroke

Cancer

Alzheimer's

70

Most commonly used recreational drug?

Marijuana

71

The proportion of older adults seeking Tx for substance abuse is increasing compared to younger adults

True

72

Alcohol/Rec. drug dependency often come about by what 3 things?

Chronic pain use - initial

Psychological probs - sleeping, anxiety, depression

Loneliness, boredom

73

4 Recreational and OTC meds abused by older adults:

Opioids

Benzodiazepines

Alcohol

Sleeping preparations

74

4 substances abused by older adults:

Rx and OTC meds

Alcohol/tobacco

Marijuana

Cocaine/Heroine (diminished after 60)

75

Most commonly abused CNS depressants?

2 other classes used fairly commonly:

Opioid analgesics

benzodiazepines, barbiturates

76

What are the 2 most commonly abused CNS stimulants?

Amphetamines

Methylphenidate

77

5 Examples of depressants:

Alcohol

Benzodiazepines

Opioids

Inhalants

Nitrous oxide

78

The most frequently abused drug:

Alcohol

79

Alcohol is oxidized to what in the liver?

Acetaldehyde

80

Acetaldehyde is metabolized to what?

Excreted where?

CO2 and water

lungs/urine

81

6 cancers linked to Acetaldehyde:

Oral

Pharyngeal

Gastric

Pancreatic

Liver

Bladder

82

Alcohol is eliminated from the body via _____ kinetics

What is the rate?

Zero-order

1g/hour

83

4 signs alcohol intoxication?

Dilated pupils

Slurred speech

Nystagmus (involuntary eye movement)

Incoordination

84

3 severe, centrally mediated signs of intoxication:

seizures

coma

death

85

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

86

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

87

Alcohol induced changes in the Elderly Brain that is often misdiagnosed as dimentia:

Biological Brain Disorder

88

Biological Brian Disorder: withdrawal, Seizures, Organic hallucinations, Psychosis, Dementia, and _______

Delirium tremens (DT's)

89

4 consequences of Chronic Alcoholism in the Elderly:

Systemic (neuropathies)

Fatigue/weight loss

Existing conditions worsen (HTN, diabetes, etc)

Psychological (isolation, depression, anxiety, suicide)

90

Mixing alcohol with what can cause GI bleeding?

Aspirin/NSAIDS

91

Alcohol plus what can cause liver damage?

Acetaminophen

92

Cold/allergy meds + antihistamines + alcohol = 4 things

Drowsiness

Impaired judgement

Reaction time

Decreased coordination

93

CNS drugs + alcohol = 5 things

Sleepiness

Poor coordination

Dyspnea

Tachycardia

Memory problems

94

Alcohol withdrawal occurs in stages and includes what 4 things?

Paranoid behavior

Disorientation

Grand mal seizures

DT's (delirium tremens), shaky tremor movements

95

Chronic signs of alcoholism, watch what 4 things:

Bleeding

Oropharyngeal cancer

Liver cancer

Peripheral neuropathy

96

Mothers that drink:

Fetal Alcohol Syndrome

97

2 features of Fetal Alcohol Syndrome:

Intellectual disabilities

Craniofacial probs

98

What drug inhibits the metabolism of Aldehyde Dehydrogenase, increasing serum levels of Acetaldehyde?

disulfiram (Antabuse )

99

disulfiram is used for what?

Tx alcoholism

100

If you drink while taking disulfiram you will _____

vomit

101

Other than alcohol, what is a contraindication when taking disulfiram (Antabuse)

Alcohol containing mouth rinses

102

For an Alcoholic, 5 Dental Tx Considerations:

Poor OH

Bilateral Parotid gland enlargement

Liver failure (bleeding)

Ascites

Difficulty metabolizing drugs

103

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

104

If you're Tx an alcoholic, examine the tongue carefully for what?

Precancerous lesions

105

4 abused opioids:

Heroin

Methadone

Morphine

Oxydodone

*oxycontin widely abused by dentists

106

Why are opioids typically abused?

Produce complete satiation for all drives of body

*only in absence of pain

107

What drug is widely abused by dentists?

