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What is the correct name for Paracetamol?
Acetaminophen
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What is the dose of paracetamol, and its maximum dose?
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Side affects of paracetamol?
- RARE, but may include -
- Rash
- blood disorders - thrombocytopenia, leukopenia
- hypotension �if IV admin
- liver and kidney damage in OD
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How much paracetamol for acute liver failure?
10 -15g
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How much paracetamol for fatal OD?
>25g
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Treatment of paracetamol OD?
- Acetylcysteine (i.v.) ideally within 8hrs ingestion of OD
- Activated charcoal
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NSAIDs, name 3:
- Ibuprofen
- Aspirin (Salicylic acid derivative)
- Diclofenac (Voltarol)
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How do NSAIDs work?
Inhibit COX pathway, stopping production of PG (chemical mediator of pain)
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Which NSAIDS inhibit platelet function?
- Aspirin irreversibly does, therefore increase bleeding time.
- Other NSAIDs do, but reversibly (only last the life of the drug)
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What else do PG do?
stimulate protective gastric mucus secretion
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Side effects of NSAIDS
- GI disturbances incl. � nausea, Diarrhoea, bleeding, ulceration
- Hypersensitivity reaction-angioedema, urticarial, rhinitis
- May impair renal function
- Worsen asthma
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Contraindications of NSAIDs
- X in pregnancy
- X in old pts -can cause heart failure
- X in pts with peptic ulcers
- X aspirin in children <12yo Reye's syndrome -URTIs, liver failure, encephalopathy
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MAX doses?
- Ibuprofen -2.4g/day
- Aspirin -4g/day
- Diclofenac -150mg/day
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Signs of OD of aspirin?
- Hyperventilation, agitated
- Tinnitus, deafness
- Vasodilation
- Sweating
- Coma (uncommon)
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Signs of OD of ibuprofen?
- Nausea, vomiting,
- Epigastric pain
- Tinnitus
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Treatment of OD of NSAIDs?
- Activated charcoal
- Gastric lavage
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What would you prescribe during/after a difficult Xraction of LL8?
- Voltarol - 75mg (MAX 150mg/day)
- Dexamethasone (steroid) 8mg, given at the end of the op
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NSAIDs are peripherally acting, where do Opioids work?
Centrally
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Name 3 opioids:
- Morphine
- Dihydrocodeine - maxfacs like
- Codeine
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What is a co-codamol a combination of?
- Codeine + paracetamol
- 30mg and 500mg
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Effects of opioids
- Analgesic
- Sedative
- Euphoric
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Unwanted SE of opioids?
- Cough suppression
- N + V
- Constipation
- Miosis (pupils small)
- Dependence
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Why not give opioids to H+N injury pts?
Because miosis, sedative effects, cough suppression, will all mask symptoms and compromised pt going into surgery
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Effects of opioids reversed by?
Naloxone
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Tricyclic Ads give two examples?
- Amitryptiline
- Nortryptiline - best analgesia, less SE
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What Tricyclic ADs do?
- AD
- sedation
- Analgesic
- Muscle relaxant
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What doses of Tricyclic ADs do you give?
- Therapeutic 10-20mg
- If for AD 80mg or more
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What is an AB?
A substance, produced by or derived from a micro-organism, that destroys or inhibits the growth of other micro-organisms.
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Which types of bacteria cause most H+N infections?
Streptococci and anaerobes
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When do you prescribe ABs?
- Systemic involvement:
- 1.pyrexia
- 2.regional lymphadenopathy,
- 3. uncontrolled/spreading swelling - facial cellulitis
- 4.Trismus
- 5.Tachycardia
- ? Immuno-compromised pt.
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Before prescribing ABs, consider pt factors:
- Allergy
- Pregnancy
- Do they take OCP?
- Renal function
- Alcoholism (METD)
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What might help you choose the correct AB?
Microbial C and S.
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Dose of ABs depends on?
Dependant on age, weight, renal function, severity of infection
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Duration of ABs depends on?
- Nature of infection
- pts response to Tx
- Too short -resistance
- Too long -Unwanted SE
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Name the Bactericidal Abs
- Penicillins
- Cephalosporins
- Metronidazole
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Name Bacteriostatic ABs
- Erythromycin
- Clindamycin
- Tetracyclines
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Name types of Penicillins?
