Pharmacology of Sympathomimetics and Analgesics

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Questions and Answers

What is the usual daily dose associated with tolerance and dependence mentioned?

600 mg

1200 mg

300 mg (correct)

150 mg

Which of the following is an adverse effect of laxative abuse?

Increased muscle strength

Weight gain

Hypokalaemia (correct)

Increased appetite

Which statement best describes a common characteristic of atherosclerosis?

It is typically asymptomatic. (correct)

It is always symptomatic.

It cannot be measured through blood pressure.

It only affects individuals with high cholesterol.

What role does LDL play in cardiovascular health?

It forms plaques that can lead to cardiovascular disease. Signup and view all the answers

What is one of the suggested methods of quitting substance dependence mentioned?

Cold turkey Signup and view all the answers

What should be measured as a predictor of atherosclerosis?

LDL cholesterol levels Signup and view all the answers

Which of the following is NOT a common stimulant laxative?

Metamucil Signup and view all the answers

Which external support option is mentioned for individuals struggling with substance dependence?

Narcotics Anonymous Signup and view all the answers

What is a primary strategy of health promotion according to the Ottawa Charter?

Empowerment Signup and view all the answers

Which of the following is NOT a key theme of health promotion as outlined in the Ottawa Charter?

Improve medication adherence Signup and view all the answers

Which role does a pharmacist NOT typically fulfill in health education/promotion?

Diagnosing all illnesses Signup and view all the answers

Which form of prevention focuses on rehabilitation after health issues have occurred?

Tertiary prevention Signup and view all the answers

What does hs-CRP measure in the context of coronary heart disease risk factors?

Inflammatory response Signup and view all the answers

In the context of cardiovascular health, which ratio is significant for assessing risk?

Total cholesterol: HDL cholesterol Signup and view all the answers

What principle underlies the health promotion efforts described in the Ottawa Charter?

Enabling control over health Signup and view all the answers

The progression from a healthy person to death can be categorized into which prevention strategies?

Primary, Secondary, Tertiary Signup and view all the answers

What is the primary therapeutic use of Loperamide?

As an antidiarrheal Signup and view all the answers

What is a consequence of using sedating antihistamines in large doses?

Mild euphoria Signup and view all the answers

Which of the following is an effect of Dextromethorphan?

Dissociative effects Signup and view all the answers

Which antihistamine is noted for its use as a cough suppressant?

Diphenhydramine Signup and view all the answers

What risk is particularly heightened in the elderly when using sedating antihistamines?

Increased risk of falls Signup and view all the answers

What effect do sympathiomimetics generally have on mood?

They elevate mood. Signup and view all the answers

Which of the following conditions might lead to Medication Overuse Headache (MOH)?

Excessive intake of non-opioid analgesics. Signup and view all the answers

What is a primary therapeutic effect of opioids at mu receptors?

Sedation. Signup and view all the answers

What is the basis for the International Olympic Committee's ban on ephedrine products?

Their stimulating effects that may enhance performance. Signup and view all the answers

Which of the following is a possible consequence of chronic opioid use?

Development of dependence. Signup and view all the answers

What is a common effect of pseudoephedrine as a decongestant?

It causes vasoconstriction of nasal blood vessels. Signup and view all the answers

Which enzyme systems significantly impact the therapeutic effect of codeine?

CYP2D6 and CYP3A4. Signup and view all the answers

What is one potential risk associated with high doses of paracetamol?

Toxicity at high doses. Signup and view all the answers

What is the concept of health that encompasses complete physical, mental, and social well-being?

Health as well-being Signup and view all the answers

According to the Ottawa Charter for Health Promotion, health is defined as what kind of resource?

A resource for everyday life Signup and view all the answers

Which of the following is NOT a determinant of health that health promotion seeks to modify?

Biology and genetics Signup and view all the answers

What is a necessary belief according to the Health Belief Model for a person to take health-related action?

The individual must believe they are susceptible Signup and view all the answers

Which level of theory involves models such as the Health Belief Model and Stages of Change Model?

Individual level Signup and view all the answers

What did Dahlgren and Whitehead illustrate about health?

