Tylenol, Aspirin, and NSAIDS.txt

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Corissa.Stovall
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244024
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Tylenol, Aspirin, and NSAIDS.txt
Updated:
2013-10-30 20:46:05
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Pharm Final
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Week 11
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  1. What are the 2 main action of Tylenol??
    What is a problem associated with Tylenol??
    • antipyretic
    • analgesic= acute mild to mod pain and chronic pain in osteoarthritis and RA

    Weak ant inflammatory effects

  2. Unlabeled use of Tylenol (3)
    decrease fever and pain in children receiving DPT vaccination

    Used in patients with gastric irritation from ASA and NSAIDS

    DOC for minor pain in children and elderly and adults
  3. How is APAP different from Aspirin?? (3)
    • weak antinflammatory effect
    • little GI effects
    • no impact on platelet aggregation
  4. Maximum daily dose of tylenol
    3000 mg per day

    4 GM/day if under care of provider
  5. High doses of Tylenol cause??
    hepatotoxicity
  6. Tylenol is a metabolite of
    phenacetin
  7. avoid tylenol in children younger than ____?
    Due to __?
    2 years old

    improper dosing
  8. MOA of Tylenol as antipyretic
    reduces fever by direct action on hypothalamic heat-regulating centers. Inhibits pyrogenic cytokines from acting on heat regulating centers.

    Dissipates body heat by vasodilation and sweating.
  9. MOA of Tylenol as analgesic
    • centrally acting analgesic.
    • works by inhibiting prostaglandin synthetase in CNS.

    APAP does not inhibit peripheral prostaglandin synthesis. This is reason is weak anti-inflammatory and does not inhibit platelet aggregations
  10. How often is Tylenol dosed?
    every 4-6 hours depending on strength.

    Do not exceed maximum daily dose

    When used in combo important for provider to monitor daily intake of APAP to avoid overdosage, must warn parents that many OTC preparations have APAP in them
  11. Considerations for elderly and APAP
    hepatic insufficiency and at risk for toxicity

    use lower doses and increased dosing intervals

    watch with care with those taking hepatic toxic drugs, ETOH consumption, and cirrhosis.
  12. pregnancy category APAP
    • B
    • is excreted in breast milk
  13. Infant drops are ____ times more concentrated than the elixir/solution
    3
  14. APAP may increase _____ prevalence in children
    asthma

    Do not use tylenol in children for more than 5 consecutive days.
  15. Indications of ASA
    short or long term symptomatic tx mild to mod pain, inflammation, fever, RA, OA, gout

    Reduces risk of TIAs or stroke in pts with TIAs caused by fibrin platelet emboli

    Reduces risk of MI, acute ischemic strokes and TIAs

    Reduces risk of death or nonfatal MI with previous infarction or unstable angina

    May reduce risk of barretts disease
  16. unlabeled use of ASA
    prevent cataracts

    toxemia in pregnancy

    decreases risk of colorectal cancer

    antiplatelet aggregation
  17. NSAIDS indications
    • OA
    • RA
    • Mild to moderate pain; dental extractions, minor surgery, soft tissue injury
    • primary dysmenorrhea
  18. Unlabeled use of NSAIDS
    tendinitis, bursitis, and migraine
  19. GI bleed may occur with ASA and NSAID without ______?
    prodromal symtoms
  20. Long term use of NSAIDs (and salicylates) may decrease what disease?
    Alzheimer's

    but not if taking for cardioprotective effects
  21. NSAIDS may be associated with increased risk of?
    • MI
    • stroke
    • adverse cardiovascular events
  22. salicylates and NSAIDs reduce inflammation by
    inhibiting the production of prostaglandins, prostacyclin, and thromboxane in both CNS and peripheral tissue
  23. Salicylates and NSAIDS reduce pain by
    • anti-inflammatory process
    • due to decrease in prostaglandin levels= reduction of inflammation
  24. ASA and antipyretic effects
    blocks interleukin-1 on the hypothalamus which is responsible for temp control.

    causes vasodilation of superficial blood vessel, which dissipates heat
  25. NSAIDs antiplatelet MOA
    block COX-1 and the production of thromboxane

    have reversible inactivation of COX, only good for duration of drug activity. - this is why ASA is used for prevention of MI and stroke
  26. Platelet activation is stimulated by thromboxane which causes _____ and ______?
    aggregation and the clotting cascade
  27. ASA and antiplatelet MOA
    • causes irreversible inactivation of COX
    • decreasing thromboxane for the 8-10 days life of platelet
  28. NSAIDS are under study for decreasing risk of what diseases
    • alzheimers
    • may decrease parkinsons disease
    • reduces risk of colon cancer

    inverse link between NSAIDS and breast cancer
  29. ADRS of ASA  and NSAIDS (2)
    Inhibition of prostaglandins causes more gastric acid production and increased risk of gastric mucosal damage

    damaged kidneys rely on prostaglandins for vasodilation, inhibition decreases blood flow to kidneys
  30. Long term use of NSAIDs and Celecoxib (COX-2 inhibitor) can cause
    renal papillary necrosis, renal insufficiency, acute renal failure, and other renal injuires.

    Pts with impaired renal fx, HF, liver dysfunction; elderly, taking diuretics, ACEIs, and ARBs are at greater risk for this reaction, D/C med and function usually returns to normal.
  31. Patient moderate to severe pain and/or inflammation what is DOC?

