drugs

• Non-opiod analgesic,
• antipyretic

• blocks peripheral pain stimuli by inhibiting prostaglandins
• direct action on hypothalamus to reduce body temperature

Adult: 650-1000 mg by mouth or PR (Per Rectum) q 6 hr PRN for pain or fever

• Infant: dependant on age and weight; given orally
• *antipyretic of choice in infants and children*

Mild to moderate pain or fever

• Allergy
• severe liver disease
• genetic G6PD deficiency

*Pregnancy and breast feeding category B (Crosses the placenta and breast milk; no adequate well controlled studies)*

• Rash
• nausea
• vomiting

• other hepatotoxic drugs
• alcohol

Overdose: Adults  > 3000 mg/day

• Toxicity:
• Liver necrosis
• Kidney problems

Blood test for Acetaminophen level

• Acetylcysteine (Prevents hepatic metabolites from forming)
• Loading dose: 140 mg/kg PO
• Then: 70 mg/kg q 4 hr for 17 doses

• Half life: 1-4 hr
• Onset of action: 10-30 min
• Peak: 30 min-2 hr
• Duration: 3-4 hr

• Salicylate (acetylated NSAID)
• antipyretic
• prophylaxis against heart disease and stroke

Block prostaglandins that contribute to inflammation, pain and fever

• Adult:
• 81-325 mg daily to prevent heart disease
• 650 mg every 4 hours for pain and fever

Infants and children: associated with progressive neurological deficits leading to coma - Reye's syndrom. *Do not give to children*

Mild to moderate pain, inflammation, and fever

• Drug allergy
• Bleeding problems
• Pregnancy
• Renal or hepatic disease

*Pregnancy category C (First and second trimester adverse effect on animal fetus), D (third trimester ): Don't use*

• Heartburn
• upset stomach
• gastrointestinal bleeding

• Alcohol and anticoagulants increase risk of bleeding
• Drugs that bind protein (Dilantin) may increase therapeutic response
• NSAIDs may reduce the effectiveness of diuretics (water pills)

• Take with food
• Monitor for bleeding

• Half Life: 5-9 hr
• Onset of action: 15-30 min
• Peak: 45 min - 3 hr
• Duration: 3-4 hr

Salicylate intoxication: Increased pulse, tinnitus, hearing loss, poor vision, dizziness, mental confusion, weakness (lassitude), drowsiness, sweating, thirst, rapid breathing (to normalize blood pH), high or low blood sugar, low BP, metabolic acidosis

• Tx:
• Reduce absorption w/ charcoal
• treat fluid and electrolyte imbalance
• Support BP with IV fluids
• Support breathing
• hemodialysis

• nonsalicylate NSAID
• antipyretic

Block prostaglandins that contribute to inflammation, pain, and fever

*Same as Aspirin*

Mild to moderate pain, inflammation, and fever

• Drug allergey
• Bleeding problems
• Pregnancy
• Renal or hepatic disease

Pregnancy category B (D in third trimester)

• Heart burn
• upset stomach
• gastrointestinal bleeding
• increased cardiovascular risk
• renal failure

• Alcohol and anticoagulants increase risk of bleeding
• Drugs that bind proteing (Dilantin) may increase therapeutic response
• NSAIDs may reduce effectiveness of diuretics (water pills)

• Take with food
• monitor kidney function
• monitor for bleeding

• Half life: >30 min
• Onset of action: 30 min - 2 hr
• Peak:1-2 hr
• Duration: 4-6 hr

• Adult: 1200-3200 mg/day in 3 or 4 divided doses
• Infants and children: 20-40 mg/kg/day in 3 or 4 divided doses

Symptoms: Headache, tinnitus, lethargy, confusion, paresthesias, numbness, seizures, nausea, vomiting, gastrointestinal bleeding, cardiac arrest

• Tx:
• Removal of drug by inducing emesis w/ gastric lavage, activated charcoal, support symptoms

*unlike aspirin hemodialysis will not remove the drug from the body completely*

NSAID; Analgesic; Anti-inflammatory

Inhibits prostaglandin synthesis to produce analgesic and anti-inflammatory

• Half Life: 13 hrs.
• Onset: 1 hr.
• Peak: 2-4 hrs.
• Duration: 7 hrs or less

Acute or long term mild to moderate pain, primary dysmenorrhea, Rheumatoid Arthritis (RA) Osteoarthritis, ankylosing spondylitis, acute gouty arthritis, bursitis, tendonitis, fever.

Hypersensitivity to NSAIDs, perioperative pain in setting of CABG surgery,.

