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CMS! > Analgesic misuse > Flashcards

Analgesic misuse Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

what are some of the associations with those unregistered?

A
  • lower SE background
  • education
  • alcohol and drug dependency
  • severe mental health problems (the social drift effect)
  • personal care takes lower priority
  • dental anxiety/phobia
  • homeless
  • visiting/temporary residents/asylum seekers
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2
Q

name 5 analgesics

A
  • asprin
  • NSAIDs (ibuprofen/diclofenac)
  • paracetamol
  • paracetamol compound preperations
  • opiates/opioids (codiene/dihydrocodiene/tramadol)
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3
Q

where is paracetamol absorbed and how well?

A

well absorbed in the small intestine

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4
Q

what is the peak plasma time for paracetamol?

A

60 mins

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5
Q

what is the half life for paracetamol?

A

2 hrs

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6
Q

what is the cyclo-oxygenase system?

A

it is an enzyme responsible for the production of prostanoids such as prostaglandins

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7
Q

what are prostaglandins?

A

a hormone like substance that participates in a variety of different bodily systems including the body’s response to damage/injury

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8
Q

is paracetamol more or less effective at inhibiting the cyclo-oxygenase system than conventional NSAIDs?

A

less effective than NSAIDs

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9
Q

how does paracetamol give analgesia?

A

it inhibits brain prostaglandin synthesis (PGE1 and PGE2)

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10
Q

paracetamol inhibits prostaglandin synthesis in the hypothalamus giving..?

A

anti-pyretic (anti-fever)

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11
Q

what are 3 possible side effects of paracetamol?

A

rash, white blood cell disorders, hepatotoxicity (destruction to the liver cells)

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12
Q

what can happen during paracetamol overdose?

A

hepatocellular necrosis

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13
Q

hepatocellular damage to can be reduced by giving what?

A

N-actyl cysteine supplement (NAC or Parvolex)

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14
Q

what is the issue with NAC in treating a paracetamol overdose?

A

it comes with risk of severe allergic reaction

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15
Q

how many phases of the paracetamol overdose are there?

A

4

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16
Q

how long are you in phase 1?

A
17
Q

what are the signs and symptoms of phase 1 paracetamol overdose?

A 
signs = pallor, malaise, vomiting, sweating
symptoms = anorexia, nausea, vomiting
18
Q

what are the signs and symptoms of phase 2 paracetamol overdose?

A 
signs = tachycardia, hypotension 
symptoms = upper abdominal pain
19
Q

when does phase 2 paracetamol overdose occur?

A

24-48 hrs

20
Q

when does phase 3 paracetamol overdose occur?

A

3-4 days

21
Q

what are the signs and symptoms of phase 3 paracetamol overdose?

A

jaundice, bleeding, encephalopathy (abnormal brain function)

22
Q

when does stage 4 paracetamol overdose occur?

A

4-11 days

23
Q

what is the signs of phase 4 paracetamol overdose?

A

recovery or death depending on damage severity

24
Q

what type of paracetamol overdose has a higher mortality/morbidity effect?

A

staggered unintentional overdose more dangerous that intentional one bolus time despite lower doses

25
Q

what is the normal toxic dose?

A

10g/24hrs or 150g/kg

26
Q

what is the ‘at risk’ of a toxic dose?

A

7mg/24hrs or 75mg/kg

27
Q

what are some of the additional risks for hepatotoxicity?

A
  • undernourished/underweight (
28
Q

what are the features of aspirin OD?

A
  • increased respiratory rate
  • ringing in ears
  • parasthesia (pins and needles)
  • vomiting/nausea
  • drowsiness
29
Q

what are the 5 main risks of aspirin OD?

A
  • bleeding
  • acidosis
  • cerebral oedema
  • coma
  • death
30
Q

what drug may cause a chemical burn to the mucosa?

A

if patient uses topical aspirin to relieve tooth ache

31
Q

what are the initial features of NSAID OD?

A
  • enhanced normal effects
  • anti-platelet effects (bleeding and bruising)
  • metabolic effects (dizziness, tinnitus, paraesthesia)
  • GI irritation (epigastric pain, nausea, vomiting)
32
Q

what are the eventual features of NSAID OD?

A
  • renal impairment
  • cerebral oedema
  • cardiac arrest
33
Q

what are the 3 main features of opiate OD?

A
  • pupils constricted
  • drowsiness but sometimes confusion and agitation
  • reduced GCS (airway risk and respiratory depression)
34
Q

what are some issues with prescribing opiates?

A
  • dependence

- misuse

35
Q

what can tramadol also cause in OD?

A

seizures and serotonin syndrome (respiratory depression not prominent with tramadol)

36
Q

what are 3 resources for advice on a patient who may have overdosed?

A

TOXBASE (online database)

NPIS (national poisons information service

Local A+E (by phone first)

37
Q

when to calculate patients weight in kg with suspected paracetamol OD?

A

if >4g in 24hrs

CMS! (23 decks)

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