Lecture 4 - Acetaminophen and other agents Flashcards
What are the differences of Acetaminophen compared to asparin (ASA)?
(Uses, what it doesn’t do that ASA does, 5 toxicities that ASA has that acetaminophen doesn’t: intestinal, uric acid, blood coagulation, cross-sensitivity, uses for kids)
- analgesic, antipyretic
- No anti-inflammatory action
Toxicities absent:
- No GI problems
- No increased uric acid (gout)
- No platelet inhibition
- No cross sensitivity to ASA
- No Reye’s syndrome (good for kids)
What is the MOA for acetaminophen?
- weak inhibitor of cyclooxygenase (only in CNS)
- inhibits central prostaglandin synthesis
- not good at peripheral inhibition, hence not a very effective anti-inflammatory
What are the serious toxicities of acetaminophen overdose?
There is a toxic P450 metabolite that affects liver, kidney, blood sugar, conciousness
- hepatic necrosis
- renal necrosis
- hypoglycemia
- coma/death
What are early symptoms of acetaminophen overdose and treatment?
(Toxicities relate to severe liver, kidney, metabolic damage)
- mild nausea, vomiting, anorexia and pain
- alcohol depletes glutathione and worsens condition
- hepatic damage 2-6 days, liver failure
- bleeding, jaundice, death
Treatment: N-acetyl cysteine
What are properties of other agents that act as analgesics and treat inflammatory disease?
(MOA, cross-sensitivity, uses, toxicities)
- all inhibit PG synthesis
- all are cross sensitive to ASA except acetominaphen
- used as anti-inflammatory or analgesic
- Ocular toxicities: diffuse corneal stromal deposits, EOM abnormalities, color vision disturbance, toxic amblyopia, blurred vision
What are some possible ocular toxicities when taking analgesics?
A. Diffuse corneal stromal deposits B. EOM abnormalities C. Color vision disturbance D. Toxic amblyopia E. All of the above.
E. All of the above.
- Diffuse corneal stromal deposits
- EOM abnormalities
- Color vision disturbance
- Toxic amblyopia
What are the differences between Indomethacin and asparin?
Potency, toxicity frequency, when to use, common toxicities
- 10-40x more potent than asparin
- More toxicities, especially with long-term use
- use only as last resort
- Common toxicity: GI and headache
What are the differences between Sulindac and Indomethacin?
Effectiveness and toxicities in general
- More effective
- Less GI toxicities
-List three other analgesics (Advil, Naprosyn, Voltaren)
- Ibuprofen
- Naproxen
- Diclofenac (decreases free arachidonic acid)
Describe Celecoxib
Drug class type, actions on GI tract, platelets, kidney, contraindications, toxicities with long term use
- Selective COX-2 inhibitors
- little action on GI tract and platelet
- can still cause kidney problems
- Contraindicated in patients with asparin sensitivity and sulfa allergies
- Toxicities: thrombotic events, myocardial infarction. Caution for patients with CV or GI disease, long term use
What are the contraindications for all NSAIDs?
Allergies, anything induced, asparin, mothers, heart surgeries
- allergic sensitivity
- NSAID induced asthma or urticaria
- asparin triad
- pregnancy
- coronary artery bypass grafting