• Frequent: Nausea, constipation, abdominal cramping/pain, heartburn, headache, dizziness, drowsiness
• Occasional: stomatitis, diarrhea, indigestion, vomiting, confusion

• May decrease effect of antihypertensives and diuretics;
• Aspirin and other salicylates may increase risk of GIside effects, bleeding
• Bone marrow depressants may increase risk of hematologic reactions;
• May increase effects of heparin, oral anticoagulants, thrombolytics

• Best taken with food or milk
• Monitor CBC, platelet count, serum renal/hepatic function tests, Hgb, daily bowel activity,

• Adults Elderly: Initially 500 mg then 250 mg q 6-8 hrs PRN
• Children older than 2: 10mg/kg/day in two divided doses
• OTC Adult: 12-65 yrs: 220 mgq 8-12 hrs. PRN
• OTC Adults >65: 220 mg q 12 hrs. PRN

• Opioid, narcotic agonist (Schedule II)
• Analgesic

Binds to opioid receptors in CNS, reducing stimuli from sensory nerve endings, inhibits ascending pain pathways. Therapeutic Effect: Alters pain reception, increases pain threshold.

• IV:
• Onset: 1–2 min
• Peak: 3–5 min
• Duration: 0.5–1 hr
• Half Life: 2–4 hrs

• IM:
• Onset: 7–15 min
• Peak: 7–15 min
• Duration: 1–2 hrs

• Transdermal:
• Onset:  6–8 hrs
• Peak:  24 hrs
• Duration: 72 hrs
• Half Life: 17 hrs

• Transmucosal:
• Onset: 5–15 min
• Peak:  20–30 min
• Duration: 1–2 hrs
• Half Life: 6.6 hrs

Primarily eliminated by biliary system

• IV:
• Adult:50–100 mcg/dose q1–2h as needed.
• Children:50–100 mcg/dose q1–2h as needed.
• Buccal Film:  Initially, 200 mcg up to 1,200 mcg. Maximum: No more than 4 doses per day, separate by at least 2 hrs. PageGo
• Buccal Tablets: Initially, 100 mcg. Titrate dose, providing adequate analgesia with tolerable side effects.
• Sublingual: Initially, 100 mcg, then titrate to desired dose/effect. Wait at least 2 hrs between doses; no more than 4 doses in 24 hrs.
• Nasal:  Initially, 100 mcg. Titrate from 100 mcg to 200 mcg to 400 mcg to 800 mcg (maximum). Wait at least 2 hrs between doses; no more than 4 doses in 24 hrs.
• Transmucosal: 200–400 mcg for breakthrough pain. Limit to 4 units/day.
• Transdermal: Initially, 100 mcg, then titrate to desired dose/effect. Wait at least 2 hrs between doses; no more than 4 doses in 24 hrs.

Pain relief, preop medication; adjunct to general or regional anesthesia.

• Transdermal: Severe respiratory disease/depression, paralytic ileus; short term therapy; intermittent pain.
• Transdermal, transmucosal, lozenges, buccal films: Management of acute or postoperative pain.
• Cautions: Bradycardia; renal, hepatic, respiratory disease; head injuries; altered LOC; biliary tract disease; acute pancreatitis; cor pulmonale; significant COPD; increased ICP; use of MAOIs within 14 days; transdermal not recommended in those younger than 12 yrs or younger than 18 yrs and weighing less than 50 kg.

Overdose or too-rapid IV administration may produce severe respiratory depression, skeletal/thoracic muscle rigidity (may lead to apnea, laryngospasm, bronchospasm, cold/clammy skin, cyanosis, coma). Tolerance to analgesic effect may occur with repeated use. Antidote: Naloxone

Frequent: IV: Postop drowsiness, nausea, vomiting. Transdermal (10%–3%): Headache, pruritus, nausea, vomiting, diaphoresis, dyspnea, confusion, dizziness, drowsiness, diarrhea, constipation, decreased appetite. Occasional: IV: Postop confusion, blurred vision, chills, orthostatic hypotension, constipation, difficulty urinating. Transdermal (3%–1%): Chest pain, arrhythmias, erythema, pruritus, syncope, agitation, skin irritations.

DRUG: Benzodiazepines may increase risk of hypotension, respiratory depression. Buprenorphine may decrease effects of fentanyl. Alcohol, CNS depressant medications may increase CNS depression. Erythromycin, itraconazole, ketoconazole, protease inhibitors (e.g., ritonavir) may increase effects of transmucosal fentanyl. MAOIs may potentiate effects

• Resuscitative equipment, opiate antagonist (naloxone 0.5 mcg/kg) must be available for initial input use. Establish baseline B/P, respirations. Assess type, location, intensity, duration of pain.
• Resuscitative equipment, opiate antagonist (naloxone 0.5 mcg/kg) must be available for initial input use. Establish baseline B/P, respirations. Assess type, location, intensity, duration of pain.
• Avoid alcohol; Avoid tasks that require alertness, motor skills

• Hydroxymethylglutaryl CoA (HMG-CoA) reductase inhibitor.
• Antihyperlipidemic

Inhibits HMG-CoA reductase, the enzyme that catalyzes the early step in cholesterol synthesis. Therapeutic Effect: Decreases LDL and VLDL, plasma triglyceride levels; increases HDL concentration.

