BNF - Chapter 4 - Nervous System - (Part 2) Flashcards
Which drugs may be classed as adjuvant analgesics for chronic pain?
Drugs such as
- Antidepressants
(either amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline to manage chronic primary pain, may be considered)
Which pain relief medications are better for musculoskeletal conditions?
- Non-opioid drugs
paracetamol and aspirin (and other NSAIDs)
What are opioid analgesics more suitable for?
Particularly of visceral origin
What is sickle cell disease?
Sickle cell disease is a group of disorders that affects hemoglobin , the molecule in red blood cells that delivers oxygen to cells throughout the body. People with this disease have atypical hemoglobin molecules called hemoglobin S, which can distort red blood cells into a sickle , or crescent, shape.
How is the pain in mild sickle-cell crisis managed?
- With paracetamol, a NSAID, codeine phosphate or dihydrocodeine tartate
How may the pain need to be managed in severe sickle-cell crisis?
- Morphine or diamorphine
Concomitant use of NSAID may potentiate analgesia and allow lower doses of the opioid to be used.
Why is pethidine hydrochloride avoided if possible in sickle-cell disease?
Because accumulation of a neurotoxic metabolite can precipitate seizures; the relatively short half-life of pethidine hydrochloride necessitates frequent injections
What is most dental pain relieved with?
- NSAIDs that are used for dental pain which include - ibuprofen, diclofenac sodium and aspirin.
Paracetamol has analgesic and antipyretic effects but no anti-inflammatory effect
Are opioid analgesics helpful in dental pain?
Opioid analgesics are relatively ineffective in dental pain and their side effects can be unpleasant.
How long is postoperative analgesia with ibuprofen or aspirin usually continued for?
For about 24 to 72 hours.
What is dysmennorhoea?
It is characterised by severe and frequent menstrual cramps and pain during period.
What can be used to prevent pain of dysmenorrhoea?
- Use of oral contraceptives
- paracetamol or NSAID
Antispasmodics (such as alverine citrate) have been advocated for dysmenorrhoea but the antispasmodic action does not generally provide significant relief.
Gastric irritation may be a problem with aspirin, how may this be minimised?
- it is minimised by taking the dose after food.
Enteric coated preparations are available, but have a slow onset of action and are therefore unsuitable for single-dose analgesic use (though their prolonged action may be useful for night pain)
Which drug interaction with aspiring is a special hazard?
Aspirin + Warfarin
Which drug has a role in the relief of persistent pain unresponsive to other non-opioid analgesics?
Nefopam hydrochloride
It causes little or no respiratory depression, but sympathomimetic and antimuscarinic side effects may be troublesome
Which non-opioid analgesic is licensed to be adminstered via intrathecal infusion for the treatment of chronic severe pain?
Ziconotide (Prialt )
What role does caffeine play in compound analgesics?
Caffeine is a weak stimulant that is often included in small doses in analgesic preparations.
It is claimed that the addition of caffeine may enhance the analgesic effect, but he altering effect, mild habit-forming effect and possible provocation of headache may not always be desirable.
Moreover, in excessive dosage or on withdrawal caffeine may itself induce headache.
Which opioid has both opioid agonist and antagonist properties?
Buprenorphine
does morphone or buprenorphine have a longer duration of action?
Buprenorphine has a much longer duration of action than morphine and sublingually is an effective analgesic for 6 to 8 hours.
Are the effects of buprenorphine fully reversed by naloxone?
Unlike most opioid analgesics, the effects of buprenorphine are only partially reversed by naloxone
Which opioid is known as heroin?
Diamorphine hydrochloride which is a powerful opioid analgesic.
Which causes more nausea and hypotension between morphine and diamorphine?
Diamorphine may cause less nausea and hypotension
Which is more soluble, morphine or diamorphine and what is the advantage of this?
In palliative care the greater solubility of diamorphine hydrochloride allows effective doses to be injected in smaller volumes and this is important in the emaciated patient.
Which three opioids are used by injection for intra-operative analgesia?
- Alfentanil
- Fentanyl
- Remifentanil
How often are fentanyl patches changed?
Every 72 hours
Which is more sedating and acts for longer, methadone or morphine?
- Methadone is less sedating than morphine and acts for longer periods.
What is the maximum times of administration for methadone in prolonged use?
Should not be administered more often than twice daily to avoid the risk of accumulation and opioid overdosage
Which opioid has a a similar profile to morphine and is commonly used as a second-line drug if morphine is not tolerated or does not control the pain?