Oxycontin

*brand that is oxycodone only

108

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

109

Oxycodone, when asked by name, should be a Red Flag?

Roxicet

*most concentrated part of oxy in middle of tablet

110

T/F
Oxycodone can be smoked,

True

111

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

112

Number of women dying from opioid painkiller overdose increased how much between 1999 and 2010?

*deaths up ____%

Fivefold

*deaths up 400%

113

T/F
In 2007 it was the first tome in 100 yrs that drug induced death exceeded death from motor vehicles

True

114

3 reasons women have more opioid overdoses?

Chronic pain

More likely to get a prescription

Engage in doctor shopping

115

Abuse of prescription (Rx) painkillers by pregnant women can affect the infant how?

This increased by ____% between 2000 and 2009

Neonatal abstinence syndrome

300%

116

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

117

2 Things clinicians must avoid when prescribing pain meds (and other controlled substances)

Overprescribing

Big quantities (always limit quantity)

118

Why injecting heroin is a problem:

3 consequences

HIV

Hep

Heart valve damage

119

If a pt has heart valve damage secondary to heroin use, what would they need prior to dental Tx?

Antibiotic premedication

120

The heroin death rate has increased by how much across 28 states?

2x

121

7 signs of Acute Opioid Overdose

*must KNOW

Pinpoint pupils

Depressed respiration

Hypotension

Shock

Slow/absent reflexes

Drowsiness

Coma

122

What is the drug to use if you overdose on an opioid?

naloxone (Narcan)

*used for acute narcotic overdose

123

What is used to treat opioid withdrawal?

Methadone

124

2 reasons Methadone is used to Tx opioid withdrawal:

Physiologically equivalent to heroin

Replace heroin and gradually withdrawn

125

Dental implication to Opioid-tolerant pts?

Require more pain meds

*asking for more pain meds may be sign of addiction

*use NSAIDS

126

diazepam (Valim), lorazepam (Ativan), alprozolam (Xanax) are what class of drugs?

Benzodiazepans

(BDZ's)

127

Unavailability of BDZ (unavailability due to hospitalization/other med problem):

Benzo-abstinence syndrome

*go through withdrawal

128

3 indications for BDZ's

*significant physical dependence/addiction

Chronic anxiety

Depression

Sleep disturbance

129

BDZ's have significant ______ effect with other sedatives.

Never combine BDZ's with what?

Additive

Alcohol

130

BDZ's have a prolonged ______, which predisposes to easy intoxication

BDZ withdrawal is similar to what kind of withdrawal?

Half life

Alcohol

131

Dangerous DDI with BDZ's

Alcohol

132

When giving a BDZ Rx teach pts to do what?

Avoid Alcohol

!!

133

Consequence of long half life of BDZ's:

Linger days after - alcohol can still be dangerous

134

What is the Antidote to BDZ overdose?

flumazenil

*generic only

135

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

136

3 uses for BDZ's in dentistry:

Anxiety

Sedation

Pre-anesthetic (amnesiac)

137

What are 2 the most commonly abused Legal stimulants?

2 Illegal?

Caffeine, Nicotine

Cocaine, methamphetamine

138

Most potent vasoconstrictor in all of medicine?

Cocaine

139

Only reason cocaine is used medically?

Eye surgery

140

Profound sense of euphoria, produces intense psychological dependency but no tolerance or withdrawal

Cocaine

141

If over-use cocaine, euphoria stays but what increases?

Paranoia

142

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

143

What should a dentist never do within 24 hrs of cocaine use?

(b/c hypertension)

give Epinephrine

144

What is the most commonly abused form of amphetamines?

Methamphetamine (crystal meth)

145

What produces LONGER effects, cocaine or meth?

Methamphetamine

146

Amphetamines are considered what?

Sympathomimetics

147

dextroamphetamine (Dexadrine) is used for what?

What does it inhibit?

ADHD (stimulant)

Monamine oxidase

148

A selective norepinephrine reuptake inhibitor used for ADHD?

Is this an amphetamine?

atomoxetine (Straterra)

no

149

Main drug for ADHD

methylphenidate (Ritalin)

150

Stimulant psychedelic, first used as an appetite suppressant?

