Inhibition of ___ in NSAIDs may result in decreased platelet aggregation and kidney damage, whereas inhibition of ___ results in decreased inflammation, fever, pain.
COX1
COX2
This nonopioid analgesic is used for inflammation suppression, analgesia for mild to moderate pain, fever reduction, dysmenorrhea, and inhibition of platelet aggregation.
NSAIDs
What 2 things do inhibition of platelet aggregation protect against?
stroke
MI
To decrease the risk of ulcer formation with NSAIDs, whta might you administer?
proton pump inhibitor (omeprazole)
h2 receptor antagonist (ranitidine)
What med may be used prophylactically to combat possible GI damage?
misoprostol
Besides GI discomfort/damage, what are other side effects of NSAIDs?
renal dysfunction
increased risk of MI and stroke
salicylism
Reye syndrome
aspirin toxicity
T/F Increased risk of MI and stroke is generally associated with nonaspirin NSAIDs.
T
This ADR may occur with aspirin and s/s include tinnitus, sweating, headach, dizziness, respiratory alkalosis.
salicylism
Children and teenagers recovering from chickenpox and flu-like symptoms should never take this med. Why?
aspirin
Aspirin has been linked with Reye's syndrome, which is a rare but serious condition that causes swelling in the liver and brain
What might aspirin toxicity therapy include?
cooling w/ tepid water
correction of dehydration & elecrolyte imbalance
reversal of acidosis & promotion of salicylate excretion w/ bicarbonate
gastric lavage
PUD, bleeding disorders (hemophilia, vitamin K deficiency), children with chickenpox/influenza are contraindications for what med class?
NSAIDs
This med class should be used cautiously in older adults, smokers, pts with H. pylori infection, hypovolemia, asthma, chronic uticaria, hx of alcoholism.
NSAIDs
What NSAID is contraindicated in pts w/ allergy to sulfonamides?
celecoxib
Which NSAID is contraindicated in pts w/ advanced renal dysfunction?
ketorolac
___ generation NSAIDs should be used cautiously in pts w/ known cardiovascular disease.
2nd
There is a potential risk of bleeding when a NSAID is combined with an ___.
anticoagulant (heparin, warfarin)
When taken with NSAIDs ___ increase risk of gastric bleeding; antiulcer prophylaxis (misoprostol) should be taken to decrease risk of gastric ulcer.
glucocorticoids
T/F Alcohol does not affect bleeding in pts taking NSAIDs.
F; alcohol increases risk of bleeding
Which NSAID decreases the antiplatelet effects of low-dose aspirin used to prevent MI?
ibuprofen
Concurrent use of other NSAIDs, especially ___, increase the risk of known side effects.
ketorolac
How long before surgery, childbirth should aspirin be d/c?
1 week
T/F NSAIDs should be taken without food.
F; with food
Use of what NSAID should not be longer than 5 days due to risk for kidney damage?
ketorolac
What's the trade name for acetaminophen?
Tylenol
What's the expected pharm action for acetaminophen?
Slows production of prostaglandins in CNS
This nonopioid analgesic is used for analgesic and antipyretic effects.
acetaminophen
Why should pts not exceed 4g/day of acetaminophen?
May cause acute toxicity that results in liver damage (s/s: n/v/d, sweating, abdominal discomfort), progressing to hepatic failure, coma, death
What's the antidote for acetaminophen?
acetylcysteine (Mucomyst)
This nonopioid analgesic should be used cautiously in pts that drink 3+ alcoholic drinks/day and those taking warfarin.
acetaminophen
With acetaminophen, ___ increases risk for liver damage.
alcohol
Acetaminophen slows the metabolism of ___, placing the pt at risk for bleeding.
warfarin
How is acetylcysteine (acetaminophen antidote) administered?
oroduodenal tube to prevent emesis/aspiration
___ may be used for short term treatment of moderate to severe pain such as that associated with postop recovery. Concurrent use with opioids allows for lower dosages of opioids and thus minimizes adverse effects (constipation, resp depression).