Oxycodone
Which other opioid other than buprenorphine has partial agonist properties?
Pentazocine
It is not recommended and, in particular, should be avoided after myocardial infarction as it may increase pulmonary and aortic blood pressure as well as cardiac work.
Which indication is pethidine used in?
It is used for analgesia in labour; however, other opioids, such as morphine or diamorphine hydrochloride, are often preferred for obstetric pain.
Which two mechanism does Tapentadol (opioid work by)?
It is an opioid-receptor agonist and it also inhibits noradrenaline reuptake. Nausea, vomiting, and constipation are less likely to occur with tapentadol than with other strong opioid analgesics.
Which two mechanism does Tramadol (opioid work by)?
Tramadol hydrochloride produces analgesia by two mechanisms: an opioid effect and an enhancement of serotonergic and adrenergic pathways. It has fewer of the typical opioid side-effects (notably, less respiratory depression, less constipation and less addiction potential); psychiatric reactions have been reported.
Name some weak opioids?
Codeine
Dihydrocodeine
Meptazinol
What is the effect if benzodiazepines or benzo like drugs are co-prescribed with methadone?
The respiratory effect of methadone may be delayed
Is codeine CI in patients of any age who are known to be CYP2D6 …. metabolisers?
CYP2D6 ultra rapid metabolisers.
What are the signs of opioid toxicity?
- reduced consciousness
- lack of appetite
- somnolence
- constipation
- respiratory depression
‘pin-point’ pupils - nausea
- vomiting
What MHRA warning has been given about codeine use in children?
- Not to be used in children under 12
- Not to be used in children aged 12-18 who have problems with breathing
What advice can be given on where to apply fentanyl patches?
Apply to dry, non-irritated, non-irradiated, non-hairy skin on torso or upper arm removing after 72 hours and siting replacement patch on a different area (avoid using the same area for several days).
Do cluster headaches respond well to standard analgesics?
No they do not
What is the drug treatment of choice for cluster headaches?
Sumatriptan given by subcutaneous injection is the drug pf choice
If an injection is unsuitable, sumatriptan nasal spray or zolmitriptan nasal spray [both unlicensed use] may be used
Alternatively, 100% oxygen at a rate of 10–15 litres/minute for 10–20 minutes is useful in aborting an attack.
Which drug class does pizotifen belong to?
It is a sedating-antihistamine
what are the indications of pizotifen?
Prevention of vascular headache prevention of classical migraine common migraine prevention of cluster headaches Prophylaxis of migraine
What is migraine?
Migraine is a common type of primary headache disorder. It occurs more commonly in women than in men, and is characterised by recurrent attacks of typically moderate to severe headaches that usually last between 4–72 hours.
Does migraine usually cause headache on one side or both sides?
he headache is usually unilateral, pulsating, aggravated by routine physical activity, and may be severe enough to impact or prevent daily activities.
What is migraine usually associated with?
It is frequently accompanied by nausea and vomiting, photophobia and phonophobia, or both.
what sub groups is migraine subdivided into?
Migraine with or without aura, and it defined as either episodic or chronic
What does migraine with aura consist of?
Migraine with aura consists of visual symptoms (zigzag or flickering lights, spots, lines, or loss of vision), sensory symptoms (pins and needles, or numbness), or dysphasia, which usually precede the onset of headache. Symptoms usually develop gradually and resolve within 1 hour.
How many days of headaches defines episodic migraine (low and high) and chronic migraine?
Episodic migraine is defined as headache which occurs on less than 15 days per month, and can be further subdivided into low frequency (1–9 days per month) and high frequency (10–14 days per month). Chronic migraine is defined as headache which occurs on at least 15 days per month and has the characteristics of a migraine headache on at least 8 days per month for greater than 3 months.
For some women what may be a trigger for migraine?
In some women, the drop in oestrogen levels just before menstruation is a trigger for migraine, with symptoms generally occurring from two days before the start of bleeding up until three days after
What is medication-overuse headache (complication of migraine)?
the frequent use of acute treatment for migraine increases the frequency and intensity of headache, and can become the cause of the headache.
What lifestyle advice can be given for migraines?
Patients should be encouraged to eat regular meals, and to maintain adequate hydration, sleep and exercise. Other potential triggers include stress, relaxation after stress, some foods and drinks, and bright lights. Known triggers should be avoided; keeping a headache diary may be useful to identify potential triggers and should be continued for a minimum of 8 weeks.
For treatment of acute migraine - to reduce risk of developing medication-overuse headache, treatment should ideally be restricted to how many days per week?
