Analgesics Flashcards
What type of analgesics are capped at OTC dosing?
NSAIDS
Ibubrofen OTC Cap
1200 mg/day
Naproxen OTC cap
440 mg/day
OTC Capping of NSAIDS vs Acet?
This means theoretically they are LESS effective than acet at OTC doses
However, for pain many say ibup works better for them
Pediatric NSAID’s to Use
Ibu –> YES
Naproxen, ASA –> NO
Ibuprofen Adults Timing
- Every 8 to 12 hours –> Mainly just BID
OTC analgesics exhibit a…….
Ceiling Effect of Pain Relief
Does Morphine pain relief ever flatten out?
NO
Ibu pain relief maxes out at….
400 mg/dose
ASA and Acet pain relief max out at…..
1000 mg/dose
In cases of inflammation, ibu doses would need to….
- Go beyond OTC cap of 1200 mg –> get anti-inflammatory action
Dosage of Ibu for Headache vs. Dental Pain
Headache - 400 mg TID
Dental Pain with Inflamm. –> 400-800 mg TID
Which OTC analagesic is the most convienient? WHy?
Naproxen (Aleve) –> BID Dosing
Are liquid gel capsules better than regular tablets?
Liquid Gels –> A little bit quicker
- Potentially carve off 2 minutes
- Not of major benefit –> If pt wants, go for it
What are the typical s/e warnings on the packaging of Ibu?
Hives - Not anaphylatic –> Rash is common
Swelling, wheezing –> Worry
Stomach Irritation
Increased risk of heart attack and/or stroke if use more than directed or for longer than directed
Is Ibu at OTC doses harder on the stomach than acet?
NO, not at OTC doses
What are the s/e of ibu and acet? Conclusion? What should we call these s/e?
Nauseau, Abdomina Pain, Dyspepsia
So, at OTC doses, ibuprofen does NOT have more side effects !!
Almost every pharmacist gives acet more credit for less s/e
Frame these as ‘nuisance side effects’ –>no one wants them but people get them
Not pathological trajectories for serious issues
When is ibu harder on the stomach/ more s/e than acet?
RX Doses
Ibuprofen S/e
Nauseau, epigastric pain, heartburn and rash (maculopapular, hives)
At OTC levels, are major intestinal s/e common? What are they?
- Gastric or duodenal ulcers
–> Epigastric pain and heartburn do not lead to gastric ulcers - OTC Levels –> Very safe agents
When giving a patient acet, what is it important for the pharmacist to ask about?
- Ask whether they currently take any other products with acetaminophen
- Remind them to stay withing dosing guidelines
Does taking analgesics with food help?
Fluid or food helps clear a pill from the esophagus
It can help reduce some local damage to stomach
It will NOT prevent GI damage via systemic PG inhib
Food can actually delay onset of action
NSAIDS work by…. (simple)
cox-1 prostaglandin synthesis inhibition
- System effect of knocking back prostaglandins
When should NSAIDS not be taken with food?
Acute Pain when a rapid onset of effect is desired, recommend taking NSAID on an empty stomach with a full glass of water
Food delays the analgesic effect of NSAIDS and there is no reliable evidence that taking NSAIDs with food prevent adverse gastrointestinal effects
Is enteric coating of NSAIDS useful for gastric sx? What are some coatings for?
- Extended release or enteric coating do not help with gastric sx
- NSAIDs are a systemic effect of knocking back prostaglandins. Does not matter where it dissolves, as a systemic effect
- Some coatings on the tablet are there to make it taste better
What is an issue with extended release/enteric coating?
Delays maximum pain relief for as long as 3-4 hours
- Does not provide fast relief of headaches
Eenteric ASA vs. Regular G.I. Bleeding Risk
- Enteric coated ASA is just as likley to cause stomach bleeding
Pharmacists should balance the use of medicine by analyzing…..
The risk of the medicine vs. the benefit of the medicine
Ibu Decision for a Pt
- 5% chance of GI problems when used
- 100% chance of pain when not used
Acetaminophen is placebo for…..
Back pain and arthritis
Pharmacists often focus on…… risks, yet fail to mention that……
GI and CV risk, yet fail to mention that by not treating, PAIN is not treated, and that may be worse for the patient
What is the number one cause of liver toxicity? Number one cause?
Drug-Induced
Acetaminophen
- Especially in combo with alcohol
Ibu vs. Acet Toxicity: Which one is more damaging to the liver?
Acet
In regards to pain, what other sx/issue is often closely related?
Insomnia
Nightime Analgesics often have….. for what effect?
Diphenhydramine –> Sedation
When does pain often get worse? Why?
- Pain often gets worse at night
- Cortisol lowers at night, and staying in one position might cause the joints to stiffen up
What are some of the major causes of pain?
Muscle/Back/Joint Pain
Headache/Migraine
Cold/Flu
How should one asses pain in a child? Treatment?
Evualuate behavioural changes (e.g. facial expressions, mood, crying, inactivity)
- fever –> Tx if affecting behvaviour
- pain –> Tx
Acet or Ibu (or combo)
Headaches Tx?
Migraine Tx
- NSAID’s or Acet
- Triptans Migraine
Osteoarthritis DOC
NSAID’s
Lower Back Pain Tx
NSAID always
What is the drug of choice for dysmenorrhea? Why?
NSAIDS
- Prostaglandin derived syndrome
- Contractions in uterus by prostaglandins
What is dysmennorhea?
Cramping pain is the lower abdomen that can start from 1-2 days before your period begins and can last for 2-4 days
Dysmenorrhea Prevalence?
- Most commonly reported menstrual disorder
- More than one half of women
Is caffeine required for dysmenorrhea?
DO NOT need caffeine
- Midol, Maxidiol –>Used for PMS; NSAIDS still better
What analgesic should be used for toothaches? What rule to follow?
- Acet or Ibu –> Also combination
- Ibu –> anti-inflamm but not at OTC doses
2-4-24 Rule –> 2 drugs, 4 doses, 24 hours
Combination products of Acet and Ibu? Dose?
Combination makes sense –> Overall safe
- Not at therapeutci doses of either agent
Acet 250
Ibu 125
2 tabs Q8h (max 6/day)
Is combogesic a recommended product?
No –> Not at therapeutic doses of acet or ibu