Pharmacology Module 4 & 5: Gout and Lithium

Gout and Treatments

• Uric acid crystals accumulate in joints causing inflammation.
• Allopurinol lowers hyperuricemia associated with severe gout.
  • Adverse effects include rash and Stevens-Johnson syndrome (SJS).
  • May take 1-3 weeks for uric acid levels to decrease.

Mental Health Medications

• Lithium: Used for bipolar disorder; acts as a mood stabilizer, mimicking sodium in the body.
  • Narrow therapeutic window; interacts with numerous medications.
  • Maximum effect typically achieved in 4-8 weeks.
• Tricyclic Antidepressants (TCAs): Second-line treatment for depression; takes 4-8 weeks for full effect.
• Diazepam: A benzodiazepine; Humira is a reversal agent.
• Antipsychotics: Risperidone is notable for having milder side effects.

Pain Management Medications

• Ibuprofen: NSAID for mild to moderate pain, fever, and inflammation.
  • Used with caution in patients with kidney disease and can increase GI events.
• Ketorolac: NSAID (Sprix, Toradol) used similarly to ibuprofen; caution against polypharmacy with NSAIDs.
• Acetaminophen (Tylenol): Alternative for those who cannot take NSAIDs.
  • Adverse effects include hypotension and constipation; recommended for patients with a history of gastric ulcers.
• Opioids: Prescribed for severe pain, persistent cough, and diarrhea.
  • Examples: morphine, oxycodone, fentanyl, methadone; high risk for dependency with rapid onset of effects.

Opioid Overdose Management

• Naloxone: Opioid receptor antagonist used for treating acute opioid overdose and respiratory depression.

Antibacterial Medications

• Vancomycin: Effective against MRSA infections; requires close monitoring of renal function and urine output.
  • Adverse effect includes oliguria.
• Sulfamethoxazole-Trimethoprim (Bactrim): Used for uncomplicated urinary tract infections (UTIs), given over a 3-day regimen.
  • Crosses placental barrier; caution advised for pregnant women.
• Gentamicin: Prototype aminoglycoside antibiotic; major risks include neurotoxicity and ototoxicity.
• Metronidazole: Antiprotozoan; contraindicated with alcohol and may increase warfarin levels.
  • Common side effects include GI upset and a metallic taste; harmful to pregnant women.

Bactericidal vs. Bacteriostatic Medications

• Sulfa Methoxazole: Bacteriostatic; inhibits bacterial replication rather than directly killing bacteria.
• Macrolide Antibiotics: Inhibit protein synthesis; can cause oral candidiasis if not adequately rinsed.

Specific Antifungal and Antibacterial Treatments

• Nystatin (Nystop): Superficial antifungal treatment for yeast infections; available in various forms.
  • May decrease absorption; no food restrictions during administration.
• Ciprofloxacin: Fluoroquinolone that poses a risk for tendon rupture (black box warning); used to treat anthrax and other serious infections.
• Fluoroquinolones: Target atypical pathogens; effective against bacterial bronchitis and pneumonia.