OTC Analgesics Flashcards
NSAID equivalence doses that match 10mg of oral morphine?
Ace: 3600mg
Aspirin: 3600mg
Ibu: 2220mg
Nap: 1380mg
OTC daily limits for Ibu & Nap?
Ibu: 1200mg
Nap: 440mg
Of the OTC analgesics, which one is most “legalistically” useful in terms of reaching 10mg Morphine strengths?
ASA / Ace… Get closer to 10mg Morphine strengths more easily.
At what singular dosage strength does Ibu-mediated pain relief not improve?
400mg (upper limit on analgesic effects)
What is the upper limit singular dosage strength in which analgesic effects are shown for ASA & Ace?
1g (both)
What is the threshold dose in which Ibuprofen demonstrates anti-inflammatory effects?
1600mg… OTC dosing for Ibu (400mg) is waaaaaaaay subtherapeutic for AI effects.
In terms of OTC analgesic options, which one is the most convenient?
Naproxen (BID Dosing)
Are liquid gel formulations of Tylenol & Advil better than the standard versions of these products?
Meh… More expensive just to get 2mins of less absorptive time.
What percentage of patients demonstrate Dermatological reactions to Advil?
3-9%
Do OTC doses of Ibuprofen demonstrate more adverse GI side effects than OTC doses of Acetaminophen?
Not at OTC levels (absolutely at Rx level dosing).
Are Duodenal Ulcers a problem at OTC dosing of Ibu?
Not really… More of a concern at Rx dosing.
Does Enteric Coating of analgesic tablets help with curbing GI side effects?
Nope
Should one take an analgesic with food?
Not recommended (food can reduce & delay analgesic effects of NSAIDs).
Is combo therapy with Ibu & Ace better than Ace monotherapy for the treatment of dental extraction / tonsillectomy pains?
Combo Therapy is better
What is the average age of Arthritis diagnosis in Canada?
50yrs
What role does caffeine have in analgesics?
-Acts as an Adjuvant (enhances analgesic efficacy in Tension Type Headaches).
What caffeine doses are required in an analgesic product to demonstrate enhanced efficacy?
TTH’s: 130mg
Migraine: > 100mg
What concern does caffeine being used in analgesics have?
-More likely to induce Medication Overuse Headaches than simple NSAIDs alone.
-Shouldn’t be used > 9 days / month.
What is the usual OTC Codeine dosage? Max OTC daily limit for Codeine?
Dosage: 15-60mg q4h
DL: 360mg
What two analgesics are we extremely concerned of regarding Adolescent Overdosing?
ASA & Tylenol (less concerned with Advil or Aleve).
At what intake within an 8hr span would we be concerned about potential hepatotoxicity due to Ace?
7.5-10g (24 RS or 15 Extra Strength)
Above what intake would fatalities due to Ace overdosing be a concern?
15g
When would OD concerns arise for pediatric Ace intake?
150-200mg / kg
Although American guidelines have shifted to 3g / day, what is the hepatotoxic range of Ace intake in Canada (daily intake)?
4g / day
What is the analgesic drug of choice for anti-coagulant patients?
Acetaminophen (b/c it doesn’t bounce drug off of Plasma Proteins like other NSAIDs)
At what intake / week might Ace interact negatively with Warfarin?
> 2.5g / wk
If I’m Aspirin-Sensitive, can I take Naproxen or Ibuprofen for acute symptom relief?
ABSOLUTELY NOT!!! Can exacerbate symptoms of Asthma & cross-reactivity is very much evident (coughing, wheezing, chest tightness, etc)!
What demographics of patients demonstrate an ~10 fold increase in Aspirin-Sensitive Allergies?
-Allergic Rhinitis
-Asthma
-Urticaria
If I have Asthma & I do NOT demonstrate ASA Sensitivity, can I use Ibu or Nap for acute symptomatic relief?
Yep (just can’t use when Aspirin-Sensitive).
How does Ibuprofen negatively interact with low-dose Aspirin (81mg)?
Binds to COX-1 enzyme & neutralizes the anti-platelet effects of ASA.
Although further NSAID addition can potentially exacerbate the risk of GI bleeds with co-admin of ASA, what would be an appropriate dosing schedule to mitigate those risks?
-Give NSAIDs either 2hrs after ASA or 8hrs before ASA.
If the protective effects of low dose ASA are desirable & I want acute pain relief for something like a headache, what alternative strategy can be deployed?
-Up the dose of Aspirin being taken… May slightly increase risk of GI bleed, but no adverse drug rxn’s as seen prior in terms of CV protective effects being eliminated!
What two drugs did Jeff mention in lecture that are definitively Category X & are teratogenic in nature?
-Isotretinoin
-Propecia
Acetaminophen is classified as a Category ___ drug (in terms of teratogenicity).
Category B
What potential teratogenic effects might NSAIDs cause?
Premature closure of the Patent Ductus Arteriosus (resulting in blood being sent to the lungs before term)…
Ibuprofen is classified as a Category ___ drug up to 30wks, & a Category ___ drug after 30wks.
Up to 30wks: Cat. C
> 30wks: Cat. D
What negative effects might NSAIDs bring about prior to the delivery of a child?
-Premature PDA closure
-Increasing bleeding risk at term
Prior to the 3rd Trimester, ASA is classified as a Category ___ drug ; During 3rd Trimester is what?
Category C ; Category D during 3rd Trimester
What combo NSAID product has great promise due to its lessened GI effects (b/c of the presence of a PPI)?
Vimovo (Nap / Esomeprazole Magnesium combo product)
-PPI in it reduces stomach acid production (so GI bleed & ulcer risk is lowered).
All NSAIDs, regardless of what they are, increase the risk of what?
CV Event
SSRI’s, Low-Dose ASA, Alcohol Consumption, & Oral Steroids (combined with NSAIDs) are examples of drugs that increase the risk of what?
GI Effects
Anti-Coagulants (combined with NSAIDs) increase the risk of what?
Bleed Risk
Blood Pressure Meds (combined with NSAID usage) increase the risk of what event occurring?
CV Events
If I’m a Chronic Alcoholic & take Acetaminophen to offset my hangover, why might this be concerning?
-Chronic Alcohol induces CYP2E1 up-regulation & leads to the generation of more toxic NAPQI metabolites.
If I binge drink at a party (but I’m not a chronic alcohol consumer), am I at risk of NAPQI metabolite production on Tylenol?
Nope… Acute Alcohol consumption actually inhibits Ace conversion to NAPQI metabolites & promotes its conjugation into non-toxic metabolites.
If I’m a chronic alcohol user & decide to take Acetaminophen for some acute pain relief, what is the daily upper limit that I can take before I see hepatotoxic effects?
< 2g… OSCE settings probably discourage Ace intake & use something else.
What athletic demographic should be more concerned around NSAID usage for acute pain flare-ups?
Endurance Athletes (ie. Distance Runners)… Prostaglandins help diffuse the Kidneys, so NSAID usage could deplete PG stores & lead to Nephrotoxicity.
