Analgesics 4

Question 1

Mention the dose needed of Salicylates used in symptomatic treatment of fever?

Answer 1

(0.3 – 1 gm orally every 4 h.)

Anti-pyretic

Question 2

Mention the dose needed of Salicylates that effective in low to moderate intensity pain as headache, arthralgia, myalgia, toothache, neuralgia, dysmenorrhea?

Answer 2

(0.3 – 1 gm orally every 4 h.).

Analgesic

Question 3

Mention the dose needed of salicylates to treat Rheumatoid arthritis?

Answer 3

highly doses usually recommended
(5-6 gm /day)

Question 4

In Rheumatic fever, Salicylates suppress inflammatory process but…………………… ,
……………………………and…………………………..
are not prevented

Answer 4

Cardiac complications
S.C nodules
encephalitis chorea

Question 5

drug used in treatment or prevention of coronary and cerebral artery thrombosis & prophylaxis against deep venous thrombosis?

+ mention the dose

Answer 5

Low dose of aspirin
(75-150/320 mg/day)

Question 6

Analgesic used topically in painful lesion in skin, muscles?

Answer 6

Methyl salicylic

Question 7

Analgesic used as keratolytic agent in treatment of corns, warts, fungistatic?

Answer 7

Salicylic acid

Question 8

Enumerate the therapeutic uses of analgesics?

Answer 8

1. Anti-pyretic: Salicylates used in symptomatic treatment of fever (0.3 – 1 gm orally every 4 h.)
2. Analgesic: Salicylates are effective in low to moderate intensity pain as headache, arthralgia, myalgia, toothache, neuralgia, dysmenorrhea (0.3 – 1 gm orally every 4 h.)
3. Anti-inflammatory:
   a. Rheumatoid arthritis: highly doses of salicylates are usually recommended
   (5-6 gm/day).
   b. Rheumatic fever:
   >Salicylates suppress inflammatory process but not affect the proliferative manifestations.
   >Best response appears within 1-2 days, and treatment must continue for 2 weeks after disappearance of all
   manifestations
4. Anti-platelet: Low dose of aspirin
   (75-150/320 mg/day) used in treatment or prevention of coronary and cerebral artery thrombosis & prophylaxis against deep venous thrombosis.
5. Pre-eclampsia and hypertension of pregnancy (excess TXA2 )
6. Cancer chemoprevention: Frequent use of aspirin reduced the risk of cancer colon and rectum by 50 %.
7. Topically:
   >Salicylic acid is used as keratolytic agent in treatment of corns, warts, fungistatic.
   >Methyl salicylic is used topically in painful lesion in skin, muscles

Question 9

Give short note about Acute salicylate poisoning?

Cause- Symptoms- Treatment

Answer 9

> Its adverse effect of toxic dose of aspirin

A.Cause: excessive intake of aspirin either accidental or as a suicidal attack
(fatal dose in adult is 10-30 gm)

B.Symptoms :
1- CNS stimulation (Hallucination – delirium – convulsions) followed by CNS depression, Coma and death due to respiratory failure.
2- metabolic acidosis, Hyperglycemia.
3- Hyperthermia, Dehydration.
4- GIT: nausea, vomiting and bleeding.

C.Treatment:
1. ↓ absorption of aspirin →(by induction of vomiting, gastric lavage, Na bicarbonate orally, or activated charcoal).

2. ↑ elimination of aspirin by:
   a. Alkalinization of urine by IV NaHCO3.
   b. Hemodialysis
3. Supportive treatment: Artificial respiration
4. Symptomatic treatment:
   a. Acidosis → NaHCo3
   b. Convulsions → Anticonvulsant “ diazepam”
   c. Hyperthermia → cold fomentation
   d. Bleeding → Vitamin K
   e. Dehydration → IV fluids

Question 10

Give short note about Salicylism?

Answer 10

> Its chronic toxicity of aspirin

A.Cause: repeated use of aspirin in high doses in patient with rheumatic fever

B.Symptoms: nausea, vomiting, diarrhea, headache, dizziness, confusion. Tinnitus and hearing loss

C.Treatment: stop the drug (drug holiday).

Question 11

Enumerate the contraindications of analgesics?
A,BB,C,G,PP

Answer 11

1-Allergy to salicylates
2- Bronchial asthma.
3- Bleeding disorder (Hemophilia)
4 - Children with fever due to viral infection as influenza.
5- GOUT (small dose)
6- Peptic ulcer.
7- Pregnancy

Question 12

Mention the adverse effect of therapeutic doses of aspirin?

Answer 12

1. Hemorrhage: ↑ bleeding tendency
   a. During pregnancy: increase risk of
   post- partum hemorrhage.
   b. GIT bleeding (melena– Hematemesis)
   c. Displacement of warfarin from plasma
   protein binding leading to bleeding.

NB: aspirin is stopped at least one week before surgery

2. Hypersensitivity reactions: skin rash, urticarial, purpura, bronchial asthma, angioneurotic edema, purpura and
   anaphylactic shock in severe cases.
3. Reye’s syndrome: Hepatic injury and encephalopathy in febrile children with viral infection.
4. Nephrotoxicity, due to chronic use of NSAIDs may cause renal impairment due to inhibition of renal PGs synthesis
5. GIT effects: nausea, vomiting, heart burn gastric ulceration.
6. During pregnancy: especially last trimester it may cause suppression of uterine PGs result in delayed labor
7. Drug interactions:
   • Displacement of oral hypoglycemic
     leading to hypoglycemia
   • Antagonize the antihypertensive action of
     B. blockers, diuretics, ACE inhibitors
   -NSAIDs cause: salt, H2o retention /
   inhibition in synthesis of vasodilator PGs
   • Patient using aspirin as anti-platelet
     should avoid use of other NSAIDs ( other
     NSAIDS will bind to COX instead of aspirin)