• Onset: N/A
• Peak: N/A
• Duration: N/A
• Half Life: 14 hrs

Primarily eliminated in biliary system

Initially, 10–20 mg/day (40 mg in pts requiring greater than 45% reduction in LDL-C). Range: 10–80 mg/day.

• For prevention of cardiovascular disease
• Adult: 10 mg/day
• Child: Initially, 10 mg/day. Maximum: 20 mg/day.Side effects

Hyperlipidemias; Primary prevention of cardiovascular disease; Heterozygous hypercholesterolemia

Active hepatic disease, lactation, pregnancy, unexplained elevated hepatic function test results; Anticoagulant therapy; history of hepatic disease; substantial alcohol consumption; major surgery; severe acute infection; trauma; hypotension; severe metabolic, endocrine, electrolyte disorders; uncontrolled seizures

• May increase concentration/toxicity of digoxin, diltiazem, verapamil. Increased risk of rhabdomyolysis, acute renal failure with cyclosporine, erythromycin, gemfibrozil, nicotinic acid;
• FOOD: Grapefruit juice in large quantities (greater than 1 quart/day) may increase serum concentrations

Potential for cataracts, photosensitivity, myalgia, rhabdomyolysis

Common: Atorvastatin is generally well tolerated. Side effects are usually mild and transient. Frequent (16%): Headache. Occasional (5%–2%): Myalgia, rash, pruritus, allergy. Rare (less than 2%–1%): Flatulence, dyspepsia, depression.

• Question for possibility of pregnancy before initiating therapy (Pregnancy Category X). Assess baseline lab results: cholesterol, triglycerides, hepatic function tests. Obtain dietary history.
• Monitor for headache. Assess for rash, pruritus, malaise. Monitor cholesterol, triglyceride lab values for therapeutic response. Monitor hepatic function tests, CPK.
• Pt. Teaching: • Follow special diet (important part of treatment). • Periodic lab tests are essential part of therapy. • Do not take other medications without consulting physician. • Report dark urine, muscle fatigue, bone pain. • Avoid excessive alcohol intake, large quantities of grapefruit juice

• Hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitor.
• Anti-hyperlipidemic

• Inhibits hydroxymethylglutaryl-CoA (HMG-CoA) reductase, the enzyme that catalyzes the early step in cholesterol synthesis. 
• Decreases LDL cholesterol, VLDL, plasma triglyceride. Slightly increases HDL.

• Onset: N/A
• Peak: N/A
• Duration: N/A
• Half Life: 3 hrs; Extended release 9 hrs

• Adults: Initially, 20 mg/day (capsule) in the evening. May increase up to 40 mg/day. Maximum: 80 mg/day. Maintenance: 20–40 mg/day in a single dose or divided doses
• Children: Initially, 20 mg/day. May increase q6wks to maximum dose of 80 mg/day, given in 2 divided doses or a single daily dose

Hyperlipoproteinemia; Heterozygous familial hypercholesterolemia

• Active hepatic disease, lactation, pregnancy, unexplained increased serum transaminase.
• Hepatic impairment; concurrent use with colchicine, gemfibrozil, fibric acid derivatives, or niacin; heavy alcohol consumption.

• DRUG: Increased risk of acute renal failure, rhabdomyolysis with cyclosporine, erythromycin, gemfibrozil, immunosuppressants, niacin. May increase concentration/toxicity of digoxin;
• FOOD: None known. LAB VALUES: May increase serum creatine kinase (CK), transaminase.

Myositis (inflammation of voluntary muscle) with or without increased creatine kinase (CK), muscle weakness occur rarely. May progress to frank rhabdomyolysis, renal impairment, renal failure.

Frequent (8%–5%): Headache, dyspepsia, back pain, myalgia, arthralgia, diarrhea, abdominal cramping, rhinitis. Occasional (4%–2%): Nausea, vomiting, insomnia, constipation, flatulence, rash, pruritus, fatigue, cough, dizziness.

• Question for possibility of pregnancy before initiating therapy (Pregnancy Category X). Assess baseline lab results (serum cholesterol, triglycerides, hepatic function test, CPK).
• Monitor daily pattern of bowel activity, stool consistency. Assess for headache, dizziness. Assess for rash, pruritus. Monitor serum cholesterol, triglyceride lab results for therapeutic response. Be alert for malaise, muscle cramping, weakness.
• Patient/family teaching: • Follow special diet (important part of treatment). • Periodic lab tests are essential part of therapy. • Report promptly vision changes, unusual bruising, yellowing of skin or eyes, any muscle pain/weakness, esp. if accompanied by fever, malaise.

