Tylenol, Aspirin, and NSAIDS.txt
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What are the 2 main action of Tylenol??
What is a problem associated with Tylenol??
Weak ant inflammatory effects
- analgesic= acute mild to mod pain and chronic pain in osteoarthritis and RA
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
How is APAP different from Aspirin?? (3)
- weak antinflammatory effect
- little GI effects
- no impact on platelet aggregation
Maximum daily dose of tylenol
3000 mg per day
4 GM/day if under care of provider
High doses of Tylenol cause??
Tylenol is a metabolite of
avoid tylenol in children younger than ____?
Due to __?
2 years old
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.
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
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
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.
pregnancy category APAP
- is excreted in breast milk
Infant drops are ____ times more concentrated than the elixir/solution
APAP may increase _____ prevalence in children
Do not use tylenol in children for more than 5 consecutive days.
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
unlabeled use of ASA
toxemia in pregnancy
decreases risk of colorectal cancer
- Mild to moderate pain; dental extractions, minor surgery, soft tissue injury
- primary dysmenorrhea
Unlabeled use of NSAIDS
tendinitis, bursitis, and migraine
GI bleed may occur with ASA and NSAID without ______?
Long term use of NSAIDs (and salicylates) may decrease what disease?
but not if taking for cardioprotective effects
NSAIDS may be associated with increased risk of?
- adverse cardiovascular events
salicylates and NSAIDs reduce inflammation by
inhibiting the production of prostaglandins, prostacyclin, and thromboxane in both CNS and peripheral tissue
Salicylates and NSAIDS reduce pain by
- anti-inflammatory process
- due to decrease in prostaglandin levels= reduction of inflammation
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
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
Platelet activation is stimulated by thromboxane which causes _____ and ______?
aggregation and the clotting cascade
ASA and antiplatelet MOA
- causes irreversible inactivation of COX
- decreasing thromboxane for the 8-10 days life of platelet
NSAIDS are under study for decreasing risk of what diseases
- may decrease parkinsons disease
- reduces risk of colon cancer
inverse link between NSAIDS and breast cancer
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
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.
Patient moderate to severe pain and/or inflammation what is DOC?
COX-2 selective NSAID
unless patient is at risk for HTN and renal disorder.
High doses of NSAIDs may want to consider adding ____ or _____?
PPI or misoprostol
Cardinal points of tx
first line tx
second line tx
Goal of tx are to ____, _____, and _____.
limit inflammatory disease process, protect the joint, and relieve pain
First line for moderate pain
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
All drugs have generic except _____?
this drug also has _______ properties?
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
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.
Indomethacin has high risk for adverse reactions such as
- aggravates epilepsy and parkinsonism
*short term use only
Patient variables with NSAIDS and ASA use
medical conditions- renal, hepatic, and cardiovascular diseases- many adverse effects related to NSAID use and these conditions!!!
non pharmalogic treatment of OA
walking can improve status
weight loss can reduce strain on joints
cornerstone of non-pharmolgical tx of mild to moderate pain
RICE for 24-48 hours
Muscle injuries, do not use NSAIDS for how long?
24 hours due to effect on platelets
Ibuprofen then usually given for 1-2 weeks
dysmenorrhea begin NSAIDS when
24-72 hours before menses
duration for 2-3 days
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
Tx for RA
NSAIDS and DMARDS
Rice 24-48 hours of exacerbaton
Leg muscle injury with bleeding use
ibuprofen for limited time of 1-2 weeks
Monitoring of all drugs for
gi distress, renal and hepatic fx.
subjective report of pain relief
Monitoring of Salicylates
vertigo, tinnitus, or impaired hearing
serum concentration can be measured
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.
pain relief in RA using NSAIDS may take how long
NSAIDs can cause what in elderly
confusion and renal clearance may be diminished
Be careful with diclofenac in elderly, watch for
- increasing HTN
- other signs of CHF
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
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
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
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)
ASA is contradicted with
asthma and hypersensitivity which can cause bronchospasm, generalized uticaria, and angioedema.
- children under 16
- pregnancy in 3rd trimester
Foods that contain salicylates
Foods that contain salicylates include- curry, paprika, licorice, prunes, raisins, tea, and gherkins.
Long acting aspirin is available and should not be used for _____ or ______?
fever or short term pain
ASA overdosage is what?
Black box warning of NSAIDS
for patients with CV disease, GI adverse events, bleeding, ulceration, and perforation
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
NSAIDs increase what drugs
- anticoagulants (especially celbrex)
NSAIDS decrease what drugs
- ACE inhibitors
- B blockers
- loop diuretics
ASA decreases what drugs
NSAIDS, ACEI, BB, loop diuretics, probenecid, sulfinpyrazone, spironolactone
ASA increases what drugs
- barbonic anhydrase inhibitors
- valproic acid
Fluconazole increases levels of
Salicylates decrease ______ but increase ______?
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