DRUGS- ABs and pain relief .txt

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DRUGS- ABs and pain relief .txt
2012-03-25 08:48:35

Pain, AB,
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  1. What is the correct name for Paracetamol?
  2. What is the dose of paracetamol, and its maximum dose?
    • 500mg-1g
    • MAX 4g per day
  3. Side affects of paracetamol?
    • RARE, but may include -
    • Rash
    • blood disorders - thrombocytopenia, leukopenia
    • hypotension �if IV admin
    • liver and kidney damage in OD
  4. How much paracetamol for acute liver failure?
    10 -15g
  5. How much paracetamol for fatal OD?
  6. Treatment of paracetamol OD?
    • Acetylcysteine (i.v.) ideally within 8hrs ingestion of OD
    • Activated charcoal
  7. NSAIDs, name 3:
    • Ibuprofen
    • Aspirin (Salicylic acid derivative)
    • Diclofenac (Voltarol)
  8. How do NSAIDs work?
    Inhibit COX pathway, stopping production of PG (chemical mediator of pain)
  9. Which NSAIDS inhibit platelet function?
    • Aspirin irreversibly does, therefore increase bleeding time.
    • Other NSAIDs do, but reversibly (only last the life of the drug)
  10. What else do PG do?
    stimulate protective gastric mucus secretion
  11. Side effects of NSAIDS
    • GI disturbances incl. � nausea, Diarrhoea, bleeding, ulceration
    • Hypersensitivity reaction-angioedema, urticarial, rhinitis
    • May impair renal function
    • Worsen asthma
  12. 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
  13. MAX doses?
    • Ibuprofen -2.4g/day
    • Aspirin -4g/day
    • Diclofenac -150mg/day
  14. Signs of OD of aspirin?
    • Hyperventilation, agitated
    • Tinnitus, deafness
    • Vasodilation
    • Sweating
    • Coma (uncommon)
  15. Signs of OD of ibuprofen?
    • Nausea, vomiting,
    • Epigastric pain
    • Tinnitus
  16. Treatment of OD of NSAIDs?
    • Activated charcoal
    • Gastric lavage
  17. 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
  18. NSAIDs are peripherally acting, where do Opioids work?
  19. Name 3 opioids:
    • Morphine
    • Dihydrocodeine - maxfacs like
    • Codeine
  20. What is a co-codamol a combination of?
    • Codeine + paracetamol
    • 30mg and 500mg
  21. Effects of opioids
    • Analgesic
    • Sedative
    • Euphoric
  22. Unwanted SE of opioids?
    • Cough suppression
    • N + V
    • Constipation
    • Miosis (pupils small)
    • Dependence
  23. 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
  24. Effects of opioids reversed by?
  25. Tricyclic Ads give two examples?
    • Amitryptiline
    • Nortryptiline - best analgesia, less SE
  26. What Tricyclic ADs do?
    • AD
    • sedation
    • Analgesic
    • Muscle relaxant
  27. What doses of Tricyclic ADs do you give?
    • Therapeutic 10-20mg
    • If for AD 80mg or more
  28. What is an AB?
    A substance, produced by or derived from a micro-organism, that destroys or inhibits the growth of other micro-organisms.
  29. Which types of bacteria cause most H+N infections?
    Streptococci and anaerobes
  30. When do you prescribe ABs?
    • Systemic involvement:
    • 1.pyrexia
    • 2.regional lymphadenopathy,
    • 3. uncontrolled/spreading swelling - facial cellulitis
    • 4.Trismus
    • 5.Tachycardia
    • ? Immuno-compromised pt.
  31. Before prescribing ABs, consider pt factors:
    • Allergy
    • Pregnancy
    • Do they take OCP?
    • Renal function
    • Alcoholism (METD)
  32. What might help you choose the correct AB?
    Microbial C and S.
  33. Dose of ABs depends on?
    Dependant on age, weight, renal function, severity of infection
  34. Duration of ABs depends on?
    • Nature of infection
    • pts response to Tx
    • Too short -resistance
    • Too long -Unwanted SE
  35. Name the Bactericidal Abs
    • Penicillins
    • Cephalosporins
    • Metronidazole
  36. Name Bacteriostatic ABs
    • Erythromycin
    • Clindamycin
    • Tetracyclines
  37. Name types of Penicillins?
    Amoxicillin, Flucloxacillin, Co-amoxiclav (augmentin), Phenoxymethyl penicillin (Pen V)
  38. How do Penicillins work?
    • Beta lactam, interfere with bacterial cell wall synthesis.
