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Acetaminophen

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Focus On: Acetaminophen Toxicity and Treatment

The 2004 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System indicated 133,125 exposures to acetaminophen and combination products containing acetaminophen. Of these, there were 218 deaths, almost half of which were due to ingestions of combination products.  
American College Of Emergency Medicine
almost 9 years ago
Preview
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23

Tamiflu: Millions wasted on flu drug, claims major report - BBC News

Hundreds of millions of pounds have been wasted on Tamiflu, a drug for flu that may work no better than paracetamol, a landmark analysis says.  
BBC News
over 5 years ago
Www.bmj
1
13

What is an “n-of-1” trial?

Researchers assessed the effectiveness of “n-of-1” trials for the short term choice of drugs for osteoarthritis. The efficacy of sustained release paracetamol was compared with celecoxib in the management of symptoms associated with osteoarthritis. A series of double blind randomised n-of-1 controlled trials using a double dummy design was performed. The intervention was sustained release paracetamol (two 665 mg tablets, three times a day), or celecoxib (200 mg daily, or 200 mg twice a day for those who were already using this dose). Each treatment regimen was taken for two weeks, administered for three treatment cycles. The primary outcome measures included pain, stiffness, and functional limitation scores; preferred treatment; and adverse effects.1  
bmj.com
over 5 years ago
Www.bmj
1
12

What is an “n-of-1” trial?

Researchers assessed the effectiveness of “n-of-1” trials for the short term choice of drugs for osteoarthritis. The efficacy of sustained release paracetamol was compared with celecoxib in the management of symptoms associated with osteoarthritis. A series of double blind randomised n-of-1 controlled trials using a double dummy design was performed. The intervention was sustained release paracetamol (two 665 mg tablets, three times a day), or celecoxib (200 mg daily, or 200 mg twice a day for those who were already using this dose). Each treatment regimen was taken for two weeks, administered for three treatment cycles. The primary outcome measures included pain, stiffness, and functional limitation scores; preferred treatment; and adverse effects.1  
bmj.com
over 5 years ago
Www.bmj
1
32

Triptans for symptomatic treatment of migraine headache

A 30 year old woman has debilitating, pulsating right sided headaches up to twice a month for several years. Her pain builds up rapidly and usually lasts 24 hours. She has to lie down during episodes, which are associated with sensitivity to light, severe nausea, and occasional vomiting. Over the counter analgesics such as ibuprofen or paracetamol were initially helpful in relieving pain, but not recently. She asks if any treatments may help with her headaches and allow her to return to her usual activities sooner.  
bmj.com
over 5 years ago
Www.bmj
1
15

What is an “n-of-1” trial?

Researchers assessed the effectiveness of “n-of-1” trials for the short term choice of drugs for osteoarthritis. The efficacy of sustained release paracetamol was compared with celecoxib in the management of symptoms associated with osteoarthritis. A series of double blind randomised n-of-1 controlled trials using a double dummy design was performed. The intervention was sustained release paracetamol (two 665 mg tablets, three times a day), or celecoxib (200 mg daily, or 200 mg twice a day for those who were already using this dose). Each treatment regimen was taken for two weeks, administered for three treatment cycles. The primary outcome measures included pain, stiffness, and functional limitation scores; preferred treatment; and adverse effects.1  
www.bmj.com
over 5 years ago
Preview
1
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Acetaminophen (Tylenol) Metabolism and Toxicity

This is the best online medical lectures site, providing high quality medical and nursing lectures for students across the globe. Our lectures are oversimpli...  
YouTube
over 5 years ago
Www.bmj
1
21

What is a crossover trial?

Researchers evaluated the effectiveness of the cannabinoid dronabinol on central neuropathic pain in patients with multiple sclerosis.[1] The effectiveness of cannabinoids in relieving pain caused by central lesions in multiple sclerosis had not been investigated previously. A randomised double blind placebo controlled crossover trial study design was used. The intervention was orally administered dronabinol at a maximum dose of 10 mg daily or corresponding placebo. Each treatment period was for three weeks, separated by a three week washout period. All analgesic drugs, except for paracetamol, were discontinued at least one week before the start of the trial.  
bmj.com
over 5 years ago
Www.bmj
1
15

What is a crossover trial?

Researchers evaluated the effectiveness of the cannabinoid dronabinol on central neuropathic pain in patients with multiple sclerosis.[1] The effectiveness of cannabinoids in relieving pain caused by central lesions in multiple sclerosis had not been investigated previously. A randomised double blind placebo controlled crossover trial study design was used. The intervention was orally administered dronabinol at a maximum dose of 10 mg daily or corresponding placebo. Each treatment period was for three weeks, separated by a three week washout period. All analgesic drugs, except for paracetamol, were discontinued at least one week before the start of the trial.  
bmj.com
over 5 years ago
Www.bmj
1
18

What is a crossover trial?

