Miscellaneous Pain Medications Medications for Pain & Inflammation ADN 110/cohort 131

OVERVIEW O Pain is subjective O Result of O Release of chemical mediators O Inflammation O pressure O Gout O Elevated uric acid ->accumulation ->localized inflammation O Migraine O Inflammation & vasodilation of cerebral blood vessels O Local anesthetics O Block motor & sensory neurons ADN 110/cohort 132

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Anti-gout Medication O Anti-inflammatory O Colchicine O Expected action – decrease inflammation O Therapeutic use – abort, treat, and decrease incidence of acute attack of gout, O Other – NSAIDs O Glucocorticoids – used if unable to take or are unresponsive to NSAIDs ADN 110/cohort 134

Anti-gout Medication O Hyperuricemia O Allopurinol O Expected action – inhibit uric acid production O Therapeutic use – hyper-uricemia O Other – febuxstat, probenecid ADN 110/cohort 135

Complications O Colchicine O GI distress O Thrombocytopenia O rhabdomyolysis O Probenecid O Renal calculi O Allopurinol O Hypersensitivity reaction O Kidney injury O Hepatitis O GI distress ADN 110/cohort 136

Contraindications/Precautions O Colchicine O Pregnancy risk C O Caution – geriatrics, debilitation, renal, cardiac, hepatic or gi dysfunction O Probenecid O Can precipitate acute gout O Allopurinol O Pregnancy risk C O Contraindicated – medication hypersensitivity, idiopathic hemochromatosis O Rhabdomyolysis- statins, impaired kidney & liver ADN 110/cohort 137

Interactions O Colchicine O Grapefruit juice O Probenecid O Salicylates O Allopurinol O warfarin ADN 110/cohort 138

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Migraine Medications ADN 110/cohort 1310 O Acetaminophen, NSAIDs O Ergot alkaloids O Serotonin receptor agonists O Beta-blockers O Anticonvulsants O TCA O Calcium channel blockers O Estrogens O Other O Ergot alkaloids O Triptans O Combination OTC O Other combinations

Purpose ADN 110/cohort 1311 O Expected Action O Prevent inflammation & dilation of the intracranial blood vessels O Therapeutic Use O Stop a migraine after it begins or after prodromal manifestations O Prevention

Complications O Ergot alkoloids O GI O Ergotism O Physical dependence O Fetal abortion O Contraindications/Precautions O Contraindicated – renal &/or liver dysfunction, hx MI & CAD, pregnancy ADN 110/cohort 1312

Complications O Serotonin receptor antagonists O Chest pressure O Coronary artery vasospasm O Dizziness/vertigo O Contraindications/Precaution O Contraindicated – liver failure, ischemic heart disease, hx MI, uncontrolled HTN, other heart diseases ADN 110/cohort 1313 continued

Complications O Beta blockers O Extreme tiredness, fatigue, depression, asthma exacerbation O Bradycardia, hypotension O Complications/Precautions O Contraindicated - >1 st degree heart block, bradycardia, asthma, cardiogenic shock, heart failure O Caution – WPW syndrome, other antihypertensives, liver or renal impairment, DM ADN 110/cohort 1314 continued

Complications O Anticonvulsants O Neural tube defects O Liver toxicity O pancreatitis O Contraindications/Precautions O Contraindicated – liver disease, pregnancy risk D ADN 110/cohort 1315 continued

Complications O TCA O Anticholinergic effects O Drowsiness, dizziness O Contraindication/Precautions O Contraindicated – recent MI, MOAIs, O Caution – seizure hx, urinary retention, prostatic hyperplasia, angle closure glaucoma, hyperthyroidism ADN 110/cohort 1316 continued

Complications O Calcium channel blockers O Orthostatic hypotension or bradycardia O Constipation O Contraindications/Precautions O Contraindicated - >1 st degree heart block, bradycardia, hypotension, left ventricle disease, a-fib/flutter, heart failure O Caution – liver or renal impairment, ICP ADN 110/cohort 1317 continued

Interactions O Ergotamine & dihydroergotamine O Triptans O HIV protease inhibitors, antifungals, macrolide antibiotics O Sumatriptan O MAOIs O Ergotamine or another triptan O SSRI’s O Propranolol O Verapamil & diltiazem O Diuretics & antihypertensives O insulin ADN 110/cohort 1318

Interactions O Divalproex O ASA, chlorpromazine, cimetidine O Benzodiazepines O Phenobarbital & phenytoin O Amitriptyline O Barbiturates O Cimetidine O MAOIs O Verapamil O Carbamazepine & digoxin O Atenolol, esmolol, propranolol & timolol ADN 110/cohort 1319

Local Anesthetics Lidocaine Other Pontacaine Novacain EMLA ADN 110/cohort 1320

Purpose ADN 110/cohort 1321 O Expected Action O Block conduction of pain impulses in a circumscribed area O Therapeutic Use O Dental procedures O Minor surgical procedures O Labor & delivery O Diagnostic procedures O Regional anesthesia O Skin & mucous membrane disorders O Minor procedures

Complications O CNS excitation O Hypotension, cardiosuppression O Allergic reactions O Prolonged labor O Fetal – fatal bradycardia & CNS depression O Spinal headache O Urinary retention ADN 110/cohort 1322

Contraindications/Precautions O Local anesthetics – pregnancy risk B O Contraindicated – Supraventricular dysrhythmias &/or heart block O Caution – liver & kidney dysfunction, heart failure, myasthenia gravis O Epinephrine – fingers, nose, other body parts with end arteries ADN 110/cohort 1323

Interactions O Antihypertensive medications ADN 110/cohort 1324