Analgesic misuse

Question 1

what are some of the associations with those unregistered?

Answer 1

• lower SE background
• education
• alcohol and drug dependency
• severe mental health problems (the social drift effect)
• personal care takes lower priority
• dental anxiety/phobia
• homeless
• visiting/temporary residents/asylum seekers

Question 2

name 5 analgesics

Answer 2

• asprin
• NSAIDs (ibuprofen/diclofenac)
• paracetamol
• paracetamol compound preperations
• opiates/opioids (codiene/dihydrocodiene/tramadol)

Question 3

where is paracetamol absorbed and how well?

Answer 3

well absorbed in the small intestine

Question 4

what is the peak plasma time for paracetamol?

Answer 4

60 mins

Question 5

what is the half life for paracetamol?

Answer 5

2 hrs

Question 6

what is the cyclo-oxygenase system?

Answer 6

it is an enzyme responsible for the production of prostanoids such as prostaglandins

Question 7

what are prostaglandins?

Answer 7

a hormone like substance that participates in a variety of different bodily systems including the body’s response to damage/injury

Question 8

is paracetamol more or less effective at inhibiting the cyclo-oxygenase system than conventional NSAIDs?

Answer 8

less effective than NSAIDs

Question 9

how does paracetamol give analgesia?

Answer 9

it inhibits brain prostaglandin synthesis (PGE1 and PGE2)

Question 10

paracetamol inhibits prostaglandin synthesis in the hypothalamus giving..?

Answer 10

anti-pyretic (anti-fever)

Question 11

what are 3 possible side effects of paracetamol?

Answer 11

rash, white blood cell disorders, hepatotoxicity (destruction to the liver cells)

Question 12

what can happen during paracetamol overdose?

Answer 12

hepatocellular necrosis

Question 13

hepatocellular damage to can be reduced by giving what?

Answer 13

N-actyl cysteine supplement (NAC or Parvolex)

Question 14

what is the issue with NAC in treating a paracetamol overdose?

Answer 14

it comes with risk of severe allergic reaction

Question 15

how many phases of the paracetamol overdose are there?

Answer 15

4

Question 16

how long are you in phase 1?

Question 17

what are the signs and symptoms of phase 1 paracetamol overdose?

Answer 17

signs = pallor, malaise, vomiting, sweating
symptoms = anorexia, nausea, vomiting

Question 18

what are the signs and symptoms of phase 2 paracetamol overdose?

Answer 18

signs = tachycardia, hypotension 
symptoms = upper abdominal pain

Question 19

when does phase 2 paracetamol overdose occur?

Answer 19

24-48 hrs

Question 20

when does phase 3 paracetamol overdose occur?

Answer 20

3-4 days

Question 21

what are the signs and symptoms of phase 3 paracetamol overdose?

Answer 21

jaundice, bleeding, encephalopathy (abnormal brain function)

Question 22

when does stage 4 paracetamol overdose occur?

Answer 22

4-11 days

Question 23

what is the signs of phase 4 paracetamol overdose?

Answer 23

recovery or death depending on damage severity

Question 24

what type of paracetamol overdose has a higher mortality/morbidity effect?

Answer 24

staggered unintentional overdose more dangerous that intentional one bolus time despite lower doses

Question 25

what is the normal toxic dose?

Answer 25

10g/24hrs or 150g/kg

Question 26

what is the 'at risk' of a toxic dose?

Answer 26

7mg/24hrs or 75mg/kg

Question 27

what are some of the additional risks for hepatotoxicity?

Answer 27

- undernourished/underweight (

Question 28

what are the features of aspirin OD?

Answer 28

- increased respiratory rate - ringing in ears - parasthesia (pins and needles) - vomiting/nausea - drowsiness

Question 29

what are the 5 main risks of aspirin OD?

Answer 29

- bleeding - acidosis - cerebral oedema - coma - death

Question 30

what drug may cause a chemical burn to the mucosa?

Answer 30

if patient uses topical aspirin to relieve tooth ache

Question 31

what are the initial features of NSAID OD?

Answer 31

- enhanced normal effects - anti-platelet effects (bleeding and bruising) - metabolic effects (dizziness, tinnitus, paraesthesia) - GI irritation (epigastric pain, nausea, vomiting)

Question 32

what are the eventual features of NSAID OD?

Answer 32

- renal impairment - cerebral oedema - cardiac arrest

Question 33

what are the 3 main features of opiate OD?

Answer 33

- pupils constricted - drowsiness but sometimes confusion and agitation - reduced GCS (airway risk and respiratory depression)

Question 34

what are some issues with prescribing opiates?

Answer 34

- dependence | - misuse

Question 35

what can tramadol also cause in OD?

Answer 35

seizures and serotonin syndrome (respiratory depression not prominent with tramadol)

Question 36

what are 3 resources for advice on a patient who may have overdosed?

Answer 36

TOXBASE (online database) NPIS (national poisons information service Local A+E (by phone first)

Question 37

when to calculate patients weight in kg with suspected paracetamol OD?

Answer 37

if >4g in 24hrs