Neurology Flashcards
When is paracetamol indicated?
Acute and chronic pain
For reduction of fever in children
What is the mechanism of action of paracetamol?
Inhibitor of cyclo-oxygenase (COX). This increases the pain threshold and reduced prostaglandin concentrations in the thermoregulatory region of the hypothalamus
What are the side effects of paracetamol?
Can cause liver failure in overdose
When should paracetamol be used with caution/avoided completely?
Chronic excessive alcohol use
Malnutrition
Low body weight
Severe hepatic impairment
What does paracetamol interact with?
CYP inducers can increase risk of liver toxicity after overdose
What are the prescriptions available for paracetamol?
IV infusion, oral tablets, rectal, oral liquid
What patient info should be communicated when starting paracetamol?
Should not exceed max daily dose
Effect occurs about half an hour after taking it
What monitoring is required for paracetamol?
Monitor pain
After overdose, INR, LFTs
When is tramadol/codeine indicated?
Mild to moderate pain when simple analgesics are insufficient
What is the MOA for codeine/tramadol?
Metabolise into small amounts of morphine in the liver to become agonists of opioid mu receptors
What are the common side effects of tramadol/codeine?
Drowsiness, Dizziness, constipation
When should tramadol be used with caution/avoided?
Avoid in uncontrolled epilepsy
Warning in hepatic impairment, elderly, renal impairment and resp distress
What do tramadol/codeine interact with?
Other sedating drugs such as antipsychotics
Serotonergic drugs such as SSRIs
What patient info should be communicated when starting tramadol or codeine?
Should be taken at equal intervals
Discuss side effects
Keep out of reach of children
Avoid paracetamol to avoid accidental overdose
How do you monitoring tramadol/codeine use?
Efficacy by symptom reduction
What are the indications for morphine?
Severe acute pain (post operative)
Chronic pain relief when other analgesics have not worked
End-of-life care
What is the MOA for morphine?
Activates opioid mu receptors in the CNS which reduce neuronal excitability and pain transmission
What are the important side effects of morphine?
Cause respiratory depression
Nausea and vomiting
Pupillary constriction
Constipation
When should morphine be used with caution/avoided?
Caution in elderly, hepatic failure, renal failure, resp failure and biliary colic
What drugs does morphine interact with?
Sedating drugs such as benzos, TCA
What patient info should be communicated when starting morphine?
Explain effectiveness of it
Nausea usually settles
How is morphine monitored?
Symptomatically
When is carbamazepine indicated?
Seizure prophylaxis in epilepsy
Trigeminal neuralgia
What is the MOA for carbamazepine?
Inhibits neuronal sodium channels to reduce neuronal activity
What are common side effects of carbamazepine?
Nausea + vomiting
Dizziness
Odema
When should carbamazepine be avoided?
Pregnancy
Hepatic, renal or cardiac disease