Health is influenced by a complex interplay of factors from individual to societal levels Signup and view all the answers

Which of the following is a key aspect of health promotion?

Engaging in action and advocacy to modify health determinants Signup and view all the answers

Which of the following theories or models is NOT part of the community level in health behavior models?

Cognitive Dissonance Signup and view all the answers

Study Notes

Sympathomimetics

Similar chemical structure to amphetamines (stimulants)
Enhance the release of endogenous noradrenaline (α and β agonists)
Increase heart rate and blood pressure, elevate mood, decrease appetite
Used as nasal decongestants due to vasoconstriction of nasal blood vessels
International Olympic Committee banned ephedrine products
Large packs of pseudoephedrine/ephedrine replaced by smaller packs (720mg equivalent of 12/60mg tablets or 24/30mg tablets)
One pack per customer and sales should be handled by a pharmacist.

Analgesics

Highest volume of OTC sales
Common abuse: chronic headaches, medication overuse
Most problematic products contain opioids (e.g., codeine, especially those on opioid substitution therapy (OST))
Some contain caffeine or antihistamines (can cause withdrawal or tolerance problems)
Analgesics, such as ibuprofen and aspirin, have subtle reinforcing effects at high doses
Paracetamol (acetaminophen) is toxic
All packs now contain warnings about 3-day maximum use and highlighting the potential for dependency.

Opioids

Primarily codeine, dihydrocodeine, and loperamide
Act as agonists at mu receptors (analgesia, bradycardia, cough suppression, euphoria, miosis, dependence, reduced GI motility, respiratory depression, sedation)
Synergistic effect with GABA agonists (e.g., alcohol, benzodiazepines, Z-drugs)
Therapeutic effect via active metabolites (e.g., codeine to morphine, hydrocodone, hydromorphone, and morphine-6-glucuronide).
Dependent on CYP2D6, 3A4 enzymes (genetic polymorphism dependent) and function of the P-glycoprotein pump.
Loperamide is an antidiarrheal drug, with less CNS effect at the therapeutic dose; a higher dose may be required to achieve the antidiarrheal effect

Antihistamines

Sedating antihistamines (in large doses) can produce mild euphoria or a dissociative effect due to anti-muscarinic properties
Diphenhydramine is used as a cough suppressant and sleep aid
Chlorphenamine is used for rashes and itching
Cyclizine is used against travel sickness
Promethazine is used against travel sickness
Elderly people are particularly susceptible to side effects
Antihistamines can substitute or enhance the effects of illicit drugs

Antitussives

Cough stimulus is from irritation of respiratory mucosa, due to contamination/infection
Dextromethorphan (DM) used to suppress (dry irritating) cough and inhibit the medullary cough centre
DMD is a direct acting metabolite that can induce a dissociative state. (Similar to PCP) main effects: dissociative, euphoria, hallucinations
Tolerance and dependence(tachycardia, hypertension, psychosis, mania) common
Usual doses 300mg per day and maximum doses can reach 2880mg over a few years

Laxatives

Stimulant laxatives are commonly used by people with eating disorders (e.g., anorexia nervosa, bulimia)
Designed to alter body image shape
Laxative abuse can cause diarrhoea, dehydration, hypotension, tachycardia, and hypokalaemia
Products such as Ex Lax, Dulcolax, and Senokot (sennoside) can be in choc or tablet forms

Treatment

NHS focuses on other dependencies (alcohol, opioids) - lacking understanding, resources, and services.
"Cold turkey" (sudden stop) or reducing doses for addiction is a common approach.
External support (online forums, Narcotics Anonymous), OverCount & Codeine Free are widely used.
Websites play a supporting role, providing reassurance and connecting people with shared experiences.
Charities offer additional support.

Atherosclerosis

Atherosclerosis is typically asymptomatic.
Usually detected after a heart attack or stroke
Low density lipoproteins (LDL) levels are commonly used as a predictor for Atherosclerosis
Blood pressure measurements are also a good indicator.
Atherosclerosis is the buildup of plaque in the arteries that can block blood flow, leading to heart attacks and strokes
The formation of plaques begins with age regardless of the person affected.

