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Phamacology Summer > Pain Management Part 2: Non-Opioids > Flashcards

Pain Management Part 2: Non-Opioids Flashcards

1
Q

NSAIDS

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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2
Q

First Generation NSAIDS

Second Generation NSAIDS

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

First
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac

Second
-Celecoxib

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3
Q

Herbals

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A
  • Feverfew

- Glucosamine + Chondroitin

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4
Q

SALICYLATES/IRREVERSIBLE

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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5
Q

REVERSIBLE

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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6
Q

REVERSIBLE

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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7
Q

USED TO TREAT
for MI/stroke reduction (prevention of clots)

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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8
Q

USED TO TREAT
If you take ? w/ibuprofen, you lose the cardio protective benefit

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

ASA

-Aspirin

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9
Q

USED TO TREAT
PRN or frequent Aspirin dosing (every 4-6 hours)
 Rheumatoid Arthritis
 Osteoarthritis
 Joint pain, swelling, inflammation (arthritis, tendonitis, bursitis, etc.)
 Fever

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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10
Q

MECHANISM OF ACTION:
 Half life of aspirin is ~20 minutes

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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11
Q

MECHANISM OF ACTION: -Aspirin

 Half life of aspirin is ~ ? minutes

A

20

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12
Q

Adverse Reaction
Bleeding
 Inhibition of platelets (thromboxane A2)

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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13
Q

Adverse Reaction
Gastric distress, heartburn, nausea

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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14
Q

Adverse Reaction
Gastric bleeding / ulceration

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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15
Q

Adverse Reaction
Renal impairment

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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16
Q

Adverse Reaction
Reye syndrome
(avoid in

A

12

-Aspirin

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17
Q

ASA=

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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18
Q

Acetyl salicylic acid=

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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19
Q 
A sthma
S alicylism poisoning (N/V/D, breathing)
P remature closing of PDA/Platelet disaggregation/
Peptic Ulcer Disease
I ntestinal bleeding
R eye Syndrome/Ringing in the ears/Renal
Impairment/rapid breathing
I diosyncratic Reaction
N oise (Tinnitus)/Nephropathy

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin

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20
Q 
A sthma
S alicylism poisoning (N/V/D, breathing)
P remature closing of PDA/Platelet disaggregation/
Peptic Ulcer Disease
I ntestinal bleeding
R eye Syndrome/Ringing in the ears/Renal
Impairment/rapid breathing
I diosyncratic Reaction
N oise (Tinnitus)/Nephropathy

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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21
Q

Which affect aspirin?
DRUG-DRUG Interactions:

  • Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin.
  • Steroids can hurt GI tract (risk for ulcer/bleed)
  • Smoking/Alcohol can increase risk for bleeding
  • Other NSAIDs!
A

All

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22
Q

Administration

  • Take with food/liquids
  • Can use enteric coated tablets to protect the stomach

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin

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23
Q

Which affect aspirin & ibuprofen, ketorolac, naproxen, indomethacin, diclofenac, & Celecoxib
DRUG-DRUG Interactions:

  • Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin.
  • Steroids can hurt GI tract (risk for ulcer/bleed)
  • Smoking/Alcohol can increase risk for bleeding
  • Other NSAIDs!
A

All

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24
Q

Administration

  • Take with food/liquids
  • Can use enteric coated tablets to protect the stomach

