MSK and Pain

Question 1

how much paracetamol can you take in 1 day? at what interval?

Answer 1

4g in 24 hours. 1g 4 times per day

Question 2

diclofenac, Naproxen are..? they work how? Side effects? Which drugs taken concordently increase the risk of side effects? What if indicated by the pt has a peptic ulcer of CVD? Advice to Patient about taking?

Answer 2

NSAID, Inhibits COX so inhibits prostaglandin release (COX 1 – GI, COX2 -pain& inflam) Side effects: Indigestion, GI toxicity (avoid in liver failure, peptic ulcer, GI bleeding), renal impairment, increased cardiovascular event risk (avoid in HF), hypersensitivity reactions, fluid retention. Many drugs increase risk of NSAID adverse effects: GI ulceration (aspirin), GI bleeding (anti-coagulants), renal impairment (ACEi, diuretic) If you need to take but they have peptic ulcer, CVD etc use the lowest effective dose. Take w/ food

Question 3

1) Weak opioids - how do they work? 2) which drug names do they include? 3) side effects? 4) can you give it IV?

Answer 3

Opioid receptor agonist Codeine, Co-codamol (Codeine (weak opioid) and 500mg paracetamol combined), Tramadol (synthetic of codeine – less resp depression & constipation) SE: Nausea, consptipation (?laxative), dizziness, drowsiness. Neurological (caution driving, heavy machinery) and respiratory depression You cannot give it IV causes hypersensitivity reaction.

Question 4

Which patients might not tolerate codine/tramadol well due to side effects? Which neuro patients should you avoid tramadol in?

Answer 4

Caution in significant respiratory disease, renal/hepatic impairment and elderly Avoid Tramadol in epilepsy- lowers seizure threshold (also avoid combining w/ other seizure lowering drugs e.g. SSRIs, tricyclic anti-depressants.)

Question 5

Side effects of morphine? how can you counteract them? Do not combine with which drugs?

Answer 5

SE: can cause respiratory depression (avoid in respiratory failure) Euphoria, detachment and neurological depression (slow brain activity – caution driving/heavy machinery if they become drowsy/confused). Nausea& Vommiting (offer anti-emetic e.g. Metoclopramide). Pupil constriction. Constipation (offer laxative e.g. senna). Skin - Histamine release - itching, sweating. Tolerance (dose may need to be increased) & dependence (on cessation) Avoid other sedating drugs e.g. antipsychotic, anti-depressant, benzodiazepine

Question 6

Allopurinol - use? how does it work? SE? reduce dose in which pts? Interactions? usually prescribed with..?

Answer 6

To prevent gout. To prevent uric acid + calcium oxalate renal stones. To prevent hyperuricaemia and cancer: tumour lysis syndrome. Inhibits Xanthine oxidase which converts xanthine (purine) to uric acid (thereby decreases concentration and precipitation of uric acid in the joints/kidneys) SE: skin rash: (stop treatment) mild or severe hypersensitivity reaction (Steven-Johnson syndrome or toxic epidermal necrolysis). Drug hypersensitivity syndrome is a rare life-threatening reaction. Starting allopurinol can trigger/worsen acute gout attack weirdly. Eliminated by liver and kidney (so reduce in liver/renal impairment. Interaction: Increases toxicity of mercaptopurine/azathioprine as they require xanthine oxidase for metabolism. Amoxicillin increases risk of skin rash. ACEi and thiazide increases risk of hypersensitivity. with NSAID/colchine