Researchers evaluated the effectiveness of the cannabinoid dronabinol on central neuropathic pain in patients with multiple sclerosis.[1] The effectiveness of cannabinoids in relieving pain caused by central lesions in multiple sclerosis had not been investigated previously. A randomised double blind placebo controlled crossover trial study design was used. The intervention was orally administered dronabinol at a maximum dose of 10 mg daily or corresponding placebo. Each treatment period was for three weeks, separated by a three week washout period. All analgesic drugs, except for paracetamol, were discontinued at least one week before the start of the trial.  
bmj.com
over 5 years ago
Www.bmj
1
17

What is a crossover trial?

Researchers evaluated the effectiveness of the cannabinoid dronabinol on central neuropathic pain in patients with multiple sclerosis.[1] The effectiveness of cannabinoids in relieving pain caused by central lesions in multiple sclerosis had not been investigated previously. A randomised double blind placebo controlled crossover trial study design was used. The intervention was orally administered dronabinol at a maximum dose of 10 mg daily or corresponding placebo. Each treatment period was for three weeks, separated by a three week washout period. All analgesic drugs, except for paracetamol, were discontinued at least one week before the start of the trial.  
bmj.com
over 5 years ago
Preview
1
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Acetaminophen (Tylenol) Metabolism and Toxicity

This is the best online medical lectures site, providing high quality medical and nursing lectures for students across the globe. Our lectures are oversimpli...  
YouTube
almost 5 years ago
Preview
1
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Paracetamol

 
almostadoctor - free medical student revision notes
over 4 years ago
Www.bmj
1
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True risks of paracetamol may be underestimated, say researchers

A systematic review of paracetamol’s efficacy and tolerability in individual conditions is necessary because the true risks of taking the drug may have been underestimated, a UK team of researchers writes in the Annals of the Rheumatic Diseases.1  
bmj.com
over 4 years ago
Www.bmj
1
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True risks of paracetamol may be underestimated, say researchers

A systematic review of paracetamol’s efficacy and tolerability in individual conditions is necessary because the true risks of taking the drug may have been underestimated, a UK team of researchers writes in the Annals of the Rheumatic Diseases.1  
bmj.com
over 4 years ago
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Surgery Mock MCQ

An obese 63 year old lady presents with jaundice. There is no history of abdominal pain. Examination of her abdomen reveals a palpable gall bladder. There is evidence of extensive pruritis. She tells you she drinks 42 units of alcohol a week. Her blood results are as follows: Albumin 32 (35-50) Alk Phos 456 (<110) ALT 88 (<40) Bilirubin 120 (<20) INR 1.6 GGT 400 (0-70) What’s the most likely diagnosis? a. Gallstones b. Paracetamol Overdose c. Pancreatic cancer d. Alcoholic Hepatitis e. Primary billiary cirrhosis  
Af Del
over 5 years ago
Foo20151013 2023 gc6z71?1444774005
7
214

