Week 1: Introduction to Analgesics/Antipyretics & Treatment of Pain Disorders

Question 1

The brand names of Acetaminophen are ____.

Answer 1

Tylenol, Feverall

Question 2

The brand names of Ibuprofen are ____.

Answer 2

Motrin, Advil

Question 3

The brand name of Naproxen sodium is ____.

Answer 3

Aleve

Question 4

The brand names of Acetylated salicylate are ____.

Answer 4

Aspirin, Bayer, St. Josephs, Ecotrin, ASA

Question 5

The 2 types of non-acetylated salicylates are ____.

Answer 5

Magnesium salicylate (Doan's)
Sodium salicylate (Alka-seltzer)

Question 6

The MOA of acetaminophen is ____.

Answer 6

central inhibition of prostaglandin synthesis

Question 7

The MOA of ibuprofen is ____.

Answer 7

• reversible inhibition of COX 1 and COX 2

- inhibition of prostaglandin synthesis

Question 8

The MOA of naproxen sodium is ____.

Answer 8

• reversible inhibition of COX 1 and COX 2 (Cyclooxygenase)

- inhibition of prostaglandin synthesis

Question 9

The MOA of salicylates is ____.

Answer 9

• irreversibly inhibits COX-1 and COX-2 (Cyclooxygenase)

- inhibits prostaglandin synthesis

Question 10

The classes of acetaminophen are ____.

Answer 10

antipyretic , analgesic

for pain and fever - NOT an effective anti-inflammatory agent

Question 11

The classes of NSAIDs (ibuprofen and naproxen sodium) include ____.

Answer 11

antipyretic, analgesis, AND ANTI-INFLAMMATORY

Question 12

The therapeutic uses of salicylates include ____.

Answer 12

• cardioprotective (inhibit platelet aggregation)
• primary and secondary prevention of thromboembolism
  (stroke or heart attack prevention in high risk patients)
• musculoskeletal pain (Topic or systemic)
• headache
• mild/moderate pain
• fever (not in children less than 12 years old or teenagers with a viral illness)

Question 13

The adult dosing (≥12 yo) for acetaminophen is _____.

Answer 13

325-1,000 mg Q 4-6 hr PRN

Regular strength: 325 mg
Extra strength: 500 mg

Question 14

The FDA MAX/DAY adult dosing (≥12 yo) for acetaminophen is _____.

Answer 14

4 grams/day (or 4,000 mg)

Question 15

The MANUFACTURER MAX/DAY adult dosing (≥12 yo) for acetaminophen is _____. Manufacturers voluntarily reduced max/day dose to reduce incidents of hepatotoxicity.

Answer 15

Regular strength: 3,250 mg/day

Question 16

The OTC adult dosing (≥12 yo) for ibuprofen is _____.

Answer 16

(1-2 tab) 200 mg PO Q 4-6 hrs PRN

Question 17

The OTC MAX/DAY adult dosing for ibuprofen is _____.

The PRESCRIPTION MAX/DAY adult dosing is ____.

Answer 17

1,200 mg (max 6 tablets/day)

3,200 mg

Question 18

The OTC adult dosing (≥12 yo) for naproxen sodium is _____.

Answer 18

(1 tab) 220 mg PO Q 8-12 hrs PRN

Question 19

The OTC MAX/DAY adult dosing (≥12 yo) for naproxen sodium is _____.

The PRESCRIPTION MAX/DAY adult dosing is ____.

Answer 19

660 mg (max 3 tablets/day)

1,500 mg

Question 20

The adult dose for Aspirin (ASA) dosing used for cardioprotection is _____ daily.

Answer 20

81-162 mg

Question 21

For an adult dose of Aspirin, you need ____ g/day for anti-inflammatory effect. Note that NSAIDS are a better choice for inflammatory conditions.

Answer 21

4-6

Question 22

The pediatric based on WEIGHT-BASED dosing for acetaminophen is _____

Answer 22

10-15 mg/kg/dose Q 4-6 hrs PRN

Maximum 5 doses/day

Question 23

The OTC pediatric dosing for Ibuprofen is ____.

Note: Naproxen is not indicated for children less than 12 years old.

Answer 23

5-10 mg/kg/dose Q 6-8 hrs

Maximum 4 doses/day

Question 24

The pediatric dosing for naproxen sodium is ____.