    Unless what?
    COX-2 selective NSAID

    unless patient is at risk for HTN and renal disorder.
  32. High doses of NSAIDs may want to consider adding ____ or _____?
    PPI or misoprostol
  33. Cardinal points of tx
    first line tx
    second line tx

    Goal of tx are to ____, _____, and _____.
    • acetaminophen
    • NSAIDs

    limit inflammatory disease process, protect the joint, and relieve pain
  34. First line for moderate pain
    NSAIDS
  35. Women of child bearing age should not be given _______?
    misoprostol unless appropriate contraception is used.  It can cause baby to be aborted.

    Get a beta HCG before using
  36. All drugs have generic except _____?
    this drug also has _______ properties?
    celecoxib

    sulfonamide properties- do not use in patients with sulfa allergy

    This drug has low Gi adverse effects

    This drug should be used cautiously in patients with heart disease
  37. DOC OA
    mild OA- tylenol

    • If tylenol not effective start on NSAID
    • NSAIDs are more effective for OA of knee or hip

    COXZ -2 in elderly for long term tx because of decreased GI effects.
  38. Indomethacin has high risk for adverse reactions such as
    • headache
    • CNS
    • hyperkalemia
    • aggravates epilepsy and parkinsonism

    *short term use only
  39. Patient variables with NSAIDS and ASA use
    medical conditions- renal, hepatic, and cardiovascular diseases- many adverse effects related to NSAID use and these conditions!!!

    Asthma

    Age

    Compliance
  40. non pharmalogic treatment of OA
    walking can improve status

    weight loss can reduce strain on joints
  41. RICE
    • rest
    • ice
    • compression
    • elevation
  42. cornerstone of non-pharmolgical tx of mild to moderate pain
    RICE for 24-48 hours
  43. Muscle injuries, do not use NSAIDS for how long?
    24 hours due to effect on platelets

    Ibuprofen then usually given for 1-2 weeks
  44. dysmenorrhea begin NSAIDS when
    24-72 hours before menses

    duration for 2-3 days
  45. What is used to reduce MI and stroke
    • aspirin 325 every other day
    • or aspirin 81 mg daily

    Do not use with NSAIDS decreases cardioprotective effects of Aspirin
  46. Tx for RA
    NSAIDS and DMARDS

    Rice 24-48 hours of exacerbaton
  47. Leg muscle injury with bleeding use
    ibuprofen for limited time of 1-2 weeks
  48. Monitoring of all drugs for
    gi distress, renal and hepatic fx.

    subjective report of pain relief
  49. Monitoring of Salicylates
    vertigo, tinnitus, or impaired hearing

    serum concentration can be measured
  50. Monitoring of NSAIDS
    short term- acute minor pain relief within an hour

    Long term- baseline CBC with diff, creatinine, UA, K. and LFTs. Baseline and 3 months the every 3-6 months

    follow up with pt weekly for pain relief or early side effects

    pain relief in RA may take up to 2 weeks

    gi bleeding can occur at any time.  monitor cbc, pt, ua, and stool for occult blood.
  51. pain relief in RA using NSAIDS may take how long
    2 weeks
  52. NSAIDs can cause what in elderly
    confusion and renal clearance may be diminished
  53. Be careful with diclofenac in elderly, watch for
    • increasing HTN
    • edema
    • other signs of CHF
  54. Pregnancy and lactation with NSAIDS and Salicylates
    Not recommended, stop prior to delivery r/t increased risk of bleeding.

    • Category C- ibuprofen, naproxen, celecoxib
    • Category D- ASA esp in 3rd trimester
    • Category D- NSAIDS
    • ASA and NSAIDS are excreted in breast milk
  55. Patient education and salicylates and NSAID
    all can cause serious gi bleed, report symptoms and stop drug

    • take med with food or milk
    • may take antacids
    • no ETOH
    • take around the clock for best serum concentration
    • Do not take more than one drug at a time from these classes
  56. Patient education and aspirin
    discard med if have vinegar like odor

    -stop taking 5-10 days before surgery (talk with dr first)

    - can cause asthma exacerbation
  57. Patient education and NSAIDS
    notify provider of SOB, wheezing, dizziness, GI distress, pruritis, or skin rash.

    -stop taking 3 days before surgery (discuss with provider first)
  58. ASA is contradicted with
    asthma and hypersensitivity which can cause bronchospasm, generalized uticaria, and angioedema.

    • children under 16
    • pregnancy in 3rd trimester
  59. Foods that contain salicylates
    Foods that contain salicylates include- curry, paprika, licorice, prunes, raisins, tea, and gherkins.
  60. Long acting aspirin is available and should not be used for _____ or ______?
    fever or short term pain
  61. ASA overdosage is what?
    life threatning
  62. Black box warning of NSAIDS
    for patients with CV disease, GI adverse events, bleeding, ulceration, and perforation
  63. NSAIDS can have ophthalmic effects of
    ophthalmic effects of blurred or diminished vison, scotomata, changes in color vision, corneal deposits, and retinal disturbances.

    Photosensitivity may occur
  64. NSAIDs increase what drugs
    • aminoglycosides
    • anticoagulants (especially celbrex)
    • cyclosporines
    • hydantoin
    • lithium
    • methotrexate
    • ASA
  65. NSAIDS decrease what drugs
    • ACE inhibitors
    • B blockers
    • loop diuretics
    • lithium
  66. ASA decreases what drugs
    NSAIDS, ACEI, BB, loop diuretics, probenecid, sulfinpyrazone, spironolactone
  67. ASA increases what drugs
    • anticoagulants
    • heparin
    • barbonic anhydrase inhibitors
    • NTG
    • valproic acid
    • methotrexate
    • insulin
  68. Fluconazole increases levels of
    celecoxib
  69. Salicylates decrease ______ but increase ______?
    • NSAIDS
    • tramadol

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