mock questions i didn't get right

Question 1

Codeine - Royal College of Paediatrics and Childheath

Answer 1

The Royal College of Paediatrics and Childhealth: Of particular concern
is the significance of ‘ultra fast metabolisers’ who rapidly metabolise codeine to morphine through a geneticvariant of cytochrome P450 CYP2D6. This variant is present in up to 0.7% of the general population but up to 30% of children of Middle Eastern and African/Ethiopian descent.

Question 2

Codeine - MHRA warnings

Answer 2

MHRA/CHM advice (July 2013) Codeine for analgesia: restricted use in children due to reports of morphine toxicity:

Codeine should only be used to relieve acute moderate pain in children older than 12 years and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen alone. A significant risk of serious and life-threatening adverse reactions has been identified in children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy:

• in children aged 12–18 years, the maximum daily dose of codeine should not exceed 240 mg. Doses may be taken up to four times a day at intervals of no less than 6 hours. The lowest effective dose should be used and the duration of treatment should be limited to 3 days
• codeine is contraindicated in all children (under 18 years) who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea
• codeine is not recommended for use in children whose breathing may be compromised, including those with neuromuscular disorders, severe cardiac or respiratory conditions, respiratory infections, multiple trauma or extensive surgical procedures
• codeine is contraindicated in patients of any age who are known to be ultra-rapid metabolisers of codeine (CYP2D6 ultra-rapid metabolisers)
• codeine should not be used in breast-feeding mothers because it can pass to the baby through breastmilk
• parents and carers should be advised on how to recognise signs and symptoms of morphine toxicity, and to stop treatment and seek medical attention if signs or symptoms of toxicity occur (including reduced consciousness, lack of appetite, somnolence, constipation, respiratory depression, ’pin-point’ pupils, nausea, vomiting)

MHRA/CHM advice (April 2015) Codeine for cough and cold: restricted use in children

Do not use codeine in children under 12 years as it is associated with a risk of respiratory side effects. Codeine is not recommended for adolescents (12–18 years) who have problems with breathing. When prescribing or dispensing codeine-containing medicines for cough and cold, consider that codeine is contraindicated in:

• children younger than 12 years old
• patients of any age known to be CYP2D6 ultra-rapid metabolisers
• breastfeeding mothers