Answer 24

NOT indicated for children less than 12 years old

Question 25

____ is under pregnancy category B (considered safe in pregnancy & lactation).

Answer 25

acetaminophen

Question 26

_____ is under pregnancy category B in the 1st and 2nd trimester BUT is under pregnancy category D in the 3rd trimester. It is safe to use if breastfeeding (lactation)

Answer 26

NSAIDS: Ibuprofen and Naproxen sodium

Question 27

List some factors (precautions) that increase risk of liver damage with acetaminophen.

Answer 27

• liver disease
• chronic use of APAP of more than 4g/daily
• ingest more than 3 alcoholic drinks
• take other drugs containing APAP (using other hepatotoxic drugs)

Question 28

NSAID (ibuprofen and naproxen) precautions and contraindications include ____.

Answer 28

1. Renal impairment (decreased kidney blood flow)
2. Stomach bleeding/bleeding disorders by:
   - if you are age 60 or over
   - consuming for than 3 alcoholic drinks
   - taking other drugs containing NSAIDS
   - taking blood thinner or steroid
   - having a history of stomach ulcers/bleeding
3. Increased risk of cardiovascular disease and cerebrovascular events with long term use

Question 29

What are the treatments for acetaminophen toxicity/overdose?

Answer 29

• acetylcysteine (Mucomyst) reduces NAPQI by replenishing GSH
• activated charcoal

Question 30

What is the toxic metabolite in acetaminophen?

Answer 30

NAPQI

Question 31

When the product labeling is for infants 2-3 years old, ____ dosing is SAFE to use even in children 0-24 months with recommendation of a healthcare provider.

Answer 31

acetaminophen

Question 32

The strength of FeverAll infant suppositories are ____.

Answer 32

80mg/suppository

Question 33

The liquid concentration of Children’s Tylenol Suspension (age 2-11) is ____.

Answer 33

160 mg/5 mL

Question 34

Name 2 drug interactions with acetaminophen.

Answer 34

1. alcohol (liver toxicity/hepatotoxicity)

2. warfarin (increased bleeding)

Question 35

____ is a dosage form of salicylates that is absorbed in the small intestine to reduce GI toxicity. It is a preferred dosage form for patients requiring chronic therapy.

Answer 35

enteric coating

Question 36

____ is a dosage form of salicylates that is absorbed more rapidly but little effect on therapeutic onset.

Answer 36

buffered (tablet and effervescent)

Question 37

____ is a dosage form of salicylates that is prolonged duration of action by slowing dissolution and absorption.

Answer 37

sustained-release

Question 38

The counseling points for Aspirin dosing is “_____”

Answer 38

take with food

Question 39

Salicylates precautions and contraindications include ___.

Answer 39

1. gastritis and ulceration of upper GI tract
2. bleeding
3. avoid in pregnancy during 3rd trimester
4. avoid in patients with gout or hyperuricemia
5. there is an increased risk of bronchospasm in patients with asthma

Question 40

Discontinue Aspirin ____ days prior to surgery

Answer 40

2-7

Question 41

Salicylates and Drug interactions that may increase the risk of GI ulcers and/or bleeding are?

Answer 41

1. NSAIDS
2. Warfarin
3. Alcohol

Question 42

Salicylates and Drug interactions that may lower the antiplatelet effect of Aspirin are?

Answer 42

1. ibuprofen

2. take Aspirin at least 30 minutes before or 8 hours after ibuprofen

Question 43

Children less than 12 years old or teenagers that may have a possible viral illness should NOT TAKE ____.

Answer 43

salicylates

Question 44

One of the symptoms of salicylate toxicity is _____ which is a ringing in the ear.

Answer 44

tinnitus

Question 45

The dose for Children’s Advil and Motrin (Ages 2-11) is ____. Note that ibuprofen is not to be used in children less than 6 months old (because they have not yet developed a Kidney)

Answer 45

100mg/ 5mL

Question 46

Some NSAID adverse effects include ____.

Answer 46

• GI upset
• fluid retention (edema)
• increased bleeding

Question 47

Some important (bolded terms) NSAID Counseling Points include?

Answer 47

1. Take with food
2. Monitor blood pressure in patients with high b.p.
3. Do not use for more than 10 days
4. Do not drink with alcohol while taking NSAIDS

Question 48

Name 2 drug interactions with NSAIDS.

Answer 48

Warfarin and Aspirin

Question 49

NSAID drug interactions that increase GI bleeding are ____.

Answer 49

1. Bisphosphonates, Alcohol

2. Warfarin

Question 50

NSAID drug interactions can lower the effect of _____.

Answer 50

Antihypertensive medications