-
Pathophysiology of Pain
- Nociceptors are peripheral pain receptors.
- They send pain stimuli to the spinal cord through afferent, nociceptive nerves.
- Impulses then pass to the brain through dorsal ganglia.
-
Pathophysiology of Fever
- The core temperature is the temperature of the blood surrounding the hypothalamus.
- The thermoregulatory center in the anterior hypothalamus controls body temperature through physiologic and behaivor mechanisms.
-
Fever-producing substances that increase the thermoregulatory set point, raising the body temperature
pyrogens
-
Name the four (4) OTC analgesic & antipyretic products
- acetaminophen (Tylenol)
- aspirin (Bayer)
- ibuprofen (Motrin, Advil)
- naproxen sodium (Aleve)
-
How does acetaminophen (Tylenol) exerts analgesic and antipyretic activity?
inhibition of prostaglandin synthesis
-
Does acetaminophen (Tylenol) has any peripheral anti-inflammatory effect?
No
-
Major SE of acetaminophen
liver toxicity (hepatotoxicity)
-
Two major DI with acetaminophen
- Alcohol - risk of hepatotoxicity increased
- Warfarin - increase bleeding effect of warfarin
-
MAX dose of acetaminophen (Tylenol)
4 g/day
-
Can acetaminophen be used during pregnancy & breast feeding?
Yes
-
How do salicylates reduce pain, inflammatory, & fever activities?
inhibit peripheral prostaglandin synthesis
-
Acetylated salicylates vs. Non-acetylated salicylates
Acetylated (eg., aspirin) - inhibit platelet aggregation
Non-acetylated - do not have antiplatelet activity
-
SE of salicylates
- gastritis
- gastric ulcers & bleeding
- Reye's syndrome
-
Potentially fatal SE of salicylates used in children
Reye's syndrome - causes numerous detrimental effects to many organs, especially the brain and liver
-
DI with salicylates
- Alcohol - risk of GI toxicity increased
- Warfarin - increase bleeding effect of warfarin
- Methotrexate - displace methotrexate from protein-binding
-
Precautions/CI to salicylates
- bleeding disorders
- hemophilia
- peptic ulcer disease
- children/teenagers with viral illness
- gout
-
MAX dose of aspirin (Bayer)
4 g/day
-
How do NSAIDs offer analgesic, antipyretic, and anti-inflammatory?
peripheral inhibition of prostaglandin synthesis
-
MAX dose of ibuprofen (Motrin, Advil) for OTC
1.2 g/day
-
MAX dose of naproxen (Aleve)
660 mg/day
-
SE of NSAIDs
- GI effects, including bleeding
- rash
- photosensitivity
- cross-reactivity with aspirin allergy
-
DI with NSAIDs
- Alcohol - increased risk of GI bleed
- Warfarin - increased risk of bleeding
- Methotrexate - decrease methotrexate clearance
- ACEI - decreased hypotensive effects, hyperkalemia
- Beta-blockers - decreased hypotensive effects
- Potassium-sparing diuretics - hyperkalemia
- Digoxin - decreased renal clearance, risk of digoxin toxicity
-
Precautions/CI to NSAIDs
- alcohol (increased risk of GI bleeding)
- renal impairment
- CHF
-
NSAIDs in pregnacy & breast feeding
Ibuprofen & naproxen are compatible with breast-feeding
Avoid NSAIDs in 3rd trimester of pregnancy
-
Which NSAIDs cannot be used in children <12 y/o?
naproxen (Aleve)
-
Which two (2) agents inhibit platelet aggregation?
Aspirin (Bayer) & NSAIDs
-
Which two (2) agents do not have antiplatelet activity?
Non-acetylated salicylates & acetaminophen (Tylenol)
-
Which two (2) agents can cause gastropathy, including gastritis, gastric ulcers, and gastric bleeding? They may decrease the effectiveness of some antihypertensives and may have deleterious effects on kidney function?
Aspirin (Bayer) & NSAIDs
|
|
