Week 8: Non Opioids, NSAIDS, and Acetaminophin, and herbals

Question 1

Salicylate NSAID:

Aspirin

Dosing?
Used for?
Don’t take what with aspirin?
Used for what type of pain?

Answer 1

ONCE DAILY DOSING
Aspirin dosing:
81 mg (baby)
325 mg (normal)

for MI/stroke reduction (prevention of clots)

**Do not take aspirin and ibuprofen at literal same time

IF NEEDED (PRN) dosing (every 4-6 hours)

◦Joint pain, swelling, inflammation (arthritis, tendonitis, bursitis, etc.)
◦Fever
◦MILD PAIN

Question 2

Aspirin

Is it reversible or irreversible?

Adverse effects?

Answer 2

Irreversible when it binds to platelets!!!!

Bleeding: Inhibition of platelets (thromboxane A2)

Gastric problems
Renal impairment
Reye’s syndrome (avoid in children less than 12)

Question 3

Aspirin overdose

Present as?

Answer 3

Salicylism Toxicity

Tinnitus

Respiratory alkalosis (rapid breathing)

Question 4

NSAID
Aspirin adverse effects

A.S.P.I.R.I.N

ASA = Acetyl Salicylic Acid

Answer 4

Asthma

Salicylism poisoning (N/V/D, breathing)

Premature closure of ductus arteriosus/Platelet disaggregation/ Peptic Ulcer Disease

Intestinal bleeding

Reye Syndrome/Ringing in the ears/Renal Impairment/rapid breathing

Idiosyncratic Reaction

Noise (Tinnitus)/Nephropathy(kidneys)

Question 5

REYE SYNDROME

Avoid what in children?
Also avoid what?
Especially avoid when?
Exception?

Answer 5

◦Avoid aspirin in children and adolescents

◦Also avoid Pepto Bismal®

◦Especially avoid if they have a virus

◦EXCEPTION: Kawasaki Disease

Question 6

Reversible NSAID

used for?

Answer 6

Joint pain, swelling, inflammation (arthritis, tendinitis, bursitis, etc.)

Fever

Mild - moderate pain

Period pain (Dysmenorrhea)

Closing PDA in pre-term infants

Question 7

Reversible NSAIDS

FIRST GENERATION?
SECOND GENERATION?

cox 2 is what?

Answer 7

FIRST GENERATION: Reversibly inhibit both COX-I and COX-II pathways

SECOND GENERATION: Reversibly inhibit COX-II pathway

COX-II is the “BAD” cox, it produces Prostaglandins in the brain which cause inflammation, fever, and pain

COX II: Sites of tissue injury

Question 8

Reversible NSAIDS

Boxed warning for what?

Max usage of Ketorolac?

Celecoxib what allergy?

Do they cause constriction or dilation?

Adverse effects?
Avoid in who?

Answer 8

BOXED WARNING: GI effects, bleeding for ALL

BOXED WARNING: Cardio thrombotic events (MI/Stroke)

(Ketorolac- max of 5 days usage, others don’t have a max!!!!!)

Sulfa allergy risk

Vasoconstriction: Increases BP, MI/Stroke Risk

Tinnitus (with high doses)

Decreased Blood Flow to Kidneys
-Risk for AKI
-Risk for Salt and Water retention

Pregnancy (avoid unless specifically prescribed)

Question 9

Acetaminophen (Tylenol) / Paracetamol

Used for?
Does not work for?
Boxed warning for what?

Answer 9

Pain or fever

This is NOT an NSAID, does NOT work for inflammation

BOXED WARNING: HEPATOTOXICITY

Question 10

Acetaminophen (Tylenol) / Paracetamol

Max single dose?
Older adult recommended max?
How much if you drink alcohol?
What is the antidote?
Contraindication?

Answer 10

Single Dose Max is 1000 mg!!!!!! (less if low body weight)

3000 mg/day for Older Adults

2000 mg/day if you drink 3 or more alcoholic beverages

ANTIDOTE: Acetylcysteine (Acetadote®)

Liver disease

Question 11

What is Acetylcysteine?

IV version?
Inhaled version?

Answer 11

IV: Helps protect the liver

INHALED VERSION: Mucomyst®

Mucolytic to thin secretions
Can see used in lung diseases like cystic fibrosis and emphysema

Question 12

Herbals

Used for what
Feverfew?
glucosamine?

Answer 12

Feverfew: Used for variety of the anti-inflammatory conditions (miscellaneous pain)

Glucosamine: Joint pain

If you see an Herbal that starts with F,G,S, usually the concern is bleeding risk if added with “blood thinners” aka Anticoagulants