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PHAR 154 > OTC Analgesics > Flashcards

OTC Analgesics Flashcards

1
Q

NSAID equivalence doses that match 10mg of oral morphine?

A

Ace: 3600mg
Aspirin: 3600mg
Ibu: 2220mg
Nap: 1380mg

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2
Q

OTC daily limits for Ibu & Nap?

A

Ibu: 1200mg
Nap: 440mg

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3
Q

Of the OTC analgesics, which one is most “legalistically” useful in terms of reaching 10mg Morphine strengths?

A

ASA / Ace… Get closer to 10mg Morphine strengths more easily.

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4
Q

At what singular dosage strength does Ibu-mediated pain relief not improve?

A

400mg (upper limit on analgesic effects)

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5
Q

What is the upper limit singular dosage strength in which analgesic effects are shown for ASA & Ace?

A

1g (both)

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6
Q

What is the threshold dose in which Ibuprofen demonstrates anti-inflammatory effects?

A

1600mg… OTC dosing for Ibu (400mg) is waaaaaaaay subtherapeutic for AI effects.

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7
Q

In terms of OTC analgesic options, which one is the most convenient?

A

Naproxen (BID Dosing)

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8
Q

Are liquid gel formulations of Tylenol & Advil better than the standard versions of these products?

A

Meh… More expensive just to get 2mins of less absorptive time.

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9
Q

What percentage of patients demonstrate Dermatological reactions to Advil?

A

3-9%

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10
Q

Do OTC doses of Ibuprofen demonstrate more adverse GI side effects than OTC doses of Acetaminophen?

A

Not at OTC levels (absolutely at Rx level dosing).

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11
Q

Are Duodenal Ulcers a problem at OTC dosing of Ibu?

A

Not really… More of a concern at Rx dosing.

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12
Q

Does Enteric Coating of analgesic tablets help with curbing GI side effects?

A

Nope

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13
Q

Should one take an analgesic with food?

A

Not recommended (food can reduce & delay analgesic effects of NSAIDs).

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14
Q

Is combo therapy with Ibu & Ace better than Ace monotherapy for the treatment of dental extraction / tonsillectomy pains?

A

Combo Therapy is better

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15
Q

What is the average age of Arthritis diagnosis in Canada?

A

50yrs

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16
Q

What role does caffeine have in analgesics?

A

-Acts as an Adjuvant (enhances analgesic efficacy in Tension Type Headaches).

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17
Q

What caffeine doses are required in an analgesic product to demonstrate enhanced efficacy?

A

TTH’s: 130mg
Migraine: > 100mg

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18
Q

What concern does caffeine being used in analgesics have?

A

-More likely to induce Medication Overuse Headaches than simple NSAIDs alone.

-Shouldn’t be used > 9 days / month.

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19
Q

What is the usual OTC Codeine dosage? Max OTC daily limit for Codeine?

A

Dosage: 15-60mg q4h
DL: 360mg

20
Q

What two analgesics are we extremely concerned of regarding Adolescent Overdosing?

A

ASA & Tylenol (less concerned with Advil or Aleve).

21
Q

At what intake within an 8hr span would we be concerned about potential hepatotoxicity due to Ace?

A

7.5-10g (24 RS or 15 Extra Strength)

22
Q

Above what intake would fatalities due to Ace overdosing be a concern?

A

15g

23
Q

When would OD concerns arise for pediatric Ace intake?

A

150-200mg / kg

24
Q

Although American guidelines have shifted to 3g / day, what is the hepatotoxic range of Ace intake in Canada (daily intake)?

A

4g / day

25
Q

What is the analgesic drug of choice for anti-coagulant patients?

A

Acetaminophen (b/c it doesn’t bounce drug off of Plasma Proteins like other NSAIDs)

26
Q

At what intake / week might Ace interact negatively with Warfarin?

A

> 2.5g / wk

27
Q

If I’m Aspirin-Sensitive, can I take Naproxen or Ibuprofen for acute symptom relief?

A

ABSOLUTELY NOT!!! Can exacerbate symptoms of Asthma & cross-reactivity is very much evident (coughing, wheezing, chest tightness, etc)!

28
Q

What demographics of patients demonstrate an ~10 fold increase in Aspirin-Sensitive Allergies?

A

-Allergic Rhinitis
-Asthma
-Urticaria

29
Q

If I have Asthma & I do NOT demonstrate ASA Sensitivity, can I use Ibu or Nap for acute symptomatic relief?

A

Yep (just can’t use when Aspirin-Sensitive).

30
Q

How does Ibuprofen negatively interact with low-dose Aspirin (81mg)?

A

Binds to COX-1 enzyme & neutralizes the anti-platelet effects of ASA.

31
Q

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?

A

-Give NSAIDs either 2hrs after ASA or 8hrs before ASA.

32
Q

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?

A

-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!

33
Q

What two drugs did Jeff mention in lecture that are definitively Category X & are teratogenic in nature?

A

-Isotretinoin
-Propecia

34
Q

Acetaminophen is classified as a Category ___ drug (in terms of teratogenicity).

A

Category B

35
Q

What potential teratogenic effects might NSAIDs cause?

A

Premature closure of the Patent Ductus Arteriosus (resulting in blood being sent to the lungs before term)…

36
Q

Ibuprofen is classified as a Category ___ drug up to 30wks, & a Category ___ drug after 30wks.

A

Up to 30wks: Cat. C
> 30wks: Cat. D

37
Q

What negative effects might NSAIDs bring about prior to the delivery of a child?

A

-Premature PDA closure

-Increasing bleeding risk at term

38
Q

Prior to the 3rd Trimester, ASA is classified as a Category ___ drug ; During 3rd Trimester is what?

A

Category C ; Category D during 3rd Trimester

39
Q

What combo NSAID product has great promise due to its lessened GI effects (b/c of the presence of a PPI)?

A

Vimovo (Nap / Esomeprazole Magnesium combo product)

-PPI in it reduces stomach acid production (so GI bleed & ulcer risk is lowered).

40
Q

All NSAIDs, regardless of what they are, increase the risk of what?

A

CV Event

41
Q

SSRI’s, Low-Dose ASA, Alcohol Consumption, & Oral Steroids (combined with NSAIDs) are examples of drugs that increase the risk of what?

A

GI Effects

42
Q

Anti-Coagulants (combined with NSAIDs) increase the risk of what?

A

Bleed Risk

43
Q

Blood Pressure Meds (combined with NSAID usage) increase the risk of what event occurring?

A

CV Events

44
Q

If I’m a Chronic Alcoholic & take Acetaminophen to offset my hangover, why might this be concerning?

A

-Chronic Alcohol induces CYP2E1 up-regulation & leads to the generation of more toxic NAPQI metabolites.

45
Q

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?

A

Nope… Acute Alcohol consumption actually inhibits Ace conversion to NAPQI metabolites & promotes its conjugation into non-toxic metabolites.

46
Q

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?

A

< 2g… OSCE settings probably discourage Ace intake & use something else.

47
Q

What athletic demographic should be more concerned around NSAID usage for acute pain flare-ups?

A

Endurance Athletes (ie. Distance Runners)… Prostaglandins help diffuse the Kidneys, so NSAID usage could deplete PG stores & lead to Nephrotoxicity.

PHAR 154 (11 decks)

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