OTC Analgesics Flashcards
Analgesia
The inability to feel pain
Analgesics
Drugs that work through various mechanisms to reduce inflammation, the perception of pain, the intensity or duration of pain, or other various mechanisms to decrease the ability to feel pain
Classes of analgesics (4)
1) acetaminophen
2) NSAIDs
3) local anesthetics
4) counterirritants
Acetaminophen (Tylenol) indications
pain and fever (good for pain scale 1-6)
Acetaminophen (Tylenol) US box warning
1) risk of medication errors and hepatotoxicity- dosing errors resulting in accidental overdose
2) cases of acute liver failure at times requiring transplantation or causing death - do not exceed maximum doses
MOA Acetaminophen (Tylenol)
1) analgesic effect –> acts in CNS
2) antipyretic effect : inhibition of the hypothalamic heat regulating center
contraindications Acetaminophen (Tylenol)
sever hepatic impairment or severe active liver disease
ADR and contraindication of Acetaminophen (Tylenol)
well tolerated- contraindicated in severe liver impairment
Acetaminophen (Tylenol) route
CAN BE IN A SUPPOSITORIES (unwrap and insert)
Pediatric Acetaminophen (Tylenol) dosing - KNOW
1) various concentrations exist
2) typical dosing is 10-15 mg/kg per dose - not to exceed 5 doses a day
3) ensure you have the correct concentration when you’re recommending doses
Non-steroidal anti-inflammatory drugs (NSAIDS) indications
Mild to moderate pain, management of inflammatory diseases and rheumatoid diseases, fever, dysmenorrhea, osteoarthritis
US Boxed warnings Non-steroidal anti-inflammatory drugs (NSAIDS)
1) increased risk of serious CV thrombotic events including myocardial infarction and stroke
2) increased risk of serious GI bleeding
MOA of Non-steroidal anti-inflammatory drugs (NSAIDS)
- reversibly inhibit COX1 and COX2
- decreased formation of prostaglandin precursors (antipyretic, analgesic, and anti-inflammatory properties)
Contraindications of Non-steroidal anti-inflammatory drugs (NSAIDS)
use in coronary artery bypass graft surgery (CABG)
Non-steroidal anti-inflammatory drugs (NSAIDS) ADR cardiovascular
increased risk of adverse cardiovascular events - MI, CVA, new onset HTN, new onset or exacerbation of HF
- done by inhibiting sodium resorption in the kidneys –> sodium water retention increased BP
Non-steroidal anti-inflammatory drugs (NSAIDS) GI effects
- COX 1 inhibition results in a reduction in mucosal protective prostaglandin E2
- longer duration of therapy increases the risk for GI inflammation or ulcers
Non-steroidal anti-inflammatory drugs (NSAIDS) Hematologic effects
- prolong bleeding time and increase risk for hemorrhage
- COX1 inhibition decreases thromboxanes- decreased platelet adhesion and aggregation
Non-steroidal anti-inflammatory drugs (NSAIDS) kidney effects
acute and chronic kidney injury, interstitial nephritis- reduce production of nephroprotective prostaglandins, increase in vasoconstriction of the afferent arteriole and impaired renal blood flow
Non-steroidal anti-inflammatory drugs (NSAIDS) hepatic effects
Rare
- mild transaminase increase, rarely serious liver injury (this is more of a problem with tylenol)
OTC NSAIDS
1) motrin –> ibuprofen
2) Aleve –> naproxen
3) voltaren gel -> diclofenac
4) aspirin
Counter irritant : Capsaicin indications
muscle/joint pain, neuropathic pain, diabetic neuropathy
MOA of Counter irritant : Capsaicin
- it reduces the synthesis of substance P ( one of the agents that tells your body its in pain)
- agonist at TRPV1
- NOCICEPTOR DEFUNCTIONALIZATION
WARNINGS of Counter irritant : Capsaicin
DO NOT USE ON WOUNDS , damaged, broken, irritated skin; do not cover with bandage; do not apply within 1 hour before or after bath, water, sauna; do not use in combo with external heat sources; don’t combine with topical analgesics
Routes of Counter irritant : Capsaicin
Patches - 8%
ADR of Counter irritant : Capsaicin
application site burning, erythema, pain
ADR of Counter irritant : Capsaicin
application site burning, erythema, pain
Lidocaine indications
temporary relief of minor localized pain
US box warning lidocaine
life threatening and fatal events in infants and young children - seizures, cardiopulm arrest, and death
- lidocaine toxicities - antiarrhythmic effects
moa lidocaine
blocks the initaiton and conductions of nerve impulses
ADR lidocaine
erythema at application site
menthol and methyl salicylate indications
temporary relief and minor localized pain
MOA menthol and methyl salicylate
menthol - counterirritants (similar to capsaicin)
ADR menthol and methyl salicylate
erythema at application site