Worst Medical Experience Ever

Worst experience ever? - this is pretty difficult as I've worked in some of the poorest countries in the world and seen some things that should never happen like children dying of dehydration and malaria. But this recent experience was definitely the worst. It was midnight and I was trying to get my 16 month old to sleep having woken up after vomiting in his cot. Despite paracetamol, ibuprofen, stripping to nappy, damp sponging and having the window open he went rigid and started fitting. It only lasted a minute or two yet felt like an eternity as he was unable to breathe and became progressively blue as my mind raced ahead to brain damage or some other horrible sequalae. The fitting stopped and my mind turned to whether I was going to have to start CPR. I lay him on the floor and put my ear to his chest and was glad to hear a strong heartbeat but he was floppy with a compromised airway so I quickly got him in the recovery position. The ambulance arrived in 8 minutes and after some oxygen and some observations he was strapped in and ready to go. He had been unconscious for about 15 minutes but was starting to come round, much to my relief. The ambulance crew were great and their quick response made all the difference but then they took nearly half an hour to get to A&E in the middle of the night because they took the most awkward route imaginable. I don't know if it was a deliberate delaying tactic or just a lack of local knowledge but even without a blue light I could have done it in half the time! Why do ambulances not have GPS - ideally with local traffic info built in? We arrived in A&E and were ushered to a miserable receptionist who took our details and told us to have a seat. I noticed above her head that the wait time was 3.5 hours, though we did see a junior nurse who took his observations again. Not long after the screen changed to a 5 hour wait and a bit later to a 6 hour wait! I am glad to say that by about 3 hours my little man was back to his usual self (as evidenced by his attempts at destroying the department) and so after getting the nurse to repeat his obs (all normal) we decided to take him home, knowing we had a few more hours to wait for the doctor, and that the doctor was now unlikely to do anything as he was now well. I tell the story in such detail in part for catharsis, in part to share my brief insight into being on the other side of the consultation, but also because it illustrated a number of system failures. It was a horrible experience but made a lot worse by those system failures. And I couldn't help but feel even more sorry for those around me who didn't have the medical experience that I had to contextualise it all. Sickness, in ourselves or our loved ones, is bad enough without the system making it worse. I had 3 hours of walking around the department with my son in my arms which gave me plenty of time to observe what was going on around me and consider whether it could be improved. I did of course not have access to all areas and so couldn't see what was happening behind the scenes so things may have been busier than I was aware of. Also it was only one evening so not necessarily representative. There were about 15 children in the department and for the 3 hours we were there only a handful of new patients that arrived so no obvious reason for the increasing delay. As I walked around it was clear to me that at least half of the children didn't need to be there. Some were fast asleep on the benches, arguably suggesting they didn't need emergency treatment. One lad had a minor head injury that just needed a clean and some advice. Whilst I didn't ask anyone what was wrong with people talk and so you hear what some of the problems were. Some were definately far more appropriate for general practice. So how could things have been improved and could technology have helped as well? One thing that struck me is that the 'triage' nurse would have been much better as a senior doctor. Not necessarily a consultant but certainly someone with the experience to make decisions. Had this been the case I think a good number could have been sent home very quickly, maybe with some basic treatment or maybe just with advice. Even if it was more complex it may have been that an urgent outpatient in a few days time would have been a much more satisfactory way of dealing with the problem. Even in our case where immediate discharge wouldn't have been appropriate a senior doctor could have made a quick assessment and said "let's observe him for a couple of hours and then repeat is obs - if he is well, the obs are normal and you are happy then you can go home". This would have made the world of difference to us. So where does the technology come in? I've already mentioned Sat Nav for the ambulance but there are a number of other points where technology could have played a part in improving patient experience. Starting with the ambulance if they had access to real time data on hospital A&E waiting times they may have been able to divert us to a hospital with a much shorter time. This is even more important for adult hospitals were the turnover of patients is much higher. Such information could help staff and patients make more informed decisions. The ambulance took us to hospital which was probably appropriate for us but not for everyone. Unfortunately many of the other services like GP out of hours are not always prepared to accept such patients and again the ambulance crews need to know where is available and what access and waiting times they have. Walk-in patients are often also totally inappropriate and an easy method of redirection would be beneficial for all concerned. But this requires change and may even require such radical ideas as paying for transport to take patients to alternative locations if they are more appropraite. The reasons patient's choose A&E when other services would be far more appropriate are many and complex. It can be about transport and convenience and past experiences and many other things. It is likely that at least some of it is that patients often struggle to get an appointment to see their own GP within a reasonable time frame or just that their impression is that it will be difficult to get an appointment so they don't even try. But imagine a system where the waiting times for appointments for all GPs and out of hours services were readily available to hospitals, ambulances, NHS direct etc. Even better imagine that authorised people could book appointments directly, even when the practice was closed. How many patients would be happy to avoid a long wait in A&E if they had the reassurance of a GP appointment the next day? And the technology already exists to do some of this and it wouldn't be that hard to adapt current technology to provide this functionality. Yet it still doesn't happen. I have my theories as to why but this is enough for one post. In case you were wondering my son appears to have made a full recovery with no obvious ongoing problems. I think I have recovered and then he makes the same breathing noises he made just before the fit and I am transported back to that fateful night. I think it will take time for the feelings to fade.  
Dr Damian Williams
over 6 years ago
Www.bmj
0
15

Managing back pain and osteoarthritis without paracetamol

Paracetamol (acetaminophen) is a drug we are all familiar with. It is cheap, readily available over the counter, and is common place in family medicine cabinets across the world. We rely on it in the middle of the night to settle childhood fevers, and it is usually our first choice drug for a wide range of painful musculoskeletal disorders, including osteoarthritis and spinal pain. Yet new evidence in a linked paper by Machado and colleagues (doi:10.1136/bmj.h1225) casts doubt on the efficacy and safety of paracetamol and questions its place as our first choice analgesic.1  
feeds.bmj.com
over 4 years ago
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Acetaminophen 'does not work for lower back pain or osteoarthritis'

Acetaminophen is ineffective for spinal pain in the lower back and has little value for hip or knee osteoarthritis, concludes a review of studies testing its safety and efficacy.  
medicalnewstoday.com
over 4 years ago
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Your pain reliever may also be diminishing your joy: Acetaminophen (paracetamol) reduces both pain and pleasure, study finds

Researchers studying the commonly used pain reliever acetaminophen found it has a previously unknown side effect: It blunts positive emotions.  
medicalnewstoday.com
over 4 years ago