Analgesics Antipyretics Flashcards
Acetaminophen (APAP) MOA
inhibition of PG synthesis in CNS; less PNS effect.
analgesic, anti-pyretic
NSAIDs MOA: Ibuprofen, Naproxen
Reversible inhibition of PG synthesis in CNS and PNS through non-specific inhibition of COX-1 and 2
analgesic, anti-pyretic, anti-inflammatory
Salicylates MOA: ASA, Mag. Salicylate
Irreversible inhibition of PG synthesis in CNS and PNS through nonspecific inhibition of COX-1 and 2
Inhibition of platelet aggregation
analgesic, anti-pyretic, anti-inflammatory
Common APAP brands
Tylenol, Midol, Pamprin
Common NSAIDs
Ibuprofen: Advil, Motrin
Naproxen Sodium: Aleve
Common ASA brand
Bayer, Ecotrin, St. Joseph
APAP formulations/strength per dose
Tylenol IR: regular 325mg, extra strength 500mg
Tylenol ER caplets: 650mg
APAP peds formulation/strength per dose
Tylenol kids/infant suspension: 160mg/5ml
Ibuprofen formulations/strength per dose
Advil/Motrin tablets/captlets/capsules: 200mg
Ibuprofen peds formulation/strength per dose
Advil/Motrin kids suspension: 100mg/5ml
Naproxen formulations/strength per dose (NO PEDS)
Aleve tablets/caplets/capsules: 220mg
APAP adult dosing
325-1000mg every 4-6 hrs
APAP max daily dose
4000mg or 4g
Ibuprofen adult dosing
200-400mg every 4-6 hrs
Ibuprofen max daily dose
1200mg
Naproxen adult dosing
220mg every 8-12hrs
Naproxen max daily dose
660mg if 12-65, 440mg if > 65
APAP peds daily dose
10-15mg/kg/dose every 4-6 hrs
APAP peds max daily dose
5 doses (calculate)
Ibuprofen peds daily dose
5-10mg/kg/dose every 6-8 hrs
Ibuprofen peds max daily dose
4 doses (calculate)
APAP SE
N/V, HA, ALT elevation, hepatic injury (rar), SJS, TEN (skin rxns)
APAP high risk populations
pt with prior liver disease, acute or chronic alcohol users at risk for liver damage
NSAID SE
Dizziness, fatigue, nervousness, HA, N, ulcer, bleeding, increased risk of CV event (ore than with Naproxen)
NSAID high risk population
Renal injury more common if elderly, HTN, DM, on diuretics, or atherosclerosis
ASA SE
N/V, dyspepsia, gastritis, ulceration, bleeding, renal, Reye’s (under 19)
ASA high risk population
Renal injury more common if elderly, HTN, DM, on diuretics, or atherosclerosis
NSAIDs, Salicylates, and GI irritation
increase gastric acid secretion
reduce bicarb and mucus production
gastric erosion, ulcers, and bleed at higher doses
NSAIDs, Salicylates, and Kidney function
Reduced GFR, reduced urinary sodium excretion.
Stay away from NSAIDs in pt with risk of kidney disease
NSAIDs and CV safety
risk depends on dose, duration, and frequency in addition to prior hx.
- potential to increase BP, exacerbate heart failure
- anti-platelet effects if given with ASA
Naproxen may have lower risk
ASA/NSAID sensitvity
COX inhibition shifts balance of production towards leukotriene = bronchial spasms
Effects:
Rhinitis with nasal polyps
Asthma exacerbation
Salicylates Labeling
- name of salicylate
- warning for Reye’s syndrome
- potential for allergic rxn
- potential for stomach bleed in: age >60, hx of ulcers/bleeds, > 3 drinks/day
NSAIDs Labeling
- name of NSAID
- potential for allergic rxn, especially if allergic to ASA
- potential for stomach bleed (same population as ASA)
APAP and Hepatotoxicity
- Uncommon at recommended dose
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