29th Pharmacology Update

“The Abuse of Drugs”

September 17, 2016
(Disclaimer: Use the notes at your own risk)
 Psychopharmacology and the Abuse of Drugs- Monina Garduno-Cruz, MD
o Substance use disorder: Occurs within a 12-month period
 Impaired control criteria (1-4)
 Social impairment criteria (5-7)
 Risky use criteria (8-9)
 Pharmacologic use criteria (10-11)
 Abuse of Pain Medications and Its Prevention- Minerva Calimag, MD
o OTC meds and abuse of pain meds
o Majority 74.6% visit pharmacist 1x a month
o Access?
o Physicians should treat pain but should also treat the underlying cause of pain
o Research shows strong relation between prescription drug and illicit drug use:
1.pain meds (ibuprofen, aspirin- Tylenol, Motrin, Advil)
2.marijuana
o Family and education are found to be strong safeguards
o Marijuana use- due to sensation-seeking
o 60% of people do not know the active ingredient of their pain meds
o Warrants the need to include this in patient education when prescribing pain meds
o 40% of Americans believe OTC drugs are not potent enough to cause real harm
o Analgesics- GI bleed, CV issues, hepatotoxicity…
o During clinics it is best to instruct patients to bring their meds
o Acetaminophen if aspirin/NSAIDS is not recommended
o NSAIDS  acetaminophen  significantly reduces cost and morbidity
o NSAIDS are the most potent pain relievers vs acetaminophens
o Consider 4 As in choosing drugs:
1.Agad-bisa (efficacy)
2.Alang panganib (safety)
3.Angkop (suitability)
4.Abot-kaya (cost)
o Long-term opioid use leads to long-term impairment, distress (and severity, whether fatal or nonfatal effects, is
related to dose)
o Tolerance and physical dependence
o Morphine: conversion factor is 1.5
o OTC drugs are not as harmless as you think
o Interprofessional care is recommended
o Educate patient
o Abuse of drugs is very much related to, “gawi at gawa ng tao”
o There is a need to address social medical issues
 Glucocorticoids- Ruth Saguil-Sy, MD
o COX1 and COX 2 inhibitors
o Celecoxib decreases ulcer, GI effects but not renal SE (shutdown), actually increases acute MI risk according to
recent studies and already in textbook print. DO NOT give to patients with heart problems or with risk for MI or
else they will develop CHF
o NSAIDS- risk for nephropathies
o Glucocorticoids have many applications, but care should be taken while using them
o Diclofenac- use sparingly for muscle pain
o Dexamethasone- may have cushingoid SE in long term use (buffalo hump, moon facies); do not withdraw
abruptly or else patient will have Addison’s disease (hypotension, increased HR)
o Zona glomerulosa- aldosterone
 o Zona fasciculata- cortisol
o Zona reticularis- testosterone
o Medulla- adrenergics
o Corticosteroid therapy: major adverse effect is pituitary suppression increased BP, hypergly, decreased bone
mass, appearance of striae, immunosuppression
o Prednisone OTC must be limited to 5mg less lang dapat
o Desilon forte is 30x more potent than cortisol
o Pharmacovigilance is important
o Still the best treatment for osteoarthritis is 4 tablets of paracetamol
o The most credible pharmacologic research study is randomized, placebo controlled double-blind study (don’t
just believe all studies)
 Closing Remarks- Dr. Merlina L. Cabrera