Tutorial 5,6 Questions (Module 3) Flashcards
(7 cards)
James returns the next afternoon and reports the back pain has improved whilst using the Nurofen® tablets and he is doing exercise and maintaining healthy movement at work with no problems. He has not experienced any of the adverse effects we discussed yesterday. His friends at work mentioned that they used to be able to get Nurofen Plus® (contains ibuprofen and codeine) over-the-counter but James understands that he will need a prescription from a doctor for codeine-containing analgesics from 1 Feb 2018. James’ comments prompted you to revise your knowledge on codeine. Compare and contrast the pharmacological actions and adverse effects of ibuprofen vs codeine.
Ibuprofen is a non-steroidal anti-inflammatory drug. Works by inhibiting COX1-1 and COX-2 enzymes, it is more weakly selective for COX-1. Reduces prostaglandin synthesis by inhibition of COX-2 resulting in reduced vasodilation and inflammation. Has analgesic effects due to less sensitization of nociceptive nerve endings. Adverse effects: nausea, vomiting, GI upset
Codeine: Opiate analgesic acting on µ(mu) opioid receptors in the brain and spinal cord, resulting in opening potassium channels and inhibiting the opening of voltage-gated calcium channels, leading to decreased neuronal excitability and reduced transmitter release. Adverse effects: drowsiness, stomach pain, nausea
James asks if it is worth adding a ‘rub’ to his back to “get to the site”. He points to Dencorub® Arthritis Ice Gel (menthol) and Voltaren® Emulgel® (diclofenac) that he has seen advertised on TV recently. Compare and contrast their mechanisms of actions and adverse effects.
Menthol is a rubefacient causing redness and warmth of the skin through the vasodilation of local capillaries. Claims to have analgesic effects. Adverse effects: burning, irritation, and rash
Diclofenac is a non-steroidal anti-inflammatory drug. Works by inhibiting COX1-1 and COX-2 enzymes, it is more weakly selective for COX-1. Reduces prostaglandin synthesis by inhibition of COX-2 resulting in reduced vasodilation and inflammation. Has analgesic effects due to less sensitization of nociceptive nerve endings. Adverse effects: Skin irritation and rash
Recommend menthol as the diclofenac may enter his systemic circulation and result in too much NSAID in the body. Both have similar side effects such as irritation and rash.
Bianca tells you that she is going to her best friend’s 30th birthday party tonight and is planning on having a great time with a few drinks. She asks if she can have alcohol with the medicine you recommended. What would be your advice? What other information would you provide to Bianca in relation to her injury?
(Bianca is taking paracetamol for an ankle injury and takes pantoprazole for PPI)
Take paracetamol 2 hours before the party. Best to avoid it if possible as alcohol increases the risk of bleeding which will cause the healing time to increase.
Bianca comes in after 24 hours and reports the ankle feels much better after following the RICE instructions and the medicine you recommended seems to have provided sufficient pain relief. She is continuing these however she is back in the pharmacy due to her mother (a retired nurse) suggesting she try Disprin® (aspirin) and Hirudoid® cream (heparinoid) to speed up recovery. Her mum noticed a bruise on Bianca’s other foot (not swollen) due to dropping a can of beans on it the other day. It doesn’t hurt, her mum suggested it will clear the foot bruise quicker and help the ankle heal. Compare and contrast pharmacological actions, adverse effects and use in sprains, of aspirin and topical heparinoid:
Aspirin is a non-steroidal anti-inflammatory drug. Works by inhibiting COX1-1 and COX-2 enzymes, it is more weakly selective for COX-1. Reduces prostaglandin synthesis by inhibition of COX-2 resulting in reduced vasodilation and inflammation. Has analgesic effects due to less sensitization of nociceptive nerve endings. It also inhibits platelet aggregation. Adverse effects: nausea, constipation, dyspepsia. Cant use aspirin with her GORD medication
Heparinoid: Topical anticoagulant and thrombolytic. Adverse effects: erythema (redness of the skin)
Can use hirudoid cream for the bruise but it won’t help with the ankle pain. Avoid using aspirin due to the high amount of side effects, can continue using paracetamol.
Your junior pharmacy assistant asks about premenstrual syndrome (PMS) and the differences between PMS and primary dysmenorrhoea. How would you respond?
Premenstrual syndrome is a recurrence of symptoms during the luteal phase of the menstrual cycle (7-14 days prior to bleeding). With PMS, patients generally experience a mixture of mood, physical and behavioural symptoms. It is more common in the 30s and 40s age category.
Primary dysmenorrhoea is cramping pain during or before menstruation, it is due to the overproduction of uterine prostaglandins that are usually inhibited by progesterone. Prrogestroeone levels decrease just prior to menstruation which is what causes the pain.
Differences
> Onset of symptoms: 7-14 days prior to menses for the PMS, but for the PD the pain starts few hours to one day prior to menses
> Age: younger for PD, older for PMS
> Presenting complaints: cramping pain around the abdomen for PD but PMS will have other symptoms in addition to physical e.g. mood and behavioral.
Silvana says that she has taken some paracetamol tablets this morning but finds it ineffective for period pain. Compare and contrast pharmacological actions, adverse effects, and place in the management of primary dysmenorrhoea of paracetamol vs mefenamic acid.
Paracetamol is a centrally acting anti-pyretic and analgesic. Effects thought to be due to its action on cyclooxygenase 2 or cyclooxygenase 3, unknown at this point in time. May inhibit prostaglandin activity through COX 2 but has negligible anti-inflammatory properties
Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID). Works by inhibiting COX1-1 and COX-2 enzymes, it is more weakly selective for COX-1. Reduces prostaglandin synthesis by inhibition of COX-2 resulting in reduced vasodilation and inflammation. Has analgesic effects due to less sensitization of nociceptive nerve endings
Recommend using mefenamic acid as it will reduce the inflammation and pain associated with primary dysmenorrhoea whereas paracetamol has negligible anti-inflammatory actions.
Jasmine calls the pharmacy to speak with you upon her mum returning home. She has been googling “headaches” and looked at a few public forums. She has noticed two common medications people seem to be claiming to help their headaches: Anagraine® tablets (500 mg paracetamol and 5 mg metoclopramide) and Imigran® 20 mg/0.1 mL nasal spray (sumatriptan). Compare and contrast sumatriptan and metoclopramide with paracetamol and their mechanisms of actions, adverse effects, and contraindications.
Sumatriptan: Vascular 5HT₁ receptor agonist – found mostly in the cranial and trigeminal nerve – actions mediate vasoconstriction and inhibit the release of pro-inflammatory neuropeptides. Adverse effects: burning/irritation in the throat, taste disturbance. Used for migraines and not infrequent tension-type headaches which Jasmine has. (cant use with anti-depressants)
Metoclopramide: Dopamine D2 receptor antagonist in the chemoreceptor trigger zone in the central nervous system. Acts as a 5HT-4 receptor agonist in the enteric nervous system to increase gastric motility and gastric emptying. Crosses the BBB so can experience CNS adverse effects. Adverse effects: may cause drowsiness, dizziness, headaches. Use for nausea and vomiting associated with migraine and not infrequent tension-type headaches which jasmine has
Paracetamol: Centrally acting anti-pyretic and analgesic. Effects thought to be due to its action on cyclooxygenase 2 or cyclooxygenase 3, unknown at this point in time. May inhibit prostaglandin activity through COX 2 but has negligible anti-inflammatory properties. Adverse effects: generally well tolerated
Don’t use any of these products as they are not suitable for the tension-type headache you currently have.
