1. What is paracetamol’s mechanism of action?  How does it differ from that of aspirin? 

Weak COX-1 and COX-2 inhibitor peripheral. Blocks COX-3 in CNS, activating declining serotonergic analgesic pathways. Antipyretic: direct action on hypothalamic thermoregulation center. it has no anti-inflammatory where asprin has.

2. Name the indications for paracetamol.  Under which circumstances is it a drug of choice for the treatment of mild pain and fever?

Adults : Acute pain: 325mg - 1000mg 4 times a day. Not more than 4 g in 24 hours (acute liver failure, skin rash: Stevens-Johnson) . Chronic pain: less than 2 g (4 tablets) per 24 hours.

Children: 10mg/kg/dose (or according to manufacturers' directions by age) 

only low doses is safe, high doses is very toxic.

3. Name side-effects that can occur with paracetamol use.  Concentrate only on general side effects and not on acute paracetamol overdose.

• low fever with nausea, stomach pain, and loss of appetite;
• dark urine, clay-colored stools; or.
• jaundice (yellowing of the skin or eyes).

4. Due to the ready availability of paracetamol and the general perception by the public that paracetamol is a very safe drug, paracetamol poisoning (by accident/intentional) is fairly common.  Compile a report in which you discuss acute paracetamol toxicity, stressing the dose, signs and symptoms and treatment.  In your textbook, as well as in the SAMF, there is valuable information that you can use.

if you use paracetamol adjustments required in: • Alcoholics • Liver –and kidney diseases • Anaemia (less glutathione). Misplaced safety delusion: 10-15g (so 20-30 tablets) can be fatal • Chronic use of 2g / day can also lead to paracetamol poisoning. • Combination of analgesics may increase toxicity.

Within 1-2 days: Nausea and vomiting Abdominal pain Decreased appetite Tired and powerless

After 1-2 days: Right subcostal pain Tar liver Jaundice Renal insufficiency occurs Liver necrosis and death