• How does colchicine work in the treatment of gout-arthritis?

Colchicine is quickly absorbed after administration; it reaches its peak plasma level within 2 hours. Colchicine will relieve the pain and inflammation of gout-arthritis. Colchicine gets its anti-inflammatory effect by binding to the intracellular protein tubulin. Because colchicine binds to tubulin, it inhibits the micro-tubules and leads to the inhibition of leukocyte proliferation and macrophages. Colchicine also inhibits chemotaxis which is the movement of leukocytes to the area of ​​inflammation.

• What are colchicine's indications, side effects and dose? In particular, make sure that you know exactly how to use colchicine during an acute gout attack.

Colchicine is indicated for gout and work also for gout attacks for longer periods for prophylaxis. Prolonged use for prophylaxis requires a very low dose of colchicine. Colchicine also prevents acute attacks of “Mediterranean fever” and has a moderately beneficial effect in sarcoid arthritis and in hepatic cirrhosis. Collagen can also be used to treat and prevent pericarditis, pleurisy, and coronary heart disease due to its anti-inflammatory effects. Colchicine causes indigestion, diarrhea, nausea and stomach pain. Hepatic necrosis, acute kidney damage, disseminated intravascular coagulation, and epileptic seizures have been noted. Coal vision can also cause alopecia and bone marrow suppression to a lesser extent as well as peripheral neuritis, myopathy and in some cases death. The more serious side effects were noticed by coagulated intravenously. With an acute attack, the patient can take 0.5 to 1 mg immediately, followed by 0.5mg every 6 hours until pain relief or gastric discomfort develops. Maximum of 2.5mg in the first 24 hours. The patient should not use more than 6mg over 4 days. The course may not be repeated within 3 days. For prophylaxis, the spot view should lower how serum uric acid levels are brought about. Then the patient will be able to be given 0.5mg colchicine 1-2 times a day to urate-reducing drugs.

• What other drugs can be used in the treatment of an acute gout attack?

For the acute gout attack, non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids may be co-administered with colchicine.

• What is probenecid classified as? How does this group of drugs work?

It is a Uricosuria drug. This group of drugs inhibits the active transport mechanism for the reabsorption and secretion in the proximal tubules in the kidney. The net reabsorption of uric acid must therefore decrease in the proximal tubules. If the urinary excretion of uric acid increases, the size of the urate pool will decrease. Urate will be reabsorbed which then gives the relief of arthritis. But with the increased excretion of uric acid, kidney stones can form and to prevent this we need the pH of the urine above 6.0 and therefore we need to give the patient a urine alkalizer to use with the probenecid.

• How does allopurinol work, what are its indications, precautions and important interactions?

Allopurinol is irreversible xanthin oxidase inhibitors. It reduces the conversion of xanthine to uric acid. By inhibiting the conversion, there will therefore be less uric acid production. The Xanthine concentration and hypoxanthine concentration are increased by Allopurinol. Both of these concentrations are more water soluble than uric acid. The honor water-soluble product is excreted first and thus the uric acid concentration in the body is lowered. A precaution is that if you give a chemotherapeutic purine together with an allopurinol, the dose will have to be reduced by 75%. Allopurinol may also increase the effects of cyclophosphamide. Allopurinol inhibits the metabolism of probenecid and oral anticoagulants and it can also increase hepatic iron concentrations. Safety in children and pregnant women has not yet been established.

• What vascular changes can be observed before and during migraines?

The trigeminal nerve spreads to the intracranial arteries. The nerves release peptide neurotransmitters, especially the calcitonin no related peptide (CGRP). Here peptide is a potent vasodilator. Substances A and Neurokinin A are also involved. Due to a leak, plasma and plasma proteins may be present in the perivascular space causing edema. Due to the stretching of the edema, it will activate pain nerve endings in the duration. 

• What is the role of serotonin in migraine headaches? 

Serotonin can play two roles in the treatment of migraines. The first one is the activation of the 5-HT1B agonist causing vasoconstriction of the cranial arteries. During the acute migraine the arteries dilate and it is very painful but the serotonin constricts the artery. The second one is the activation of the 5-HT1D receptors on the presynaptic trigeminal nerve endings. The activation will result in inhibiting vasopeptic (CGRP) release and because the transmission is then interrupted, pain message will not be able to go to brain and the vasodilation effect cannot continue because it is suppressed.

• How is ergotamine used during a migraine attack? 

It should be taken with first signs of migraine to be effective for an acute migraine attack. It can also be used in combination with caffeine. The ergotamine should be used with caution as it has many side effects. Dosage: Take 1 tablet with first warning of attack. Then take 0.5 to 1 tablet every 30 min as needed. A maximum of 4 tablets may be taken in a migraine attack and a maximum of 6 tablets may be taken per week.

• What side effects are experienced with ergotamine use? 

What contraindications are there for ergotamine use? Ergotamines have many side effects. Nausea and vomiting, Diarrhea, Hallucinations and confusion, Gangrene, retroperitoneal fibrosis, or bradycardia and angina pain. Relapse headaches can also happen with regular use. Ergotamines cannot be used if the patient has any blood vessel diseases such as coronary, cerebral, and peripheral vascular diseases. It is contraindicated if the patient's hypertension is uncontrolled if he / she has hepatic and renal impairment. Absolutely contraindicated is pregnancy and it can also not be used with any triptans at all.

• What other drugs can be used in an acute migraine attack? How do all these drugs work?

Other treatments that can be used for migraines besides ergotamines and serotonin agonists are analgesics such as paracetamol, non-steroidal anti-inflammatory drugs and aspirin. Antiemetics such as metoclopramide, domperidone and cyclicin can also be given and finally sedatives such as diazepam can be given. Analgesics are used as the first line medication in a migraine attack. The medication will relieve the pain of mild to moderate migraines. Because nausea and vomiting occur very frequently with a migraine attack, we will give you an anti-emetic to relieve the nausea and vomiting. Cyclicin is an H1 antagonist that blocks antimuscarinic activity in the vomiting center. The metoclopramide and domperidone are D2 antagonists and an advantage of both is that they are prokinetic. Because sedatives are habit-forming, they are not widely used but when used they are due to muscle relaxation and sedation.

• Name the drugs that can be used as migraine prophylaxis, as well as their specific side effects and precautions. 

There are 6 drugs that can be used as prophylaxis. 

1. Beta-blockers- Some of the side effects are bradycardia, drowsiness, depression, sexual dysfunction and nightmares. Precautions are that pregnant and breastfeeding woman can not use edit. People with a liver or kidney problem should also be careful, it is also forbidden in some sports. 

2. Anticonvulsants- Some of the side effects are paresthesia, dizziness, fatigue, nausea, anorexia, drowsiness and memory problems Precautions are again for pregnant and breastfeeding women. Babies can be born with cleft palate. Patients with kidney problems should also be careful. 

3. Ca + 2 antagonists- Some of the side effects are drowsiness, depressive and weight gain. 

4. Tricyclic antidepressants- One of the side effects is that it can make you drowsy know a precaution is that it is administered in low doses for migraines. 

5. 5-HT2 antagonists- Sedation, Increased appetite weight gain, vision disorders urinary retention and dry mouth. A precautionary measure is that it may not be used in pregnancy or breastfeeding, even if you have a spinal or kidney problem.

6. A2 agonist- Some of the side effects are that it may aggravate depression and cause insomnia. The precautions are that pregnant and breastfeeding woman may not use edit and if you have a kidney restriction should not use.