Module 5: Unit A&B: ASA, NSAIDS Flashcards
Safety considerations with Aspirin?
It should not be used in children with a viral illness under the age of 19.
Increases the risk of bleeding.
Do not give in dose greater than 150mg to pregnant or lactating.
Should aspirin be used as primary prevention for heart attacks?
Aspirin should not be used in the routine primary prevention of ASCVD due to a lack of net benefit.
When should patients stop taking aspirin?
if tinnitus occurs, 7 days prior to surgery.
Who is ASA recommended for?
post-MI to decrease reoccurrence.
Who should avoid APAP (Acetaminophen)
Avoid in patients with:
chronic hepatitis, B/C/D, dehydration, liver disease, cirrhosis, or high alcohol intake
Is Tylenol safe in pregnancy?
yes, generally considered safe
What dosage do you want to limit Tylenol to?
Keep doses less than 4 grams/day for a healthy individual and 3 grams/day for frail or those at risk of liver toxicity.
Who should have caution with using NSAIDS?
Caution or avoid use in those with a hx of MI (dramatically increases the risk of repeat MI), CVA, emboli, ulcer, renal disease, elderly, and heart failure.
Drug to Drug cautions with NSAIDs?
Avoid using long-term if also taking ASA for prevention, as it interferes with ASA’s cardioprotective effects.
Caution with concurrent use of
corticosteroids, anticoagulants, ASA, and alcohol, as this can further increase the risk of upper gastro bleeding.
What else should you prescribe if a patient is on long term NSAID use?
PPI, H2RA, or Cytotec. Especially important for those over 70.
What pain medication worsens htn?
NSAIDS
Indication for aspirin?
Protection against clotting disorders as a secondary preventative measure, as an antipyretic, for effective relief of mild-moderate pain, and as an anti-inflammatory for rheumatoid arthritis, tendinitis, and bursitis.
MOA ASA?
Inhibits COX 1 and 2
BBW ASA?
Increased risk of GI bleed
Example of Cox 1 and 2 drugs?
Ibuprofen (Motrin) Diclofenac (Voltaren) Ketorolac (Toradol) Naproxen sodium (Aleve) Magnesium salicylate (Doan’s)
Indication for cox 1 and cox 2? (Toradol, aleve, ibuprofen, etc.)
antipyretic, for effective relief of mild-moderate pain, and as an anti-inflammatory for rheumatoid arthritis, tendinitis, and bursitis
MOA of Torodol, Motrin, aleve, doan’s, voltaren:
inhibition of the enzymes COX-1 and COX-2
Safety with all cox1/cox 2?
Increase both bleeding and cardiovascular disease (CVD)
Prescribing NSAIDs with corticosteroids increases bleeding risk 12-fold, spironolactone 11-fold, and selective serotonin reuptake inhibitors (SSRIs) 7-fold.
contraindicated during pregnancy, especially during the 3rd trimester, when they can cause premature closure of the ductus arteriosus, prolonged labor, and increased bleeding
Safety with Aleve?
contains sodium. Avoid in pts who should not have sodium.
Who should not take Doan’s?
not for patients with renal insufficiency.
BBW cox1 and 2?
Increased risk of GI bleed, and cardiovascular events, hospitalization, death.
What does cox1/cox2 do to platelets?
Little or no suppression of platelet aggregation