- ideally restricted to 2 days per week and patients should be advised of the risk of developing medication over use headaches.
What drug class is 5HT1 receptor agonists?
(‘triptan)
What is the monotherapy recommended for acute migrains?
- Aspirin or
- Ibuprofen or
- 5HT1 receptor agonist (triptans)
When should a triptan be taken, timing wise?
should be taken as soon as the patient knows that they are developing a migraine (start of headache phase).
how about in patients who have migraines with aura - when are they advised to take their 5HT1 receptor agonist (Triptans)?
it is recommended that 5HT1-receptor agonists are taken at the start of the headache and not at the start of the aura (unless the aura and headache start at the same time).
With triptans, if there has been no response from initial dose when can second dose be taken?
Treatment with a 5HT1-receptor agonist can be repeated after 2 hours with the same or different drug if there has been an inadequate response to the initial dose.
What is the 5-HT1 receptor agonist of choice?
Based on its clinical efficacy and safety profile, sumatriptan is the 5HT1-receptor agonist of choice.
What are alternatives 5-HT1 receptor agonists?
almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, and zolmitriptan
Which 5-HT1 receptor agonist is recommended in patients who present with early vomiting or who have severe migraine attacks?
- Subcutaneous sumatriptan
or - Nasal Zolmitriptan
For acute migraine, those who fail to respond to monotherapy, a combination of which drugs can be given?
Sumatriptan and naproxen
For those with nausea and vomiting, which antiemetics can be used?
Metoclopramide - but should not be used regularly due to the risk of EPSs
Domperidone (unlicensed in those weighing less than 35Kg) may be used as an alternative antiemetic).
What is recommended first line for prevention of migraine?
Propranolol hydrochloride is recommended as first-line preventative treatment in patients with episodic or chronic migraine.
For patients in whom propranolol is unsuitable, other beta-blockers that can be considered are metoprolol tartrate, atenolol [unlicensed indication], nadolol, and timolol maleate.
If a beta blocker is unsuitable - which drug can be given for prophylaxis of migraine?
.Topiramate can be given if a beta-blocker is unsuitable, however in women of childbearing potential, advice should be given on the associated risks during pregnancy, the need to use highly effective contraception and to seek further information if pregnant or planning a pregnancy.
Can TCAs be used for prophylaxis of migraine?
Amitriptyline hydrochloride is effective for migraine prophylaxis and should be considered for patients with episodic or chronic migraine. A less sedative tricyclic antidepressant can be used if amitriptyline hydrochloride is not tolerated.
How long should preventative medication for migraine be tried before considering it as ineffective?
Preventative treatment should be tried for at least 3 months at the maximum tolerated dose, before deciding whether or not it is effective
What is a good response to treatment of prophylaxis of migraine considered as?
A good response to treatment is defined as a 50% reduction in the severity and frequency of migraine attacks
How long should a review of ongoing prophylaxis of migraine be considered?
after 6–12 months; treatment can be gradually withdrawn in many patients.
Patient should be referred to a neurology or specialist headache clinic if trial with how many drugs have been unsuccessful.
3 or more drugs
What type of migraine is botulinum toxin type A recommended?
Botulinum toxin type A (specialist use only) is recommended for prophylaxis of chronic migraine where medication-overuse has been addressed and where 3 or more oral prophylactic treatments have failed.
Which NSAID is licensed for treatment of acute migraine?
- Tolfenamic acid
Are triptans licensed for use in the elderly?
No
Name the triptans?
Almotriptan Eletriptan Frovatriptan Naratriptan Rizatriptan Sumatriptan Zolmitriptan
Can sumatriptan 50mg be sold OTC?
Yes to those who have been previously diagnosed with migraine
Neuropathic pain occurs as a result of what?
Neuropathic pain, which occurs as a result of damage to neural tissue, includes phantom limb pain, compression neuropathies, peripheral neuropathies (e.g. due to Diabetic complications, chronic excessive alcohol intake, HIV infection, chemotherapy, idiopathic neuropathy), trauma, central pain (e.g. pain following stroke, spinal cord injury, and syringomyelia), and postherpetic neuralgia (peripheral nerve damage following acute herpes zoster infection (shingles)). The pain may occur in an area of sensory deficit and is sometimes accompanied by pain that is evoked by a non-noxious stimulus (allodynia).
What is trigeminal neuralgia caused by?
Trigeminal neuralgia is also caused by dysfunction of neural tissue, but its management is distinct from other forms of neuropathic pain.