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin

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25
``` Used to treat Joint pain, swelling, inflammation (arthritis, tendinitis, bursitis, etc. -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
26
Fever  Mild – moderate pain -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
27
Remember these are DIFFERENT FROM ASPIRIN! -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
28
MECHANISM OF ACTION: Reversibly inhibit both COX-I and COX-II pathways- Stops prostaglandin production in both Reduces pain, inflammation, fever -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-(ibuprofen, ketorolac, naproxen, indomethacin, | diclofenac
29
ADVERSE EFFECTS:  GI effects, bleeding ?- max of ? days usage! -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
``` -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib Ketorolac 5 ```
30
ADVERSE EFFECTS:  Increased blood pressure (MI/Stroke) -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
31
Renal impairment (potential for AKI) -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-(ibuprofen, ketorolac, naproxen, indomethacin, | diclofenac
32
Not to be used in heart failure (sodium/fluid retention) -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
33
``` Remember ? is the unique exception that protects from heart attack and stroke -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
aspirin
34
``` MI/Stroke Concerns -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
35
``` Not ideal in hx of MI or HTN -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-(ibuprofen, ketorolac, naproxen, indomethacin, | diclofenac
36
Two Boxed Warnings: Increased risk for thrombotic events (except?) Increased risk for GI Bleeding, Ulcers -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib Except -ASA
37
Drug intraction - Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin. - Steroids can hurt GI tract (risk for ulcer/bleed) - Smoking/Alcohol can increase risk for bleeding - Other NSAIDs! -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
38
Fluid Retention Concerns due to sodiam accumenlation  Avoid in heart failure patients -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi
-Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
39
``` Take with food/liquids -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
40
``` Avoid salicylates in children (this includes Pepto-Bismol!) -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Aspirin
41
``` Boxed Warnings: Cardiac Risk! GI toxicity! -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Celecoxib
42
``` Boxed Warnings: Cardiac Risk! -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Celecoxib
43
``` Boxed Warnings: GI toxicity! -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Celecoxib
44
``` Selective blockade of cyclooxygenase 2 enzyme -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Celecoxib
45
``` Aviod - Sulfa-Allergy -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Celecoxib
46
``` USED TO TREAT: Pain or Fever -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
47
``` ADVERSE EFFECTS:  Extremely rare at therapeutic dosages  NO gastric ulceration, renal impairment, bleeding compared to NSAIDS! -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
48
``` Liver toxicity / damage -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
49
```  Do not exceed 1000 mg/dose -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
50
```  No anti-inflammatory properties! -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
51
```  Tylenol, acetaminophen, paracetamol, APAP -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
52
``` Patients may present ASYMPTOMATIC -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
53
``` Present with = Diaphoresis, N/V/D -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
54
``` ANTIDOTE:  Acetylcysteine (Acetadote®) -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetaminophen (APAP))
55
``` Inhaled version (Mucomyst) to thin secretions -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetylcysteine
56
```  Can see used in lung diseases like cystic fibrosis and emphysema -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetylcysteine
57
```  Protects Liver -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetylcysteine
58
```  Oral Version (Cetylev)- Smells like rotten eggs -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetylcysteine
59
```  Intravenous Version (Acetadote)-this is what we use for overdose -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Acetylcysteine
60
``` Cardio-protective -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Aspirin
61
``` dangerous for hx of cardiac disease -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Celecoxib
62
``` Used to treat the pain of OA -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Glucosamine + Chondroi
63
``` Adverse effects  GI discomfort  Drowsiness, headache, skin reactions (glucosamine) -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Glucosamine + Chondroi
64
```  Drug interactions  Enhances effects of warfarin -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Glucosamine + Chondroi
65
```  Drug interactions  May increase insulin resistance (glucosamine) -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Glucosamine + Chondroi
66
 Anti-inflammatory properties - Feverfew - Glucosamine + Chondroi
-Feverfew
67
``` Used to treat migraine headaches, menstrual cramps, inflammation, and fever -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Feverfew
68
``` May cause GI distress, altered taste, muscle stiffness -Aspirin -(ibuprofen, ketorolac, naproxen, indomethacin, diclofenac -Acetaminophen (APAP)) -Celecoxib -Acetylcysteine -Feverfew -Glucosamine + Chondroi ```
-Feverfew
69
May interact with aspirin and other NSAIDs, as well as anticoagulants -Feverfew -Glucosamine + Chondroi
-Feverfew
70
 If you see an Herbal that starts with G or F, usually the concern is bleeding risk if added with an anticoagulant like Warfarin T or F
T

Phamacology Summer (48 decks)

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