• HMG-CoA reductase inhibitor. 
• Anti-hyperlipidemic

• Inhibits HMG-CoA reductase, the enzyme that catalyzes the early step in cholesterol synthesis.
• Decreases LDL, VLDL, triglycerides; increases HDL.

• Onset: 3 days
• Peak: N/A
• Duration: N/A
• Half Life: 1.1-1.7 hrs

• Adult: Initially, 20–60 mg once daily at bedtime. Maximum: 60 mg once daily at bedtime.
• Children: Initially, 10 mg/day. May increase to 20 mg/day after 8 wks and 40 mg/day after 16 wks if needed.

Atherosclerosis; coronary artery disease; Hypercholesterolemia; Heterozygous familial hypercholesterolemia

Active hepatic disease, pregnancy, unexplained elevated hepatic function tests. Pregnancy, breast-feedingHistory of heavy/chronic alcohol use; renal impairment; previous history of liver disease; concomitant use of amiodarone, cyclosporine, fibrates, gemfibrozil, niacin, verapamil.

• DRUG: Cyclosporine, fibrates, gemfibrozil, niacin may increase risk of rhabdomyolysis, acute renal failure;
• FOOD: Large amounts of grapefruit juice may increase risk of side effects (e.g., myalgia, weakness). Red yeast rice may increase concentration

Potential for cataract development. Occasionally produces myopathy manifested as muscle pain, tenderness, weakness with elevated creatine kinase (CK). Severe myopathy may lead to rhabdomyolysis

Generally well tolerated. Side effects usually mild and transient. Frequent (9%–5%): Headache, flatulence, diarrhea, abdominal pain, abdominal cramping, rash, pruritus. Occasional (4%–3%): Nausea, vomiting, constipation, dyspepsia. Rare (2%–1%): Dizziness, heartburn, myalgia, blurred vision, eye irritation.

• Obtain dietary history. Question for possibility of pregnancy before initiating therapy (Pregnancy Category X). Assess baseline lab results: serum cholesterol, triglycerides, hepatic function tests.
• Monitor daily pattern of bowel activity, stool consistency. Monitor for headache, dizziness, blurred vision. Assess for rash, pruritus. Monitor serum cholesterol, triglycerides for therapeutic response. Be alert for malaise, muscle cramping/weakness. Monitor hepatic function tests.
• Patient Teaching: • Follow special diet (important part of treatment). • Periodic lab tests are essential part of therapy. • Avoid grapefruit juice, alcohol. • Inform physician of severe gastric upset, vision changes, myalgia, weakness, changes in color of urine/stool, yellowing of eyes/skin, unusual bruising.

• HMG-CoA reductase inhibitor
• Antihyperlipidemic.

• Interferes with cholesterol biosynthesis by inhibiting conversion of HMG-CoA reductase to a precursor to cholesterol.
• Lowers total cholesterol, LDL cholesterol, apolipoprotein B (Apo B), plasma triglycerides; increases HDL cholesterol.

• Onset: N/A
• Peak: N/A
• Duration: N/A
• Half Life: 12 hrs

ADULTS: Initially, 2 mg/day

• ◂ ALERT ▸ Before initiating therapy, pt should be on standard cholesterol-lowering diet for minimum of 3–6 mos. Continue diet throughout pitavastatin therapy
• Hypercholesterolemia

• Active hepatic disease or unexplained, persistent elevations of hepatic function tests; concurrent cyclosporine use, pregnancy, breast-feeding
• History of hepatic disease, substantial alcohol consumption, moderate renal impairment. Withholding/discontinuing pitavastatin may be necessary when pt at risk for renal failure. Pts at risk for myopathy: advanced age, renal impairment, inadequately treated hypothyroidism

Hypersensitivity (rash, pruritus, urticaria) occurs rarely

Generally well tolerated. Side effects usually mild and transient. Rare (less than 4%): Myalgia, constipation/diarrhea, back/extremity pain, arthralgia, headache, nasopharyngitis.

DRUG: Increased risk of rhabdomyolysis, acute renal failure with cyclosporine, erythromycin, gemfibrozil, niacin, other immunosuppressants. Cyclosporine, erythromycin, lopinavir/ritonavir, rifampin significantly increase serum pitavastatin levels

• Question for possibility of pregnancy before initiating therapy (Pregnancy Category X). Assess baseline lab results: cholesterol, triglycerides, hepatic function tests
• Monitor cholesterol and triglyceride lab results for therapeutic response. Monitor hepatic function tests. Monitor daily pattern of bowel activity, stool consistency. Check for myalgia, arthralgia, headache. Assess for rash, pruritus. Be alert for malaise, muscle cramping/weakness.
• Patient Teaching: Follow special diet (important part of treatment). • Periodic lab tests are essential part of therapy. • Report promptly any muscle pain/weakness. • Use nonhormonal contraception