What are neuropathic pain usually managed with?
Neuropathic pain is generally managed with a tricyclic antidepressant or with certain antiepileptic drugs.
Which drug are effective for neuropathic pain?
- Amitriptyline
- Pregabalin
These two can be used in combination if the patient has an inadequate response to either drug at the maximum tolerated dose.
Gabapentin is also effective for treatment of neuropathic pain
Which opioids analgesics may be used for neuropathic pain?
There is evidence of efficacy for tramadol hydrochloride, morphine, and oxycodone hydrochloride; however, treatment with morphine or oxycodone hydrochloride should be initiated only under specialist supervision. Tramadol hydrochloride can be prescribed when other treatments have been unsuccessful, while the patient is waiting for assessment by a specialist.
Which topical drug is licensed for neuropathic pain?
Capsaicin is licensed for neuropathic pain (but the intense burning sensation during initial treatment may limit use)
What role does a corticosteroid have in treatment of neuropathic pain?
A corticosteroid may help to relieve pressure in compression neuropathy and thereby reduce pain.
Which drug taken at the acute stages of trigeminal neuralgia reduce the frequency and severity of attacks?
Carbamazepine
It is very effective for the severe pain associated with trigeminal neuralgia and (less commonly) glossopharyngeal neuralgia.
Blood counts and electrolytes should be monitored when high doses are given
Small doses should be used initially to reduce the incidence of side-effects e.g. dizziness.
Which other anti-epileptic may be useful in trigeminal neuralgia?
- Phenytoin; the drug may be given by IV (possible as fosphenytoin sodium) in a crisis (specialist use only)
Which opioid is the drug of choice for treatment of neuropathic pain?
Tramadol
What are anxiolytics?
- are (‘sedatives’) and will induce sleep when given at night
What about hypnotics?
Most hypnotics will sedate when given during the day
what is the problem with prescribing of these drugs?
Dependence (both physical and psychological) and tolerance occur.
This may lead to difficulty in withdrawing the drug after the patient has been taking it regularly for more than a few weeks
Which receptors do benzodiazipines act on and what are they associated with?
they act at benzodiazepine receptors which are associated with gamma-aminobutyric acid (GABA) receptors
Benzodiazepines are usually indicated for short term relief for how many weeks?
2-4 weeks
Can benzodiazepines be used for short term management of mild anxiety?
No this in appropriate
What may abrupt withdrawal of benzos produce?
- confusion, toxic psychosis, convulsions, or a condition resembling delirium tremens
It is characterised by insomnia, anxiety, loss of appetite and of body-weight, tremor, perspiration, tinnitus, and perceptual disturbances.
When does benzodiazepine withdrawal syndrome occur?
Can develop anytime up to 3 weeks after stopping a long acting benzodiazepine but may occur within a day for short acting one.
What is the suggested protocol for withdrawal for prescribed long-term benzodiazepine patients?
Transfer patient stepwise, one dose at a time over about a week, to an equivalent daily dose of diazepam preferably taken at night.
Reduce diazepam dose, usually by 1–2 mg every 2– 4 weeks (in patients taking high doses of benzodiazepines, initially it may be appropriate to reduce the dose by up to one-tenth every 1–2 weeks). If uncomfortable withdrawal symptoms occur, maintain this dose until symptoms lessen.
Reduce diazepam dose further, if necessary in smaller steps; steps of 500 micrograms may be appropriate towards the end of withdrawal. Then stop completely.
For long-term patients, the period needed for complete withdrawal may vary from several months to a year or more.
What are the approximately equivalent doses of diazepam 5mg to other benzos?
Approximate equivalent doses, diazepam 5 mg
≡ alprazolam 250 micrograms
≡ clobazam 10 mg
≡ clonazepam 250 micrograms
≡ flurazepam 7.5–15 mg
≡ chlordiazepoxide 12.5 mg
≡ loprazolam 0.5–1 mg
≡ lorazepam 500 micrograms
≡ lormetazepam 0.5–1 mg
≡ nitrazepam 5 mg
≡ oxazepam 10 mg
≡ temazepam 10 mg
how long should withdrawal symptoms for long-term users of Benzos resolve within?
6-18 months of the last dose
The addition of which drugs should be avoided for patients with benzo withdrawal syndrome?
- beta-blockers
- antidepressants
antipsychotics
In which patients are short acting hypnotics preferrable in?
Short-acting hypnotics are preferable in patients with sleep onset insomnia, when sedation the following day is undesirable, or when prescribing for elderly patients.