Amoxicillin, Flucloxacillin, Co-amoxiclav (augmentin), Phenoxymethyl penicillin (Pen V)
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How do Penicillins work?
- Beta lactam, interfere with bacterial cell wall synthesis.
- Therefore bactericidal
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Risk of allergy to Penicillin?
- Risk of allergy 1-10%
- e.g. rash or anaphylaxis 0.05%
- (N.B. Most common drug allergy)
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Is penicillin safe in pregnancy?
Yes
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How are penicillins excreted?
Renal
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Side FX of penicillin?
Diarrhoea can be a frequent side-effect
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Amoxicillin is broad spec or narrow spec?
- Broad-spectrum
- Therefore some positive, some negative, (few anaerobes)
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What is an advantage of amoxicillin?
Well absorbed (not affected by presence of food in stomach)
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What is a disadvantage of amoxicillin?
Inactivated by penicillinases (? lactamases)
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How much amoxicillin do you give?
250-500mg tds
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Flucloxacillin, broad or narrow spec?
- Narrow spectrum
- Therefore only gram positive
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Advantage of flucloxacillin?
Not inactivated by penicillinases, thus often used for infections caused by penicillin-resistant staphylococci.
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Indications of flucloxacillin?
staph skin infections + cellulitis
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How much flucloacillin do you give?
250mg qds
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Co-amoxiclav is what? AKA?
- Amoxicillin + Clavulanic Acid. AKA Augmentin
- Clavulanic acid = ? lactamase inhibitor
- Combination of 2 drugs means active against penicillinases
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Indications co-amoxiclav:
severe dental infections with spreading cellulitis
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Side effect co-amoxiclav?:
Stevens-Johnson syndrome
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Dose of Co-amoxiclav?
- 250mg/125mg i.e. 375mg or
- 500mg/125mg tds i.e. 625mg
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Is MND bacteriostatic? Which bacteria is it effective against?
- No, bactericidal.
- Effective against anaerobic bacteria and protozoa
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How MND does work?
Inhibits DNA synthesis by causing strand breakage of bacterial DNA
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Indications of MND?
ANUG, pericoronitis, useful for other oral infections
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What does MND react with?
- Alcohol -Disulfiram-like reaction
- Lithium (for manic depression) - lithium toxicity
- Warfarin - increases bleeding tendency
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Common SE of MND?
- GI disturbance common, allergy rare
- Other - oral candidal overgrowth causes tongue discolouration
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How much METD?
200-400mg tds
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Clindamycin is static or cidal?
Bacteriostatic
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Which bacteria does clindamycin attack?
- Gram +ve cocci (incl. penicillin-resistant staph)
- many anaerobes
- Not negative
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Serious SE of clindamycin?
Pseudomembranous colitis. Patients must discontinue AB if diarrhoea develops.
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Why use clindamycin?
Good bone penetration, but not a routine AB for oral infections
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So when is clindamycin used if not routinely?
- Indications: bone infections e.g. osteomyelitis, also skin e.g. cellulitis and soft-tissue infections
- Poss treat dentoalveolar abscess that not responded to penicillin or MET
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Dose clindamycin?
150mg qds
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What are TETRACYCLINES, static or cidal?
Bacteriostatic, Broad spec
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Give examples of tetracyclines:
- Tetracycline 250mg qds
- Doxycycline 100mg bd
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Indications of tetracyclines:
perio disease, sinusitis
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Who not to give tetracyclines:
Tetracycline staining - not given to under 12's and pregnant/breast-feeding women
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What reduces absorption of tetracyclines:
Antacids and milk reduce their absorption
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Erythromycin is static or cidal?
Static.
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What family is erythromycin from?
Macrolide
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Erythromycin - Broad or narrow spec?
Narrow spectrum
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GI relevance of erythromycin?
- Poor absorption
- GI disturbance � nausea + vomiting
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What may erythromycin be useful in?
- Alternative to penicillin in hypersensitive patients
- But, Poor action against oral anaerobes due to rapidly developing resistance
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Relevance of sulphonamides?
Erythema multiforme
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