OTC - Pain & Fever

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  1. Pathophysiology of Pain
    • Nociceptors are peripheral pain receptors.
    • They send pain stimuli to the spinal cord through afferent, nociceptive nerves.
    • Impulses then pass to the brain through dorsal ganglia.
  2. Pathophysiology of Fever
    • The core temperature is the temperature of the blood surrounding the hypothalamus.
    • The thermoregulatory center in the anterior hypothalamus controls body temperature through physiologic and behaivor mechanisms.
  3. Fever-producing substances that increase the thermoregulatory set point, raising the body temperature
  4. Name the four (4) OTC analgesic & antipyretic products
    • acetaminophen (Tylenol)
    • aspirin (Bayer)
    • ibuprofen (Motrin, Advil)
    • naproxen sodium (Aleve)
  5. How does acetaminophen (Tylenol) exerts analgesic and antipyretic activity?
    inhibition of prostaglandin synthesis
  6. Does acetaminophen (Tylenol) has any peripheral anti-inflammatory effect?
  7. Major SE of acetaminophen
    liver toxicity (hepatotoxicity)
  8. Two major DI with acetaminophen
    • Alcohol - risk of hepatotoxicity increased
    • Warfarin - increase bleeding effect of warfarin
  9. MAX dose of acetaminophen (Tylenol)
    4 g/day
  10. Can acetaminophen be used during pregnancy & breast feeding?
  11. How do salicylates reduce pain, inflammatory, & fever activities?
    inhibit peripheral prostaglandin synthesis
  12. Acetylated salicylates vs. Non-acetylated salicylates
    Acetylated (eg., aspirin) - inhibit platelet aggregation

    Non-acetylated - do not have antiplatelet activity
  13. SE of salicylates
    • gastritis
    • gastric ulcers & bleeding
    • Reye's syndrome
  14. Potentially fatal SE of salicylates used in children
    Reye's syndrome - causes numerous detrimental effects to many organs, especially the brain and liver
  15. DI with salicylates
    • Alcohol - risk of GI toxicity increased
    • Warfarin - increase bleeding effect of warfarin
    • Methotrexate - displace methotrexate from protein-binding
  16. Precautions/CI to salicylates
    • bleeding disorders
    • hemophilia
    • peptic ulcer disease
    • children/teenagers with viral illness
    • gout
  17. MAX dose of aspirin (Bayer)
    4 g/day
  18. How do NSAIDs offer analgesic, antipyretic, and anti-inflammatory?
    peripheral inhibition of prostaglandin synthesis
  19. MAX dose of ibuprofen (Motrin, Advil) for OTC
    1.2 g/day
  20. MAX dose of naproxen (Aleve)
    660 mg/day
  21. SE of NSAIDs
    • GI effects, including bleeding
    • rash
    • photosensitivity
    • cross-reactivity with aspirin allergy
  22. DI with NSAIDs
    • Alcohol - increased risk of GI bleed
    • Warfarin - increased risk of bleeding
    • Methotrexate - decrease methotrexate clearance
    • ACEI - decreased hypotensive effects, hyperkalemia
    • Beta-blockers - decreased hypotensive effects
    • Potassium-sparing diuretics - hyperkalemia
    • Digoxin - decreased renal clearance, risk of digoxin toxicity
  23. Precautions/CI to NSAIDs
    • alcohol (increased risk of GI bleeding)
    • renal impairment
    • CHF
  24. NSAIDs in pregnacy & breast feeding
    Ibuprofen & naproxen are compatible with breast-feeding

    Avoid NSAIDs in 3rd trimester of pregnancy
  25. Which NSAIDs cannot be used in children <12 y/o?
    naproxen (Aleve)
  26. Which two (2) agents inhibit platelet aggregation?
    Aspirin (Bayer) & NSAIDs
  27. Which two (2) agents do not have antiplatelet activity?
    Non-acetylated salicylates & acetaminophen (Tylenol)
  28. Which two (2) agents can cause gastropathy, including gastritis, gastric ulcers, and gastric bleeding? They may decrease the effectiveness of some antihypertensives and may have deleterious effects on kidney function?
    Aspirin (Bayer) & NSAIDs
Card Set
OTC - Pain & Fever
OTC - Pain & Fever
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