Neurology

Question 1

When is paracetamol indicated?

Answer 1

Acute and chronic pain

For reduction of fever in children

Question 2

What is the mechanism of action of paracetamol?

Answer 2

Inhibitor of cyclo-oxygenase (COX). This increases the pain threshold and reduced prostaglandin concentrations in the thermoregulatory region of the hypothalamus

Question 3

What are the side effects of paracetamol?

Answer 3

Can cause liver failure in overdose

Question 4

When should paracetamol be used with caution/avoided completely?

Answer 4

Chronic excessive alcohol use
Malnutrition
Low body weight
Severe hepatic impairment

Question 5

What does paracetamol interact with?

Answer 5

CYP inducers can increase risk of liver toxicity after overdose

Question 6

What are the prescriptions available for paracetamol?

Answer 6

IV infusion, oral tablets, rectal, oral liquid

Question 7

What patient info should be communicated when starting paracetamol?

Answer 7

Should not exceed max daily dose

Effect occurs about half an hour after taking it

Question 8

What monitoring is required for paracetamol?

Answer 8

Monitor pain

After overdose, INR, LFTs

Question 9

When is tramadol/codeine indicated?

Answer 9

Mild to moderate pain when simple analgesics are insufficient

Question 10

What is the MOA for codeine/tramadol?

Answer 10

Metabolise into small amounts of morphine in the liver to become agonists of opioid mu receptors

Question 11

What are the common side effects of tramadol/codeine?

Answer 11

Drowsiness, Dizziness, constipation

Question 12

When should tramadol be used with caution/avoided?

Answer 12

Avoid in uncontrolled epilepsy

Warning in hepatic impairment, elderly, renal impairment and resp distress

Question 13

What do tramadol/codeine interact with?

Answer 13

Other sedating drugs such as antipsychotics

Serotonergic drugs such as SSRIs

Question 14

What patient info should be communicated when starting tramadol or codeine?

Answer 14

Should be taken at equal intervals
Discuss side effects
Keep out of reach of children
Avoid paracetamol to avoid accidental overdose

Question 15

How do you monitoring tramadol/codeine use?

Answer 15

Efficacy by symptom reduction

Question 16

What are the indications for morphine?

Answer 16

Severe acute pain (post operative)
Chronic pain relief when other analgesics have not worked
End-of-life care

Question 17

What is the MOA for morphine?

Answer 17

Activates opioid mu receptors in the CNS which reduce neuronal excitability and pain transmission

Question 18

What are the important side effects of morphine?

Answer 18

Cause respiratory depression
Nausea and vomiting
Pupillary constriction
Constipation

Question 19

When should morphine be used with caution/avoided?

Answer 19

Caution in elderly, hepatic failure, renal failure, resp failure and biliary colic

Question 20

What drugs does morphine interact with?

Answer 20

Sedating drugs such as benzos, TCA

Question 21

What patient info should be communicated when starting morphine?

Answer 21

Explain effectiveness of it

Nausea usually settles

Question 22

How is morphine monitored?

Answer 22

Symptomatically

Question 23

When is carbamazepine indicated?

Answer 23

Seizure prophylaxis in epilepsy

Trigeminal neuralgia

Question 24

What is the MOA for carbamazepine?

Answer 24

Inhibits neuronal sodium channels to reduce neuronal activity

Question 25

What are common side effects of carbamazepine?

Answer 25

Nausea + vomiting
Dizziness
Odema

Question 26

When should carbamazepine be avoided?

Answer 26

Pregnancy

Hepatic, renal or cardiac disease