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What is the correct name for Paracetamol?
What is the dose of paracetamol, and its maximum dose?
Side affects of paracetamol?
- RARE, but may include -
- blood disorders - thrombocytopenia, leukopenia
- hypotension �if IV admin
- liver and kidney damage in OD
How much paracetamol for acute liver failure?
How much paracetamol for fatal OD?
Treatment of paracetamol OD?
- Acetylcysteine (i.v.) ideally within 8hrs ingestion of OD
- Activated charcoal
NSAIDs, name 3:
- Aspirin (Salicylic acid derivative)
- Diclofenac (Voltarol)
How do NSAIDs work?
Inhibit COX pathway, stopping production of PG (chemical mediator of pain)
Which NSAIDS inhibit platelet function?
- Aspirin irreversibly does, therefore increase bleeding time.
- Other NSAIDs do, but reversibly (only last the life of the drug)
What else do PG do?
stimulate protective gastric mucus secretion
Side effects of NSAIDS
- GI disturbances incl. � nausea, Diarrhoea, bleeding, ulceration
- Hypersensitivity reaction-angioedema, urticarial, rhinitis
- May impair renal function
- Worsen asthma
Contraindications of NSAIDs
- X in pregnancy
- X in old pts -can cause heart failure
- X in pts with peptic ulcers
- X aspirin in children <12yo Reye's syndrome -URTIs, liver failure, encephalopathy
- Ibuprofen -2.4g/day
- Aspirin -4g/day
- Diclofenac -150mg/day
Signs of OD of aspirin?
- Hyperventilation, agitated
- Tinnitus, deafness
- Coma (uncommon)
Signs of OD of ibuprofen?
- Nausea, vomiting,
- Epigastric pain
Treatment of OD of NSAIDs?
- Activated charcoal
- Gastric lavage
What would you prescribe during/after a difficult Xraction of LL8?
- Voltarol - 75mg (MAX 150mg/day)
- Dexamethasone (steroid) 8mg, given at the end of the op
NSAIDs are peripherally acting, where do Opioids work?
Name 3 opioids:
- Dihydrocodeine - maxfacs like
What is a co-codamol a combination of?
- Codeine + paracetamol
- 30mg and 500mg
Effects of opioids
Unwanted SE of opioids?
- Cough suppression
- N + V
- Miosis (pupils small)
Why not give opioids to H+N injury pts?
Because miosis, sedative effects, cough suppression, will all mask symptoms and compromised pt going into surgery
Effects of opioids reversed by?
Tricyclic Ads give two examples?
- Nortryptiline - best analgesia, less SE
What Tricyclic ADs do?
- Muscle relaxant
What doses of Tricyclic ADs do you give?
- Therapeutic 10-20mg
- If for AD 80mg or more
What is an AB?
A substance, produced by or derived from a micro-organism, that destroys or inhibits the growth of other micro-organisms.
Which types of bacteria cause most H+N infections?
Streptococci and anaerobes
When do you prescribe ABs?
- Systemic involvement:
- 2.regional lymphadenopathy,
- 3. uncontrolled/spreading swelling - facial cellulitis
- ? Immuno-compromised pt.
Before prescribing ABs, consider pt factors:
- Do they take OCP?
- Renal function
- Alcoholism (METD)
What might help you choose the correct AB?
Microbial C and S.
Dose of ABs depends on?
Dependant on age, weight, renal function, severity of infection
Duration of ABs depends on?
- Nature of infection
- pts response to Tx
- Too short -resistance
- Too long -Unwanted SE
Name the Bactericidal Abs
Name Bacteriostatic ABs
Name types of Penicillins?
Amoxicillin, Flucloxacillin, Co-amoxiclav (augmentin), Phenoxymethyl penicillin (Pen V)
How do Penicillins work?
- Beta lactam, interfere with bacterial cell wall synthesis.
- Therefore bactericidal
Risk of allergy to Penicillin?
- Risk of allergy 1-10%
- e.g. rash or anaphylaxis 0.05%
- (N.B. Most common drug allergy)
Is penicillin safe in pregnancy?
How are penicillins excreted?
Side FX of penicillin?
Diarrhoea can be a frequent side-effect
Amoxicillin is broad spec or narrow spec?
- Therefore some positive, some negative, (few anaerobes)
What is an advantage of amoxicillin?
Well absorbed (not affected by presence of food in stomach)
What is a disadvantage of amoxicillin?
Inactivated by penicillinases (? lactamases)
How much amoxicillin do you give?
Flucloxacillin, broad or narrow spec?
- Narrow spectrum
- Therefore only gram positive
Advantage of flucloxacillin?
Not inactivated by penicillinases, thus often used for infections caused by penicillin-resistant staphylococci.
Indications of flucloxacillin?
staph skin infections + cellulitis
How much flucloacillin do you give?
Co-amoxiclav is what? AKA?
- Amoxicillin + Clavulanic Acid. AKA Augmentin
- Clavulanic acid = ? lactamase inhibitor
- Combination of 2 drugs means active against penicillinases
severe dental infections with spreading cellulitis
Side effect co-amoxiclav?:
Dose of Co-amoxiclav?
- 250mg/125mg i.e. 375mg or
- 500mg/125mg tds i.e. 625mg
Is MND bacteriostatic? Which bacteria is it effective against?
- No, bactericidal.
- Effective against anaerobic bacteria and protozoa
How MND does work?
Inhibits DNA synthesis by causing strand breakage of bacterial DNA
Indications of MND?
ANUG, pericoronitis, useful for other oral infections
What does MND react with?
- Alcohol -Disulfiram-like reaction
- Lithium (for manic depression) - lithium toxicity
- Warfarin - increases bleeding tendency
Common SE of MND?
- GI disturbance common, allergy rare
- Other - oral candidal overgrowth causes tongue discolouration
How much METD?
Clindamycin is static or cidal?
Which bacteria does clindamycin attack?
- Gram +ve cocci (incl. penicillin-resistant staph)
- many anaerobes
- Not negative
Serious SE of clindamycin?
Pseudomembranous colitis. Patients must discontinue AB if diarrhoea develops.
Why use clindamycin?
Good bone penetration, but not a routine AB for oral infections
So when is clindamycin used if not routinely?
- Indications: bone infections e.g. osteomyelitis, also skin e.g. cellulitis and soft-tissue infections
- Poss treat dentoalveolar abscess that not responded to penicillin or MET
What are TETRACYCLINES, static or cidal?
Bacteriostatic, Broad spec
Give examples of tetracyclines:
- Tetracycline 250mg qds
- Doxycycline 100mg bd
Indications of tetracyclines:
perio disease, sinusitis
Who not to give tetracyclines:
Tetracycline staining - not given to under 12's and pregnant/breast-feeding women
What reduces absorption of tetracyclines:
Antacids and milk reduce their absorption
Erythromycin is static or cidal?
What family is erythromycin from?
Erythromycin - Broad or narrow spec?
GI relevance of erythromycin?
- Poor absorption
- GI disturbance � nausea + vomiting
What may erythromycin be useful in?
- Alternative to penicillin in hypersensitive patients
- But, Poor action against oral anaerobes due to rapidly developing resistance
Relevance of sulphonamides?