Analgesic

Question 1

Acetaminophen (Tylenol)

Answer 1

analgesic
antipyretic
anti- prostaglandin

Uses;
-post op pain relief

MOA;

• NMDA receptor blocker in CNS
• Blocks substance P in SC
• Desensitizes TRPA channel which transmits Ca and Na

Dose;
1 g IV q 4 - 6 hours
325 - 650 mg PO do not exceed 4g/day

Pharmacokinetics;
-Peak 30 - 60 min
(recal peak 1-2 hrs)

Metabolized by the liver (hydrolysis and conjugated)

Little excreted unchanged by kidney

Side Effects;
renal toxicity

Contraindications;

• Liver disease (alcohol cirrhosis, hepatitis)
• Renal disease

Overdose can lead to liver failure, ulcers and impaired platelets function

Question 2

Ketorolac (Toradol)

Answer 2

Non steroids anti-inflammatory NSAID

MOA; blocks cyclooxyrgenase (COX) 1 & 2; inhibits prostaglandin synthesis; producing anti-inflammatory effects

Dose; 30 mg IV x1 or q 6 hrs
Max dose; 120mg

Pharmacokinetics;

• onset; 10 min
• Peak; 2 - 3 hours
• E1/2t; 5 hrs (longer n elderly)
• DOA; 6 - 8 hrs
• Pb; 99%

metabolism; conjugated by the liver
excreted; 61% unchanged by the kidneys

Side Effects;

• severe bronchospasm
• acute renal failure
• anaphylaxis
• Steven johnson syndrome
• GI bleeding, ulceration, perforation
• decreased platelet aggregation; increased bleeding time
• impaired bone and wound healing (ask surgeon before giving)
• NO CV or respiratory depression

Contraindicated;

• asthma
• renal failure
• Liver failure
• CHR
• hypovolemia (predisposes to renal failure)
• Coag defects
• GI bleeding
• hypersensitivity/aspirin allergy
• pregnancy (3rd trimester)

Do not use with methotrexate; severe bone marrow suppression