Anti-Inflamatory dec 2 Flashcards
Acetaminophen is a
Analgesic and antipyretic
Acetaminophen MOI
Mechanism of action not well known
Thought to act by inhibiting central and peripheral prostaglandin synthesis
Acetaminophen reduced fever by
direct actions on the hypothalamic heat-regulating centers
acetaminophen does not
effect COX, so does not affect platelet aggregation or cause GI irritation
Ibprofen (NSAID) hard on
Tylenol hard on
kidney (NSAID)
Liver (AcEtaminophen)
Tylenol and NSAID are rapidly
absorbed after oral administration
Absorption delayed by food
NSAIDs are metabolized by
liver and excreted in urine.
Acetaminophen is metabolized by
Liver
do not take any more than ___ for acetaminophen per day
3000 mg to 4000 mg
follow label
When acetaminophen is taken regularly or in large doses, the stores of
glutathione become depleted, and hepatic necrosis may occur.
Overuse of NSAID can stress
kidneys
NSAID Most common ADR
GI disturbances
Take with food to reduce GI upset.
Monitor for ulcers and GI bleed.
NSAID can cause
acute renal insufficiency
NSAID inhibit
platelet aggregation and may increase bleeding time
NSAID cause fluid
retention and peripheral edema
Indomethacin (NSAID): may
aggravate depression or other psychiatric disturbances
COX-2 inhibitors and all NSAIDs have
Black Box warning for patients about cardiovascular risk.
All NSAIDs may increase the risk of a heart attack or stroke
Acetaminophen ADR acute hepatic necrosis occurs with
with doses of 10 to 15 g.
Doses above 25 g are usually fatal.
Acetaminophen poisoning treatment
Refer to poison center.
Get acetaminophen level.
Oral N-acetylcysteine is a specific antidote for acetaminophen toxicity.
Rheumatoid arthritis
Use and follow
Use NSAIDs or celecoxib to reduce joint pain and swelling.
Follow American College of Rheumatology suggestions for treatment.
There is increased risk for complications, so monitor closely.
Osteoarthritis use
Acetaminophen or NSAIDs can be used for pain.
Gout use
Indomethacin, naproxen, and sulindac
Mild to moderate pain use
Non-opioid analgesia includes NSAIDs and acetaminophen.
Ibuprofen and naproxen are most commonly used.
Primary dysmenorrhea use
NSAIDs (ibuprofen or naproxen) are the drugs of choice.
Tendonitis and bursitis use
Indomethacin SR, naproxen, and sulindac are used.
Fever use
Ibuprofen is the drug of choice.
Acetaminophen
Drug of choice for
mild to moderate pain in:
Pregnancy
Patients with history of GI bleed
Aspirin allergy, blood coagulation disorders, upper GI disease
Acetaminophen
Drug of choice for fever in
older adults (not as hard on kidneys) ]
Children, infants younger than 6 months of age
Especially children with fever during flu-like illness
NSAIDs
monitoring
Renal function with long-term therapy
GI ulcer or GI bleed
CBC prior to initiation of therapy and annually thereafter
Acetaminophen
Monitoring
Dosing for overdosing with self-medication
Liver function if on high-dose or long-term therapy
NSAID patient education
Take as directed.
Limit alcohol consumption.
Maximum acetaminophen dose is 3 g/24 hours.
NSAID ADR
Report GI upset or “coffee ground” emesis
Aspirin and Salicylates action
These drugs have analgesic, anti-inflammatory, antipyretic, and antiplateletactivities
Aspirin and Salicylates
The anti-inflammatory and analgesic activities are mediated through
inhibition of prostaglandin synthesis.
Aspirin irreversibly inhibits
platelet aggregation.
Aspirin
Rapidly and completely
Aspirin
Rapidly and completely
Widely distributed to all tissues
Metabolized by liver and eliminated via urine
Aspirin: ADRs GI
ulcers, bleeding, iron-deficiency anemia
ASA is what at higher levels
ototoxic
ulcers, bleeding, iron-deficiency anemia
or chickenpox associated with the development of Reye’s syndrome
ASA Avoid after
Avoid after
ASA pregnancy category
D
Aspirin Poisoning - Leathel dose
10 to 30 g.
what happens with ASA poisoning
respiratory alkalosis
ASA trement includes
induction of emesis or gastric lavage to remove any unabsorbed drug from the stomach if less than 2 hours from ingestion.
ASA Alkalinizing urine may increase
excretion
ASA Hemodialysis may be used for
Hemodialysis may be used for sever poisoning
ASA fever
Aspirin is effective antipyretic
Do not use in pregnant patients or children.
what is the gold standard for mild ot moderate pain
ASA
ASA rheumatoid arthritis
Aspirin is the gold standard.
Margin is narrow between a good therapeutic level and toxicity in treating patients with RA.
Juvenile patients with RA take aspirin.
ASA osteoarthritis
works well to treat pain
