Analgesics - Paracetamol Flashcards

1
Q

Which 2 of the following drugs are part of stage 1 of the analgesic ladder?

1 - codeine
2 - tramadol
3 - paracetamol
4 - NSAIDs

A

3 - paracetamol
4 - NSAIDs

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2
Q

Which 2 of the following drugs are part of stage 2 of the analgesic ladder?

1 - codeine
2 - tramadol
3 - paracetamol
4 - NSAIDs

A

1 - codeine
2 - tramadol

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3
Q

Which of the following is on stage 3 of the analgesic ladder?

1 - codeine
2 - morphine
3 - paracetamol
4 - NSAIDs

A

2 - morphine

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4
Q

NSAIDS have 3 properties: analgesic (pain-killing), anti-inflammatory and antipyretic (fever-reducing) properties. Which of the following is NOT classed as a NSAIDs?

1 - aspirin
2 - paracetamol
3 - ibuprofen
4 - diclofenac

A

2 - paracetamol

  • analgesic and antipyretic only
  • NOT anti-inflammatory
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5
Q

A 22-year-old man presents with complaints of ankle pain and swelling from a sports injury oneday prior. X-rays are negative for a fracture and he is directed to rest the joint and allow it to heal. Which drug will provide LESS benefit in alleviating pain and inflammation of the swollen joint?

A. Celecoxib
B. Naproxen
C. Diclofenac
D. Acetaminophen

A

D. Acetaminophen
- more commonly known as paracetamol

  • other 3 drugs are NSAIDS
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6
Q

A patient with which of the following conditions is the most appropriate candidate for use of acetaminophen to manage chronic pain associated with osteoarthritis?

A. Chronic malnutrition
B. Obesity
C. Alcoholism
D. Viral hepatitis

A

B. Obesity
- other conditions increase risk of acetaminophen (paracetamol) related hepatotoxicity.

  • acetaminophen depletes glutathione concentrations in the liver and NAPQI builds up.
  • low levels of glutathione are common in malnutrition, again increasing levels of NAPQI
  • alcoholism depletes endogenous glutathione
  • viral hepatitis damages the liver, and could reduce levels of glutathione
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7
Q

Among NSAIDs, aspirin is unique because it:

(A) Irreversibly inhibits its target enzyme
(B) Prevents episodes of gouty arthritis with long-term use
(C) Reduces fever
(D) Reduces the risk of colon cancer
(E) Selectively inhibits the COX-2 enzyme

A

(A) Irreversibly inhibits its target enzyme

  • non-selective irreversibly inhibition of cyclooxygenase 1 and 2
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8
Q

Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action?

(A) Acetaminophen
(B) Celecoxib
(C) Colchicine
(D) Indomethacin
(E) Probenecid

A

(A) Acetaminophen

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9
Q

An 18-month-old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patient’s death?

(A) Arrhythmia
(B) Haemorrhagic stroke
(C) Liver failure
(D) Noncardiogenic pulmonary edema
(E) Ventilatory failure

A

(C) Liver failure

  • liver failure as a result of its conversion by hepatic cytochrome P450 enzymes to a highly reactive metabolite NAPQI
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10
Q

A 54-year-old woman presented with signs and symptoms consistent with an early stage of rheumatoid arthritis. The decision was made to initiate NSAID therapy. Which of the following patient characteristics is the most compelling reason for avoiding celecoxib in the treatment of her arthritis?

(A) History of alcohol abuse
(B) History of gout
(C) History of myocardial infarction
(D) History of osteoporosis
(E) History of peptic ulcer disease

A

(C) History of myocardial infarction

  • COX-2-selective inhibitor
  • increased risk of arterial thrombotic events.
  • history of MI would be a compelling reason to avoid a COX-2 inhibitor
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11
Q

Which of the following statements is correct regarding morphine?

1 - Morphine is the most lipophilic opioid.
2 - Morphine is metabolised through CYP2D6 and ­CYP3A4 and has numerous drug interactions.
3 - Morphine has active metabolites that can accumulate in renal impairment, leading to clinically relevant effects.
4 - Morphine can cause opioid-induced constipation upon initiation of opioid therapy, but tolerance occurs after 1 to 2weeks of opioid exposure.

A

3 - Morphine has active metabolites that can accumulate in renal impairment, leading to clinically relevant effects.

  • Morphine has two active metabolites M3G and M6G, which are renally eliminated.
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12
Q

Paracetamol overdose is dangerous for which organ?

1 - heart
2 - kidney
3 - liver
4 - GIT

A

3 - liver

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13
Q

If a patient takes an overdose of paracetamol (acetaminophen) what can this create in the liver that is toxic?

1 - cytochrome P450
2 - N-acetyl-p-benzoquinone (NAPQI)
3 - N-acetylcysteine
4 - glutathione

A

2 - N-acetyl-p-benzoquinone (NAPQI)

glutamyl-cysteinyl-glycine (Glutathione (GSH)) metabolises NAPQI and neutrilises it
- but in overdose glutathione runs out

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14
Q

If a patient takes an overdose of paracetamol (acetaminophen), N-acetyl-p-benzoquinone (NAPQI) levels increase and can cause liver failure. What is given to patients to neutralise NAPQI?

1 - cytochrome P450
2 - naloxone
3 - N-acetylcysteine
4 - glutathione

A

3 - N-acetylcysteine
- provides cysteine that is a substrate for glutathione

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15
Q

Although paracetamol doesn’t typically need monitoring, but in a suspected paracetamol overdose, all of the following must be monitored, EXCEPT?

1 - INR
2 - LFTs
3 - U&Es
4 - creatinine concentrations

A

3 - U&Es

  • may be done, but not as important as other
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16
Q

Paracetamol are level 1 of the analgesic ladder. Which of the following are paracetamol indicated in?

1 - acute low grade pain
2 - fever
3 - chronic low grade pain
4 - all of the above

A

4 - all of the above

17
Q

Which of the following effects does paracetamol have in the central nervous system?

1 - inhibits COX-2 and therefore prostaglandin
2 - reduces pain sensitivity
3 - reduces pain transmission between spinal cord and higher centres
4 - reduces prostaglandin in hypothalamus and reduces fever
5 - all of the above

A

5 - all of the above

  • has little affect in the PNS
18
Q

Although paracetamol is a very safe medication, often making it the first analgesia choice. The dose does need to be modified in all of the following EXCEPT?

1 - chronic excessive alcohol use
2 - malnutrition
3 - low body weight
4 - peptic ulcers
5 - severe hepatic impairment

A

4 - peptic ulcers

  • any damage to liver may reduce its ability to metabolise and increase toxic levels of NAPQI
  • malnutrition causes low stores of glutathione
19
Q

There are few interactions of paracetamol. Once is any drugs that induce cytochrome P450. What would this do to paracetamol?

A
  • increase paracetamol metabolism and increase NAPQI levels
20
Q

Paracetamol can be administered orally, IV or suppository. What is the usual standard dose?

1 - 2g /4 hours or 8g/day
2 - 1-2g /4 hours or 6-8g/day
3 - 1g/4 hours or 3-4g/day
4 - 0.5 - 1g /4 hours or 4g/day

A

4 - 0.5 - 1g /4 hours or 4g/day