Question

16)Review what medications can cause an anaphylactic reaction to penicillin

17)Medication dosage: Review how to calculate pediatric dose of penicillin based on weight.

18)Differentiate between chronic, referred, somatic, visceral pain, neuropathic, and phantom pain

19)Review the role of prostaglandins in relationship to injury and pain.

20)Review nonsteriodal antiinflammatory drugs (NSAIDs): what are they, when and why are they used, common side effects, maximum doses, and patient education key points

Answer 1

16) The Medications which can cause Anaphylactic reaction to Penicillin includes the following:

* Methotrexate-

It is an antirheumatic drug used to treat psoriasis, rheumatoid arthritis and some type of malignancy. Taking penicillin along with methotrexate decreases the ability of kidney to clear methotrexate from body thereby causing nausea, vomiting, stomach pain, yellowish discolouration of eyes and skin, dark urine, fever, fatigue and many other side effects that maybe life threatening.

* Allopurinol-

It is a drug used to treat gout. Taking allopurinol with penicillin can cause allopurinol hypersensitivity syndrome which is marked by skin rashes, fever and also internal organ involvement.

17) Penicillin has several classification. For each classification and depending on the type of infection dosage varies.

Dosage for Penicillin G for bacterial infections is:

Oral-

Adults : 125 - 312 mg every 4 to 6 hours

For Children less than 12 years: 4167 to 30000 units / kg body weight.

Intravenously- Adult- 1000000 to 5000000 ever 4 to 6 hours

Children - 8333 to 25000 units/ kg body weight.

Paediatric dose of insulin is calculated as follows:

Dosage = 8333 to 25000 units/ kg body weight.  

Physician will decide how much unit to be taken depending on the disease condition and age of the child.

For example, if child weigh is 20 kg and dosage is taken as 20000 units / kg body weight,

Then, dosage to be administered = 20000 * 20

= 400000 units.

18) CHRONIC PAIN:

Chronic pain is defined as the type of pain that lasts from weeks to years.

REFERRED PAIN:

Referred pain is the pain felt at a site different from the injured region. It is a result of a network of interconnecting sensory nerves that supply many different tissues.

SOMATIC PAIN:

Somatic pain occurs when pain receptors in tissues including the skin, muscles, joints, skeleton and connective tissues are activated. Stimuli such as force, temperature, vibration or swelling activates these receptors.

VISCERAL PAIN:

Visceral pain is the pain from internal organs and is described as dull, diffuse, poorly localised and characterised by hypersensitivity to a provocative stimulus such as organ distension.

NEUROPATHIC PAIN:

Neuropathic pain is the pain caused by a lesion or disease of the somatosensory nervous system.

PHANTOM PAIN:

Phantom pain is the pain that feels like it's coming from a body part that is no longer there. It is experienced by the people who underwent amputation of body part.

19) ROLE OF PROSTAGLANDINS IN INJURY AND PAIN:

These a type of hormones which play a major role in healing of injury and pain. When a tissue is damaged or infected these hormones will create the reactions that causes fever, pain and inflammation which helps in healing process. It also stimulates the formation of blood clots and the contraction of blood vessel wall when your body is bleeding.

20) NSAIDS :

NSAIDS or Non steroidal anti inflammatory drugs are medicines used to relieve pain, reduce inflammation and bring down high temperature.

NSAIDS is used for the following:

* To relieve pain

*To reduce inflammation

* To bring down high temperature

* To relieve symptoms of headache, painful periods, Spadina and strains,cold and flu, arthritis and other causes of long term pain.

SIDE EFFECTS OF NSAIDS:

* Indigestion

* Stomach ulcers

* Headache

* Drowsiness

* Dizziness

* Allergic reactions

MAXIMUM DOSAGE OF NSAIDS IS :

* Ibuprofen - 1200 mg/day

* Naproxen sodium- 660 mg/ day

* Aspirin - 4000 mg / day

KEY POINTS FOR PATIENTS TAKING NSAIDS :

* Always take the drug with meals. Taking empty stomach can cause stomach problems.

* Donot take more than the recommended dosage

* Tell the patient to report if they experience any chest pain, shortness of breath or trouble breathing, weakness in one part or side of the body or slurred speech.

* Avoid NSAIDs before surgery

* Tell the patient to report any signs of bleeding.