Clinical Use of Analgesics I - Paracetamol Flashcards
What are the paracetamol associated ADRs?
Rash, blood disorders, acute pancreatitis
Liver and renal damage following overdose
What does paracetamol interact with?
Not many
Warfarin (increases the INR)
What are the GI tract ADRs that can be caused by NSAIDs
Ulceration and erosion
What are the renal ADRs that can be caused by NSAIDs
Poor renal perfusion
Retention of sodium and potassium
Water retention
What are the haematological ADRs that can be caused by NSAIDs
reduce platelet aggregation as reduced thromboxane (COX-1)
aspirin irreversible
NSAIDs reversible
What are the respiratory ADRs that can be caused by NSAIDs?
Bronchospasm PGs involved
Leukotrienes increase sensitivty of bronchioles
What options are there for gastroprotection?
H2 receptor antagonists completely inhibit histamine at H2 receptors on gastric parietal cells to modulate pH
Misoprostol - synthetic PG E1 analogue
Proton pump inhibitors inhibit acid secretion by binding irreversibly to proton pump
What is the role of coxibs?
Target PGs released as a result of pain and inflammation
As effective as NSAIDs
Reduce but do not eliminate GI adverse effects
What are the precautions with COX-2 inhibitors (coxibs)
Patients with significant risk factors for cardiovascular disease (e.g. hypertension, hyperlipidaemia, DM, smoking) or peripheral vascular disease
Diclofenac also similar cardiovascular risk