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
multiple classes of analgesics
acetaminophen (central acting analgesic)
NSAIDs
local anesthetics
counterirritants
acetaminophen
tylenol
tylenol indications
pain, fever
tylenol US boxed warnings
risk of medication errors and hepatotoxicity-dosing errors resulting in accidental overdose
cases of acute liver failure at times requiring transplantation or causing death-do not exceed maximum doses
tylenol contraindications
severe hepatic impairment or severe active liver disease
tylenol ADRs
well tolerated-possibly GI side effects
tylenol metabolism/excretion
no renal or hepatic adjustments
contraindicated in severe liver impairment
pediatric acetaminophen
various concentrations exist
ensure you have the correct concentration when you’re recommending doses
typical pediatric acetaminophen dosing
10-15 mg/kg per dose-not to exceed 5 doses per day
NSAIDs indications
mild to moderate paid, management or inflammaroty diseases and rheumatoid diseases, fever, dysmenorrhea, osteoarthritis
NSAIDs US boxed warnings
increased risk of serious cardiovascular thrombotic events including myocardial infarction and stroke
increased risk of serious gastrointestinal bleeding
NSAIDs MOA
reversibly inhibits COX-1 and COX-2: decreased formation of prostaglandin precursors-antipyretic, analgesic, and anti-inflammatory properties
NSAIDs contraindications
use in coronary artery bypass graft surgery
NSAIDs metabolism/excretion
avoid in renal impairment, no hepatic adjustment needed
NSAIDs ADRs
cardiovascular effects
gastrointestinal effects
hematologic effects
acute and chronic kidney injury, interstitial nephritis
NSAIDs cardiovascular effects
increased risk of serious adverse cardiovascular events- MI, CVA, new-onset hypertension, new-onset or exacerbation of heart failure
inhibit sodium reabsorption in the kidneys- increased water retention, increased bp
NSAIDs GI effects
GI inflammation, hemorrhage, ulcer, perforation-can be fatal
COX-1 inhibition results in a reduction in mucosal-protective prostaglandin E2
longer duration of therapy increases risk
NSAIDs hematologic effects
prolong bleeding time and increase risk for hemorrhage
COX-1 inhibition decreases thromboxanes (thromboxane A2), decreased platelet adhesion and aggregation
NSAIDs acute and chronic kidney injury, interstitial nephritis
reduce production of nephroprotective prostaglandins-increase in vasoconstriction of the afferent arteriole and impaired renal blood flow
ibuprofen
motrin
motrin dosing
200 mg tabs 3-4 times/day
naproxen
aleve
aleve dosing
220 mg tabs 2x day (BID)
divlofenac
voltaren gel
voltaren gel dosing
4x day
2 gm on upper joints
4 gm on lower joints
no more than 2 body areas at the same time
aspirin dosing
81 mg daily (cardiac dose)
325 mg 3-4x day
capsaicin indications
muscle/joint pain, neuropathic pain, diabetic neuropathy
capsaicin warnings
do not use on wounds, damaged, broken, irritated skin, or into skin folds; do not cover with bandage; do not apply within 1 hour before or after bath, shower, hot tub, or sauna; do not use in combination with external heat sources; do not combine with other topucal analgesics
capsaicin ADRs
application sire burning, erythema, pain
capsaicin metabolism/excretion
no adjustments needed
lidocaine indications
temporary relief of minor localized pain
lidocaine US boxed warnings
life-threatening and fatal events in infants and young children seizures, cardiopulmonary arrest, and death
lidocaine toxicities
antiarrhythmic effects
lidocaine ADRs
erythema at application site
lidocaine metabolis/excretion
no adjustments needed in hepatic or renal dysfunction
lidocaine MOA
blocks the initiation and conduction of nerve impulses
menthol and methyl salicylate indications
temporary relief of minor localized pain
menthol and methyl salicylate MOA
menthol-counterirritants
menthol and methyl salicylate ADRs
erythema at application site
menthol and methyl salicylate metabolism/excretion
no adjustments needed in hepatic or renal dysfunction