In which patients are long-acting hypnotics indicated in?
Long-acting hypnotics are indicated in patients with poor sleep maintenance (e.g. early morning waking) that causes daytime effects, when an anxiolytic effect is needed during the day, or when sedation the following day is acceptable.
What is transient insomnia and what should be used?
Transient insomnia may occur in those who normally sleep well and may be due to extraneous factors such as noise, shift work, and jet lag. If a hypnotic is indicated one that is rapidly eliminated should be chosen, and only one or two doses should be given.
For short term insomnia - how many weeks max should be given of hypnotics?
3 weeks (prefer to be 1 week) Intermittent use is desirable with omission of some doses. A short-acting drug is usually appropriate.
Which anxiolytics/ hypnotics should be avoided in the elderly?
Benzodiazepines and the Z–drugs should be avoided in the elderly, because the elderly are at greater risk of becoming ataxic and confused, leading to falls and injury.
Which drugs are used for some anxious dental patients during dental procedures?
Some anxious patients may benefit from the use of hypnotics during dental procedures such as temazepam or diazepam. Temazepam is preferred when it is important to minimise any residual effect the following day.
Which benzodiazepines are used as hypnotics?
- Nitrazepam
- Flurazepam
Which have prolonged action and may give rise to residual effects on the following day; repeated doses tend to be cumulative
Which benzos are short acting and have little to no hangover effect?
Loprazolam, lormetazepam, and temazepam act for a shorter time and they have little or no hangover effect.
Withdrawal phenomena are more common with the short-acting benzodiazepines.
Which drug can be used for insomnia that is associated with daytime anxiety?
If insomnia is associated with daytime anxiety then the use of a long-acting benzodiazepine anxiolytic such as diazepam given as a single dose at night may effectively treat both symptoms.
What are the Z drugs?
Zolpidem tartrate and zopiclone are non-benzodiazepine hypnotics (sometimes referred to as Z-drugs), but they act at the benzodiazepine receptor.
Are Z drugs licensed for long term use?
No
Do Z drugs have short duration of action?
Yes both do
Who can melatonin be used in for insomnia?
Melatonin is a pineal hormone; it is licensed for the short-term treatment of insomnia in adults over 55 years; and for the short-term treatment of jet-lag in adults.
Which drugs are used as substitution therapy in opioid dependence?
Methadone
Buprenorphine
If a patient misses 3 days of methadone/ buprenorphine then tolerance is reduced - and if patient misses how many days would it indicate an assessment of illicit drug use?
If the patient misses 5 or more days of treatment, an assessment of illicit drug use is also recommended before restarting substitution therapy; this is particularly important for patients taking buprenorphine because of the risk of precipitated withdrawal.
Why is buprenorphine sometimes more preferred than methadone?
As it is less sedating and for this reason it may be more suitable for employed patients or those undertaking other skilled tasks such as driving.
Buprenorphine is safer than methadone hydrochloride when used in conjunction with other sedating drugs, and has fewer drug interactions. Dose reductions may be easier than with methadone hydrochloride because the withdrawal symptoms are milder, and patients generally require fewer adjunctive medications; there is also a lower risk of overdose
Can methadone or buprenorphin be given to be taken on alternate days i.e. miss a day?
Buprenorphine can be given on alternate days in higher doses and it requires a shorter drug-free period than methadone hydrochloride before induction with naltrexone hydrochloride for prevention of relapse.
Is methadone a long acting or short acting opioid agonist?
Long acting
Which out of the two buprenorphine or methadone is licensed in pregnancy?
Methadone is
buprenorphine is not licensed in pregnancy
Many pregnanat women choose instead to go with a withdrawal regimen, why should withdrawal be avoided in the first trimester of pregnancy?
because it is associated with an increased risk of spontaneous miscarriage.
When should methadone or buprenirphine be withdrawn in pregnancy if needed?
2nd trimester
Not 1st and not 3rd
What may be increased in the third trimester of pregnancy?
Drug metabolism can be increased in the third trimester; it may be necessary to either increase the dose of methadone hydrochloride or change to twice-daily consumption (or a combination of both strategies) to prevent withdrawal symptoms from developing.
What about opioid substitution during breastfeeding?
Doses of methadone and buprenorphine should be kept as low as possible in breast-feeding mothers. Increased sleepiness, breathing difficulties, or limpness in breast-fed babies of mothers taking opioid substitutes should be reported urgently to a healthcare professional.
Which drug can be used to alleviate some of the psychical symptoms of opioid withdrawal?