    • Therefore bactericidal
  39. Risk of allergy to Penicillin?
    • Risk of allergy 1-10%
    • e.g. rash or anaphylaxis 0.05%
    • (N.B. Most common drug allergy)
  40. Is penicillin safe in pregnancy?
  41. How are penicillins excreted?
  42. Side FX of penicillin?
    Diarrhoea can be a frequent side-effect
  43. Amoxicillin is broad spec or narrow spec?
    • Broad-spectrum
    • Therefore some positive, some negative, (few anaerobes)
  44. What is an advantage of amoxicillin?
    Well absorbed (not affected by presence of food in stomach)
  45. What is a disadvantage of amoxicillin?
    Inactivated by penicillinases (? lactamases)
  46. How much amoxicillin do you give?
    250-500mg tds
  47. Flucloxacillin, broad or narrow spec?
    • Narrow spectrum
    • Therefore only gram positive
  48. Advantage of flucloxacillin?
    Not inactivated by penicillinases, thus often used for infections caused by penicillin-resistant staphylococci.
  49. Indications of flucloxacillin?
    staph skin infections + cellulitis
  50. How much flucloacillin do you give?
    250mg qds
  51. Co-amoxiclav is what? AKA?
    • Amoxicillin + Clavulanic Acid. AKA Augmentin
    • Clavulanic acid = ? lactamase inhibitor
    • Combination of 2 drugs means active against penicillinases
  52. Indications co-amoxiclav:
    severe dental infections with spreading cellulitis
  53. Side effect co-amoxiclav?:
    Stevens-Johnson syndrome
  54. Dose of Co-amoxiclav?
    • 250mg/125mg i.e. 375mg or
    • 500mg/125mg tds i.e. 625mg
  55. Is MND bacteriostatic? Which bacteria is it effective against?
    • No, bactericidal.
    • Effective against anaerobic bacteria and protozoa
  56. How MND does work?
    Inhibits DNA synthesis by causing strand breakage of bacterial DNA
  57. Indications of MND?
    ANUG, pericoronitis, useful for other oral infections
  58. What does MND react with?
    • Alcohol -Disulfiram-like reaction
    • Lithium (for manic depression) - lithium toxicity
    • Warfarin - increases bleeding tendency
  59. Common SE of MND?
    • GI disturbance common, allergy rare
    • Other - oral candidal overgrowth causes tongue discolouration
  60. Contraindication MND?
    • Pregnancy
    • Alcoholism
  61. How much METD?
    200-400mg tds
  62. Clindamycin is static or cidal?
  63. Which bacteria does clindamycin attack?
    • Gram +ve cocci (incl. penicillin-resistant staph)
    • many anaerobes
    • Not negative
  64. Serious SE of clindamycin?
    Pseudomembranous colitis. Patients must discontinue AB if diarrhoea develops.
  65. Why use clindamycin?
    Good bone penetration, but not a routine AB for oral infections
  66. 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
  67. Dose clindamycin?
    150mg qds
  68. What are TETRACYCLINES, static or cidal?
    Bacteriostatic, Broad spec
  69. Give examples of tetracyclines:
    • Tetracycline 250mg qds
    • Doxycycline 100mg bd
  70. Indications of tetracyclines:
    perio disease, sinusitis
  71. Who not to give tetracyclines:
    Tetracycline staining - not given to under 12's and pregnant/breast-feeding women
  72. What reduces absorption of tetracyclines:
    Antacids and milk reduce their absorption
  73. Erythromycin is static or cidal?
  74. What family is erythromycin from?
  75. Erythromycin - Broad or narrow spec?
    Narrow spectrum
  76. GI relevance of erythromycin?
    • Poor absorption
    • GI disturbance � nausea + vomiting
  77. What may erythromycin be useful in?
    • Alternative to penicillin in hypersensitive patients
    • But, Poor action against oral anaerobes due to rapidly developing resistance
  78. Relevance of sulphonamides?
    Erythema multiforme