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
Cox 2 example
celecoxib (Celebrex)
MOA of celebrex?
selectively inhibits COX-2
Contradicated with celebrex?
Contraindicated during pregnancy
Contraindicated for those with a history of MI or current unstable angina.
Risks and D2D with celebrex?
Decreased GI issues but increased cardiac issues
Potential for decreasing digitalis (digoxin) clearance.
Use with extreme caution in diabetics and others who use ACEIs because of potential damage to the kidneys
Indication for Acetaminophen
antipyretic and analgesic
MOA tylenol?
Inhibition of Cox in the CNS
D2D Tylenol?
Increase warfarin (Coumadin)=bleed risk
Who should avoid Tylenol?
Avoid in patients with hepatitis, dehydration, liver disease, cirrhosis, or those who are heavy drinkers.
Who is most at risk for liver toxicity with tylenol?
patient drinks >3 drinks/day or take other liver-toxic drugs.
Example of Topical NSAIDs
Diclofenac sodium
Voltaren
MOA of Voltaren?
Inhibition of COX 1 and 2
Safety with VOltaren?
While low serum concentrations, they can still cause GI bleeding.
MOA Lidocaine
Block action potential and sensation
Side effects with Lidocaine?
Vasovagal related to pain
Rare seizure
Rare cardiac toxicity
Local Capsaicin (Qutenza) Indication
arthritis, diabetic neuropathy, postherpetic neuralgia, headaches, and Fibromyalgia
MOA Capsaicin (Qutenza)
releases substance P, a sensory neurotransmitter that mediates pain.
Safety Capsaicin. (Qutenza)?
Avoid mucus membranes and eyes
Careful disposal
Example Anticonvulsant
Pregabalin (Lyrica), Topomax, Gabapentin, depakote.
INdication Lyrica?
Epilepsy, neuropathic pain, Fibromyalgia, general anxiety disorder
MOA Lyrica
Inhibits release of neurotransmitters
Safety and D2D with Lyrica
Scheduled V
Potential physical dependence
drug-to-drug interactions: alcohol, benzos, CNS depressants
Anticonvulsant example
Gabapentin, (Neurontin)
Indication Gabapentin
Antiseizure, postherpetic neuralgia (off-label diabetic neuropathy, migraine prophylaxis, Fibromyalgia, RLS)
MOA Gaba
May enhance GABA release)
Safety with gaba
Avoid driving may cause drowsiness
TCAs Examples
Nortriptyline (Elavil)
Indication TCAs (Elavil)
Migraine prevention, Depression, Fibromyalgia, neuropathic pain
MOA TCA
Block reuptake of NE and 5-HT
Safety TCA
Orthostatic hypotension Anticholinergic effects Diaphoresis Sedation Cardiac toxicity seizures
BBW TCA
May increase the risk of suicide
Muscle Relaxants Example
Cyclobenzaprine (Flexaril/Amrix)
Metaxalone (Skelaxin)
Indication Cyclobenzaprine and Metaxalone (Skelaxin)
Muscle spasm
Safety with Muscle relaxants
Physical dependence CNS depression Anticholinergic effects Cardiac rhythm disturbances Do not combine with MAOIs
Metaxalone (Skelaxin)- Liver damage; check LFTs before beginning and periodically.
Indication for Medical Marijuana
Suppression of emesis
Appetite stimulation
Treatment of Lennox-gastaut and Dravat syndrome
Relief of neuropathic pain
Safety with MJ
Schedule I
Inhibits CYP450
