Tylenol, Aspirin, and NSAIDS.txt

• antipyretic
• analgesic= acute mild to mod pain and chronic pain in osteoarthritis and RA

Weak ant inflammatory effects

decrease fever and pain in children receiving DPT vaccination

Used in patients with gastric irritation from ASA and NSAIDS

DOC for minor pain in children and elderly and adults

• weak antinflammatory effect
• little GI effects
• no impact on platelet aggregation

3000 mg per day

4 GM/day if under care of provider

hepatotoxicity

phenacetin

2 years old

improper dosing

reduces fever by direct action on hypothalamic heat-regulating centers. Inhibits pyrogenic cytokines from acting on heat regulating centers.

Dissipates body heat by vasodilation and sweating.

• centrally acting analgesic.
• works by inhibiting prostaglandin synthetase in CNS.

APAP does not inhibit peripheral prostaglandin synthesis. This is reason is weak anti-inflammatory and does not inhibit platelet aggregations

every 4-6 hours depending on strength.

Do not exceed maximum daily dose

When used in combo important for provider to monitor daily intake of APAP to avoid overdosage, must warn parents that many OTC preparations have APAP in them

hepatic insufficiency and at risk for toxicity

use lower doses and increased dosing intervals

watch with care with those taking hepatic toxic drugs, ETOH consumption, and cirrhosis.

• B
• is excreted in breast milk

3

asthma

Do not use tylenol in children for more than 5 consecutive days.

short or long term symptomatic tx mild to mod pain, inflammation, fever, RA, OA, gout

Reduces risk of TIAs or stroke in pts with TIAs caused by fibrin platelet emboli

Reduces risk of MI, acute ischemic strokes and TIAs

Reduces risk of death or nonfatal MI with previous infarction or unstable angina

May reduce risk of barretts disease

prevent cataracts

toxemia in pregnancy

decreases risk of colorectal cancer

antiplatelet aggregation

• OA
• RA
• Mild to moderate pain; dental extractions, minor surgery, soft tissue injury
• primary dysmenorrhea

tendinitis, bursitis, and migraine

prodromal symtoms

Alzheimer's

but not if taking for cardioprotective effects

• MI
• stroke
• adverse cardiovascular events

inhibiting the production of prostaglandins, prostacyclin, and thromboxane in both CNS and peripheral tissue

• anti-inflammatory process
• due to decrease in prostaglandin levels= reduction of inflammation

blocks interleukin-1 on the hypothalamus which is responsible for temp control.

causes vasodilation of superficial blood vessel, which dissipates heat

block COX-1 and the production of thromboxane

have reversible inactivation of COX, only good for duration of drug activity. - this is why ASA is used for prevention of MI and stroke

aggregation and the clotting cascade

• causes irreversible inactivation of COX
• decreasing thromboxane for the 8-10 days life of platelet

• alzheimers
• may decrease parkinsons disease
• reduces risk of colon cancer

inverse link between NSAIDS and breast cancer

Inhibition of prostaglandins causes more gastric acid production and increased risk of gastric mucosal damage

damaged kidneys rely on prostaglandins for vasodilation, inhibition decreases blood flow to kidneys

renal papillary necrosis, renal insufficiency, acute renal failure, and other renal injuires.

Pts with impaired renal fx, HF, liver dysfunction; elderly, taking diuretics, ACEIs, and ARBs are at greater risk for this reaction, D/C med and function usually returns to normal.

COX-2 selective NSAID

unless patient is at risk for HTN and renal disorder.

PPI or misoprostol

• acetaminophen
• NSAIDs

limit inflammatory disease process, protect the joint, and relieve pain

NSAIDS

misoprostol unless appropriate contraception is used.  It can cause baby to be aborted.

Get a beta HCG before using

celecoxib

sulfonamide properties- do not use in patients with sulfa allergy

This drug has low Gi adverse effects

This drug should be used cautiously in patients with heart disease

mild OA- tylenol

• If tylenol not effective start on NSAID
• NSAIDs are more effective for OA of knee or hip

COXZ -2 in elderly for long term tx because of decreased GI effects.

• headache
• CNS
• hyperkalemia
• aggravates epilepsy and parkinsonism

*short term use only

medical conditions- renal, hepatic, and cardiovascular diseases- many adverse effects related to NSAID use and these conditions!!!

Asthma

Age

Compliance

walking can improve status

weight loss can reduce strain on joints

• rest
• ice
• compression
• elevation

RICE for 24-48 hours

24 hours due to effect on platelets

Ibuprofen then usually given for 1-2 weeks

24-72 hours before menses

duration for 2-3 days

• aspirin 325 every other day
• or aspirin 81 mg daily

Do not use with NSAIDS decreases cardioprotective effects of Aspirin

NSAIDS and DMARDS

Rice 24-48 hours of exacerbaton

ibuprofen for limited time of 1-2 weeks

gi distress, renal and hepatic fx.

subjective report of pain relief

vertigo, tinnitus, or impaired hearing

serum concentration can be measured

short term- acute minor pain relief within an hour

Long term- baseline CBC with diff, creatinine, UA, K. and LFTs. Baseline and 3 months the every 3-6 months

follow up with pt weekly for pain relief or early side effects

pain relief in RA may take up to 2 weeks

gi bleeding can occur at any time.  monitor cbc, pt, ua, and stool for occult blood.

2 weeks

confusion and renal clearance may be diminished

• increasing HTN
• edema
• other signs of CHF

Not recommended, stop prior to delivery r/t increased risk of bleeding.

• Category C- ibuprofen, naproxen, celecoxib
• Category D- ASA esp in 3rd trimester
• Category D- NSAIDS
• ASA and NSAIDS are excreted in breast milk

all can cause serious gi bleed, report symptoms and stop drug

• take med with food or milk
• may take antacids
• no ETOH
• take around the clock for best serum concentration
• Do not take more than one drug at a time from these classes

discard med if have vinegar like odor

-stop taking 5-10 days before surgery (talk with dr first)

- can cause asthma exacerbation

notify provider of SOB, wheezing, dizziness, GI distress, pruritis, or skin rash.

-stop taking 3 days before surgery (discuss with provider first)

asthma and hypersensitivity which can cause bronchospasm, generalized uticaria, and angioedema.

• children under 16
• pregnancy in 3rd trimester

Foods that contain salicylates include- curry, paprika, licorice, prunes, raisins, tea, and gherkins.

fever or short term pain

life threatning

for patients with CV disease, GI adverse events, bleeding, ulceration, and perforation

ophthalmic effects of blurred or diminished vison, scotomata, changes in color vision, corneal deposits, and retinal disturbances.

Photosensitivity may occur

• aminoglycosides
• anticoagulants (especially celbrex)
• cyclosporines
• hydantoin
• lithium
• methotrexate
• ASA

• ACE inhibitors
• B blockers
• loop diuretics
• lithium

NSAIDS, ACEI, BB, loop diuretics, probenecid, sulfinpyrazone, spironolactone

• anticoagulants
• heparin
• barbonic anhydrase inhibitors
• NTG
• valproic acid
• methotrexate
• insulin

celecoxib

• NSAIDS
• tramadol