Fioricet

Generic Name: acetaminophen, butalbital, and caffeine (a SEET a MIN oh fen, bue TAL bi tal, and KAF een)
Brand Names: Alagesic, Anolor 300, Dolgic LQ, Dolgic Plus, Esgic, Esgic-Plus, Fioricet, Geone, Margesic, Medigesic, Repan, Zebutal

What is Fioricet?

Fioricet contains a combination of acetaminophen, butalbital, and caffeine. Acetaminophen is a pain reliever and fever reducer.

Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fioricet is used to treat tension headaches that are caused by muscle contractions.

Fioricet may also be used for purposes not listed in this medication guide.

Important information about Fioricet

Do not use Fioricet if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

Tell your doctor if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen. Do not take more Fioricet than is recommended. An overdose of acetaminophen can damage your liver or cause death. Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.

Avoid drinking alcohol. It may increase your risk of liver damage while taking Fioricet due to the acetaminophen component.

Before taking Fioricet

Do not use Fioricet if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects. Tell your doctor if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen. You should not take Fioricet if you are allergic to acetaminophen, butalbital, or caffeine, or if you have porphyria.

To make sure you can safely take Fioricet, tell your doctor if you have any of these other conditions:

• kidney disease,
• liver disease; or
• a history of mental illness or suicidal thoughts.

Butalbital may be habit forming and should be used only by the person it was prescribed for. Never share Fioricet with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

FDA pregnancy category C. It is not known whether Fioricet will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Acetaminophen, butalbital, and caffeine can pass into breast milk and may harm a nursing baby. Do not use Fioricet without telling your doctor if you are breast-feeding a baby.

Cocaine Induced Myocardial Infarction

The American Heart Association (AHA) early this month (April 2008) has just came out with a guidelines on the management of cocaine induced myocardial infarction.

Cocaine can cause myocardial ischemia because it blocks the reuptake of norepinephrine and dopamine at the presynaptic adrenergic terminals, thus results in an accumulation of catecholamines at the postsynaptic receptor (powerful sympathetic activities).

The effects of this increased sympathetic activity include:

1. including increased chronotropy and inotropy

2. coronary vasospasm

3. prothrombotic state, and

4. accelerated atherosclerosis — and, in some individuals, can actually cause MI.

But in terms of the symptoms, signs, and diagnostic workup in patients with cocaine-associated MI are similar to those in patients with MI unrelated to cocaine.

However, treatment of cocaine-triggered ischemia and infarct differs in several ways, but the two most important differences are:

1. Benzodiazepines should be given very early; administration of these agents can dramatically reduce and counteract the sympathomimetic effects of cocaine.

2. Beta blockade, because of its unopposed alpha-adrenergic effects, leads to coronary vasoconstriction,increased blood pressure, and increased mortality in cocaine-associated ischemia, and so beta blockers must be avoided in the acute treatment of these patients. 

Other than that, management strategies are almost similar with non-cocaine induced MI (e.g. nitrates and aspirin)

Another point:

In the setting of ST-segment-elevation acute coronary syndromes, primary PCI is better than fibrinolytics because of the relatively high incidence of false-positive ST elevations in patients who have used cocaine.

You can download the AHA guidelines on cocaine induced MI here.

Source: http://emergencymedic.blogspot.com/search/label/myocardial%20infarction