Ecstasy

151

Ecstasy side effects include: Anorexia, nausea, muscle stiffness, ataxia, sweating, tachycardia, hypertension _______ and ______

Trismus

Bruxism

152

6 side effects of Ecstasy:

Trismus/Bruxism

Fatigue, insomnia

Tolerance

Hepatotoxic

Long term psychiatric

Fatal

153

Meth is a stimulant where?

CNS

154

What form of meth is used for ADHD, narcolepsy, and obesity?

*medical form

dextromethamphetamine (Desoxyn)

*know both names

155

Meth is dangerous b/c it uses multiple pathways in the brain and downregulates ______

*brain structure/function become altered with chronic use

dopamine

156

1st time on meth:

surge of dopamine

(and norepinephrine and serotonin)

157

Sensation of insects crawling beneath the skin, seen in meth use (crank bugs)

formication

158

Meth is especially neurotoxic to what?

dopaminergic neurons

159

Degradation of dopamine produces what?

*secondary to Meth use

ROS - reactive oxygen species

*likely what kills neurons after meth use

160

What are 4 manifestations of Amphetamine Psychosis?

Hallucinations

Paranoia

Delusions

Thought disorders

161

T/F
Parents often miss meth withdrawal signs, b/c they include prolonged sleep moodiness, and depression

True

162

Depression with Meth is often longer/deeper than with Cocaine, which is why _____ is common

relapse

163

What is the antidote to meth?

None

*nothing comparable to heroin addicts

164

2 most common routes of taking meth?

oral

smoking

165

Who uses meth?

increasing in college and young professionals

166

Meth OD is heart failure, and long term physical damage to kidneys, liver, and lungs

True

167

Meth Use

*know these 7 signs!!

Dilated pupils

HTN/tachycardia

Anorexia

increased sweating

moodiness

xerostomia

bruxism

168

T/F
Like cocaine, there is no tolerance effect to prolonged use of Meth

False

*tolerance develops

169

Erosion, poor OH, caries, perio infection, bruxism, tissue damage, oral ulcerations/infections, oral burns:

Meth Mouth

170

Signs of Acute OD of CNS stimulants

*know these 8

dilated pupils

HTN

elevated pulse

arrhythmias

extreme sweating

hyperthermia

hyperactivity

tremors

171

Withdrawal rxns to CNS stimulants in a Modest Abuser:

Heavy Abuser:

fatigue, prolonged sleep

Prolonged sleep, depression, suicidal tendency

172

Consequences of smoking: lung cancer, oral cancer, lowered ______, heart disease, periodontal disease

estrogen levels

(osteoporosis)

173

Nicotine turns on what cytokine?

function?

IL-6

turns on osteoclasts - leads to osteoporosis/rapid bone loss in perio disease

174

When burned, how many chemicals are in cigarette smoke?

4000

175

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

176

Orally, in smokers, where will you most often see narrow, deep, perio defects with fibrotic tissue.

Around anterior

177

What is a secondary reason meth users will have bad teeth?

Meth users crave sugar

178

Irritability, HTN, increased pulse, nausea/vomiting, dizzy, coronary artery disease, lung and oral cancer:

Nicotine

179

8 notable chemicals in cigarettes:

Tar

hydrogen cyanide-genocidal agent WWII

Benzene

Acetone

Formaldehyde

Ammonia

CO

nicotine

180

Erosion, poor OH, Caries, perio infection, bruxism, tissue damage, oral ulcerations, oral burns:

Meth Mouth

181

Anxiety, irritability, difficulty concentrating, headaches, drowsiness, increased apetite, sleep disturbances, and craving

Nicotine (tobacco) withdrawal

182

T/F
Cigars are safer than cigarettes

False

*and more nicotine

183

Major cause of esophageal cancer:

Cigarettes

184

3 ways smoking contributes to cancer:

(3 types of cancer)

Esophageal cancer

Mouth cancer

Oral cavity/pharynx cancer

185

T/F
Girls smoke more than boys

True

*boys do it to look cool, girls establish at younger age

186

What are "light" cigarettes?