Risk Factors of Cardiovascular Disease

Genetic variations/family history
Lipid disorders
Hypertension
Type 2 diabetes
Smoking, physical inactivity
Increased cardiovascular risk
High CRP
Prior CVD events
Age, race, sex
Metabolic syndrome

Detection

Atherosclerosis detection is typically asymptomatic.
Manifests after heart attack or stroke
LDL measures within blood are strong indicators.
Blood pressure measures are significant indicators.
20% of events occur in those without major risk factors
LDL (Bad cholesterol) form plaques with age.
Cholesterol is a surrogate marker for CVD.

Prevalence of Risk Factors (Coronary Heart Disease)

Data is presented in a bar graph format, showing prevalence of risk factors amongst male and female groups
Data is presented in a bar graph format, showing prevalence of risk factors for men and women.

Relative Risks of Future MI Among Healthy Middle-Aged Men

Chart displays relative risks of future myocardial infarction (MI) among healthy middle-aged men - factors tested.

Cardiovascular Conditions in Scotland by Age & Deprivation

Data is presented in graphs showing the percentage of adults with cardiovascular conditions
Different age groups and levels of deprivation show variations.

Role of the Pharmacist in Health Promotion

Pharmacists assess, manage, and educate on diseases like high blood pressure, asthma, and diabetes.
Understanding illness and medications
Ensuring compliance via community relations with nurses and dentists
Essential that structures for access are in place so that the public can use those services

Health Disease Progression

Health progression in a person can range from a healthy individual to someone with a disability/death
Pre-disease is reversible however once the symptoms become more advanced , it becomes not reversible
Primary Prevention: Healthy people, preventing diseases from occurring
Secondary Prevention: Detecting diseases at early stages before they advance
Tertiary Prevention: Helping people with disabilities and advanced stages of disease.

Ottawa Charter (WHO 1986)

Encourages empowering people to manage their health.
Processes for enabling individuals increase their control and improve health.

Health Promotion Strategies and Key Themes

Health promotion approaches for empowerment, mediation and advocacy.
Healthy policy building, supportive environments, community action, health skill development, and health services re-evaluation

Definitions of Health

Health as the absence of disease (ancient Greeks).
Health as ‘well-being’ (WHO 1948, a complete state of physical, mental, social well-being; not merely the absence of illness)
Health as a resource (Ottawa charter; a positive concept emphasizing social and individual resources as well as physical capabilities, not merely the absence of disease).

Factors Influencing Health

Factors influencing human health are multiple and interactive, both within and outside an individual's control.
Modifiable determinants are individual health behaviours/lifestyles, access to education, employment, and physical environment.
Non-Modifiable determinants are biology and genetics.

Models for Health and Illness Behaviour

Models for explaining health and illness behaviours, including the Health Belief Model, Stages of Change Model, Social learning theory etc

Health Belief Model

For a person to take action, they must believe they are susceptible to a health problem, believe the problem is serious, and believe the advantages of taking action outweigh the disadvantages.

Dahlgren and Whitehead (1991)

A framework that shows factors influencing health at different levels (individual to societal).
Demonstrates factors like socioeconomic, cultural, and environmental factors that influence health
Aims to identify layers and help prevent inequalities in health.

Changing Health Behaviour

Health behaviour changes based on the individual
Identify factors posing greatest threat to health.
Lifestyle factors such as diet, relationships, managing stress, safe sex, drug/alcohol use, exercise and tobacco use.

Factors Influencing Behaviour Change

Predisposing factors (knowledge, beliefs, attitudes based on life experiences, gender, age)
Enabling factors (skills, abilities, available resources)
Reinforcing factors (support from others, encouragement/discouragement)

Percentage of Smokers by Scottish Deprivation Index

Data visualization showing a trend in smoking prevalence across different levels of deprivation in Scotland.

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Description

Explore the key concepts and implications of sympathomimetics and analgesics in pharmacology. This quiz covers their chemical structures, effects on the body, and controversies surrounding their use. Understand the regulations and concerns associated with these common medications.