Lofexidine hydrochloride may alleviate some of the physical symptoms of opioid withdrawal by attenuating the increase in adrenergic neurotransmission that occurs during opioid withdrawal.
Which patients may naltrexone be given to?
Naltrexone hydrochloride precipitates withdrawal symptoms in opioid-dependent subjects. Because the effects of opioid-receptor agonists are blocked by naltrexone hydrochloride, it is prescribed as an aid to prevent relapse in formerly opioid-dependent patients.
Is opioid substitution appropriate in under 18s?
In younger patients (under 18 years), the harmful effects of drug misuse are more often related to acute intoxication than to dependence, so substitution therapy is usually inappropriate.
Maintenance treatment with opioid substitution therapy is therefore controversial in young people; however, it may be useful for the older adolescent who has a history of opioid use to undergo a period of stabilisation with buprenorphine or methadone hydrochloride before starting a withdrawal regimen.
What is delirium tremens (DTs)?
Delirium tremens (DTs) is the most severe form of ethanol withdrawal, manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse
Delirium tremens is a medical emergency that requires specialist inpatient care
What is delirium tremens in inpatients characterised by?
(characterised by agitation, confusion, paranoia, and visual and auditory hallucinations
What is first line treatment for delirium tremens?
oral lorazepam should be used as first-line treatment. If symptoms persist or oral medication is declined, parenteral lorazepam [unlicensed], or haloperidol [unlicensed] can be given as adjunctive therapy.
For alcohol withdrawal treatment, which drugs are offered first-line?
- Acamprosate calcium
or - Naltrexone
can be used in combination with a psychological intervention
Which drug is used an alternative in patients whom Acamprosate and oral naltrexone are not suitable?
- Disulfiram
or if patient prefers disulfiram and understands the risks of taking the drug.
In which patients is nalmefene recommended in?
Nalmefene is recommended for the reduction of alcohol consumption in patients with alcohol dependence who have a high drinking risk level, without physical withdrawal symptoms, and who do not require immediate detoxification.
In which alcohol dependent patients may corticosteroids be used?
Patients with severe alcohol-related hepatitis with a discriminant function of 32 or more can be given corticosteroids but only after any active infection or gastro-intestinal bleeding is treated, any renal impairment is controlled, and following discussion of the potential benefits and risks of treatment. Corticosteroid treatment has been shown to improve survival in the short term (1 month) but not over a longer term (3 months to 1 year). It has also been shown to increase the risk of serious infections within the first 3 months of starting treatment.
For patients with chronic alcohol-related pancreatitis are supplements indicated when pain is the only symptom?
supplements are not indicated when pain is the only symptom.
Which condition are patients with alcohol dependence at risk of developing?
Wernicke’s encephalopathy
patients at high risk are those who are malnourished, at risk of malnourishment, or have decompensated liver disease.
Which drug should patients be given who are risk of Wernicke’s encephalopathy?
Parenteral thiamine, followed by oral thiamine, should be given to patients with suspected Wernicke’s encephalopathy, those who are malnourished or at risk of malnourishment, those who have decompensated liver disease or who are attending hospital for acute treatment.
Prophylactic oral thiamine should be given to which patients?
Prophylactic oral thiamine should also be given to harmful or dependent drinkers if they are in acute withdrawal, or before and during assisted alcohol withdrawal
To aid smoking cessation, which nicotine replacement therapy drugs can be used?
- Varenicline
- bupropion
Which NRT are long lasting?
Transdermal patch
Which NRT are short lasting?
lozenges, gum, sublingual tablets, inhalator, nasal spray and oral spray
What is the treatment of choice for smoking cessation?
Varenicline, or a combination of long-acting NRT (transdermal patch) and short-acting NRT (lozenges, gum, sublingual tablets, inhalator, nasal spray and oral spray), are the most effective treatment options and thus the preferred choices. If these options are not appropriate, bupropion hydrochloride or single therapy NRT should be considered instead.
Who may the 24 hour patch for NRT benefit?
Smokers which experience strong nicotine cravings upon waking
Is the use of NRT combined with varenicline or bupropion recommended?
No - he use of NRT combined with varenicline or bupropion hydrochloride is not recommended, and both varenicline and bupropion hydrochloride should not be prescribed together.
What important safety information has been released around the use of bupropion?
- cases of serotonin syndrome have been reported in patients taking bupropion with other serotonergic drugs such as selective serotonin re-uptake inhibitors (SSRIs) and serotonin and noradrenaline re-uptake inhibitors (SNRIs).