Are they less dangerous?

Less tar

No

187

E-cig nicotine can help people to quit long term

True

188

What is the only cancer that hasn't had any statistical changes for a 5 year prognosis?

Oral cancer

189

Why are women more likely to be successful when attempting to stop smoking?

more likely to use support group

190

Ask, Advise, Refer:

Program to assist dental professionals with helping pts to quit smoking

191

4 hallucinogens:

LSD

PCP

Mescaline

Marijuana

192

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

193

T/F
The safety and efficacy of nicotine therapy are not established in children

True

194

People require how many attempts on average to stop smoking?

5-8

195

7-12 weeks (3 months) less dosage than through smoking, designed to decrease nicotine craving:

Step-down approach

196

3 risks to bupropion (Zyban) for smoking cessation:

seizures

HTN

psycho

197

Dopamine reuptake inhibitor used as an antidepressant and for smoking cessation:

bupropion (Zyban)

***wellbutrin if antidepressant

198

smoking cessation drug that is a partial neuronal alpha4 B2 nicotinic receptor agonist (occupies nicotine receptor sites in brain)

varenicline (Chantix)

199

varenicline (Chantix) mechanism:

stimulates dopamine activity

*but less than nicotine - decreases craving/withdrawal symptoms

200

Some people have a higher chance of relapse at certain times of day

True

201

What drug used for smoking cessation has the highest success rate?

verenicline (Chantix)

202

2 contraindications to nicotine replacements:

Pregnancy

CV

203

Hallucinogens (psychodelics) foster _____ dependence

_____ develops quickly

psychological

tolerance

204

3 consequences of long-term use of hallucinogens:

depression

panic disorders

schizo

205

Hallucinogens are powerful _______ and ______

stimulants

sympathomimetics

206

2 major psychoactive chemicals in marijuana:

delta-9-tetrahydrocannabinol (THC)

Cannibidiol (CBD)

207

What marijuana chemical is an appetite stimulant?

Which is neuroprotective?

THC

CBD

208

What does long-term chronic use of marijuana cause?

physical dependence

Withdrawal

psychological dependence

addiction

209

Teens with genetic predisposition for depression, schizophrenia, and psychotic disorders are at increased risk for these if they use marijuana

True

210

4 oral complications to marijuana use:

xerostomia

gingivitis

leukoplakia

hyperkeratinized tissues

211

What herbal mixture produces the same effect as marijuana and acts on same receptors as THC?

K2/spice

212

K2/spice has what type of effects?

sympathetic

213

What is the synthetic version of marijuana?

Schedule ____ drug

Approved for what 2 things?

dronabinol (Marinol)

III

nausea, appetite stimulation

214

4 predatory drugs:

ecstasy

gamma hydroxy-butyrate

ketamine

rohypnol

215

Another name for Rohypnol:

it is a _______

flunitrazepam

benzodiazepine

216

What euphoric sedative (anabolic) drug is associated with sexual assualt cases?

analogue found in industrial solvents:

GHB - gamma hydroxy-butyrate

sodium oxybate (Xyrem)

217

A sedative hyptnotic drug, analgesic and hallucinogenic

(also used as general anesthetic in vetrinary medicine)

Ketamine

218

nightmares

suicidal thoughts

adverse cardiac events

xerostomia

headache

nausea

verenicline (Chantix)

*side effects

219

The high of marijuana:

medical effects:

THC

CBD

220

What molecule is implicated in a lot of psychiatric disorders such as anxiety, depression, OCD, and schizophrenia?

Serotonin (5-HT)

221

Headaches and migraines involve a disregulation of what?

serotonin

222

What receptors are important for pain modulation in descending pathways, especially chronic pain?

Serotonin (5-HT) - stimulation produced analgesia

223

Data supports that migraines are caused by what?

Chronic 5-HT dysregulation

224

What family of drugs is a vasoconstrictor that inhibits depolarization of Dural blood vessel-associated nociceptors and possibly blocks neurogenic inflammation?

