Explore chapters and articles related to this topic
The patient is constipated
Published in Wesley C Finegan, Being a Cancer Patient’s Carer, 2018
Have you bought the patient any medication over the counter or from the pharmacist? One of the commonly sold pain-killing tablets is cocodamol (a combination of paracetamol and codeine), which is sold under a variety of trade names. Codeine is well known as a cause of constipation. Check and see if you have bought anything containing codeine and let the nurse or doctor know about this, or any other medication you purchased. You never know; it could be something as simple as that! Make a note of anything you buy for future reference.
Liaison psychiatry
Published in Gideon Felton, Fast Revision for the MRCPsych CASC Exam, 2017
Hilda Watson is 62 years old and suffers from chronic back pain. She has no psychiatric history. Her pain management consultant writes to you stating that ten tablets of cocodamol (30:500) per day no longer control her pain and she is requesting stronger opiate-based analgesia. This consultant cannot identify a cause despite extensive surgical investigation and wonders if there is a psychological cause. Mrs Watson agrees to see you. She is able to accept the findings of the investigations. There is no relevant medical history.
Reduced sperm concentration in a patient from a suspected post-operative infection: a case study
Published in British Journal of Biomedical Science, 2020
Another aspect to consider is the body temperature of the patient during this episode (otherwise known as a febrile illness or episode). It has been understood for some time that an increase in temperature can impact negatively sperm quality including motility, concentration and morphology [13]. There is still a wide variation in the clinical definition of what a fever is although it is considered acceptable to take a fever as ˃37°C with some UK health providers considering it more realistic to define it as any temperature over 37.5°C [14]. The patient’s temperature was never >36.8°C during their hospital stay as recorded using a tympanic thermometer. This included when he first presented to accident and emergency before having any treatment for the infection. Patients who do experience fevers are advised that semen analysis results may be affected, and a three-month repeat is advised to ensure that the results are as accurate as possible. As the patient did not have a fever recorded during his stay, it is unclear that this is the reason for the abnormal result although the patient also was on regular co-codamol, which contains paracetamol that has an anti-pyrexic effect on the body, reducing fever.
Cold water extraction of codeine/paracetamol combination products: a case series and literature review
Published in Clinical Toxicology, 2020
James T. Harnett, Alison M. Dines, David M. Wood, John R. H. Archer, Paul I. Dargan
Three papers investigated the technique of cold-water extraction [18,21,25], developing standardized laboratory procedures from varying information sources online. Fleming et al. first duplicated water extraction techniques using methods discovered on Internet forums and applied these to a range of different over-the-counter codeine containing analgesics [25]. They reported recovery of codeine in the solution ranging from 42-100% and paracetamol ranging from 1–84%. However, they applied a cold-water technique to only one of eight paracetamol/codeine products tested (co-codamol 8/500 effervescent tablets) and filtered the remaining seven products at room temperature. Specifically, the cold-water experiments produced 100% recovery of the codeine, with only 8% of the paracetamol remaining.
Designing safer analgesics: a focus on μ-opioid receptor pathways
Published in Expert Opinion on Drug Discovery, 2018
Joseph V. Pergolizzi, Jo Ann LeQuang, Robert Taylor, Michael H. Ossipov, Daniel Colucci, Robert B. Raffa
In a study of 50 hip-fracture patients randomized to receive transdermal buprenorphine (10 µg/h) or oral tramadol 50 mg three times a day, transdermal buprenorphine patients had significantly lower pain intensity starting from 24 h postoperatively and for the next 7 consecutive days; vomiting rates were significantly lower for the buprenorphine patch patients (66%) than the tramadol patients (79%) [43]. In an observational study of 966 patients with chronic pain associated with knee or hip osteoarthritis, patients with transdermal buprenorphine patches reported significantly higher satisfaction scores with their pain treatment than the other groups [44]. In a randomized trial of osteoarthritis patients, 7-day buprenorphine patches with oral acetaminophen were found noninferior to co-codamol (codeine plus acetaminophen) in terms of pain relief with a comparable rate of adverse events (86.4% of buprenorphine patients reported adverse events compared to 81.7% with co-codamol) [45]. In a retrospective study of 16 placebo-controlled, active-controlled, and uncontrolled clinical trials (n = 6566), the incidence of adverse events was similar in older patients (≥65 years) than in younger patients (<65 years): 63.8% vs. 61.0%, respectively [46]. It should be noted, though, that in general transdermal opioids are relatively better tolerated than are oral opioids, so some of the comparisons might reflect the contribution of benefits of the route of administration rather than solely to the drug itself.