Ergot derivatives

225

2 examples of Ergot derivatives used to "abort" a migraine?

ergotamine

ergotamine + caffeine

226

Timing is an important factor for migraine drugs, and taking them at the beginning of the episode will be more effective

True

227

What ergot derivative is used for chronic, protracted migraine in a hospital setting?

dihydroergotamine (Migranal)

228

3 families of drugs that can be used to treat migraines:

Ergot derivatives

Triptans

Antiemetics

229

What anti-emetic is used for migraines?

isometheptene (Midrin)

230

Family of drugs that cause vasoconstriction and reduce neurogenic inflammation and provide relief from nausea (antiemetic)?

Triptans

231

First drug in the class of Triptans?

(vasoconstrictor, reduces neurogenic inflammation)

sumatriptan (Imitrex)

232

2 examples of Triptans?

sumatriptan

zolmitriptan

233

Acetaminophen + sedative that helps migraines and tension headaches?

isometheptene

234

2 components of isometheptene and what they do:

acetaminophen - analgesic

dichrolalphenazone - tranquilizing

235

Why are anti-emetics used to treat migraines?

Control nausea/gastric irritation

236

Because antiemetics are also antipsychotics, they cause _______ effects in the brain and result in ______

extrapyramidal

movement disorders

237

3 antiemetics:

prochloroperazine

metoclopramide

promethazine

238

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

239

NSAID used for migraine prophylaxis:

indomethacin (Indocin)

240

Intractable migraine, only drug to use after hasn't responded to other interventions?

corticosteroids

241

4 corticosteroid mechanisms:

(migraine specific)

GABA receptor modulators

Suppress neurogenic inflammaiton

Block neurogenic extravasation

Block high-voltage activated Ca++ currents by blocking Ca++ channels

242

A form of arthritis caused by accumulation of uric acid crystals in joints:

Gout

243

Overload of uric acid in Gout leads to what?

Formation of tiny crystals of urate

244

Gout is considered a chronic and progressive disease

True

245

Gout affects joints, but does not affect organs

False

*decreases kidney function

246

Gout can be inherited

True

247

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

248

Where is gout usually found?

Extremities, esp big toe

249

Elevated levels of Uric Acid w/o symptoms:

Asymptomatic hyperuricemia

250

2 types of Gout:

Excessive production of uric acid

Reduced excretion of uric acid

251

With gout, what foods should you avoid?

Purine-rich

252

5 things that predispose to Gout:

Dehydration

Fever

Infection

After surgery

Injury to joint

253

5 foods that are protective against Gout:

Cherry juice

Veggies

Dairy

Dark pure chocolate

Pineapple

254

Pts with longstanding hyperuricemia can have uric acid crystal deposits called what?

*this is in other tissue

Tophi

255

4 distinct stages of Gout:

Asymptomatic

Acute phase

Intercritical phase

Chronic

256

Drug used to treat Acute attack of Gout (only use for drug)

*inhibits neutrophil migration/phagocytic activity of inflamed joints

colchicine (Colcrys)

257

Original drug on the market for gout?

colchicine

258

4 side effects for colchicine (for gout)

GI toxicity

bone marrow depression

myopathy

alopecia

259

Drug of choice for pts that make too much uric acid

*works by inhibitying synth of uric acid

allopurinol (Zyloprim)

260

Drug used for management of Chronic Gout

*also used during chemo and radiation

allopurinol

261

4 side effects of allopurinol:

hepatotoxic

pruritic rash

allergic skin

blood rxns

262

What drug for Gout works by increasing the excretion of uric acid?

*Uricosuric Agent

probenecid (Bememid)

263

probenecid (Bememid) is indicated for what?

*2 things

Chronic gout

Acute gout w/ increased severity/frequency

264

What drug interferes with the Uricosuric action of probenecid?

Aspirin

*only at LOW DOSE

265

probenecid can be combined with what antibiotic to delay the excretion of the antibiotic?

penicillin

*allows you to keep penicillin in body for longer

266

What is the purpose of NSAIDS to treat Gout?

Relieves pain, tenderness, swelling of Joint

*no mechanism against gout itself

Decks in Tim's Cards Class (140):