ANS Final SG - Non Prescription Analgesics...

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Non Prescription Analgesics - Acetaminophen (Not a NSAID) o Chronic overdose > 4 grams for several weeks o Acute overdose ≥ 10grams o Acute or chronic overdose with APAP Hepatic Necrosis Hepatotoxicity rare with dose < 10 grams Acute liver failure: Using with alcohol, Death rare with doses <15 grams using > 1 APAP containing product and 3 alcoholic drinks a day exceeding maximum recommended dose Nephrotoxity (pretty rare) Renal tubular necrosis Renal failure Death (15 grams in one time period) o Children Max Daily Dose 75mg/kg 106-375 mg/kg/day o Adverse Effects Rare ↓ GI irritation, erosion and bleeding compared to NSAID Dermatologic rxns rarely occur o No clinical significant drug interxns GOOD! - Salicylate NSAIDs o Asprin (acetylsalicylic acid) Acetylated Salicylate o Choline Salicylates o Magnesium Salicylates Non Acetylated Salicylates (Poor inhibitors of cyclooxygenase) o Sodium Salicylates - Proprionic Acids (Non Salicylates NSAIDs) o Ibuprofem o Ketoprofen o Naproxen/Naproxen Sodium - Buffered salicylates: Combo of 2 of the following: o Calcium carbonate Magnesium carbonate o Magnesium hydroxide Aluminum hydroxide o Magnesium oxide o Examples: Bufferin, bayer buffered aspirin, Alka-Seltzer with asprin, arthritis pain formula, ascription **Avoid Alka-Seltzer in CHF ptn bc of Sodium Bicaronate content** Na causes H2O and fluid retention exacerbate problem - Adverse effects of NSAIDs o Cardiovascular No definitive evidence that ton aspirin NSAIDS have cardioprotective effect Naproxen 50% increase in CV event Supervised if taking > 10days o CNS
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Proprionic acids H/A Dizziness Drowsiness Excitation (ketoprofen only) ↑Ibuprofen & Naproxen cognitive dysfxn Nervousness o Gastrointestinal GI bleeding and peptic ulcers (best agent) Ibuprofen < Aspirin < Naproxen Ketoprofen (worse agent) o Due to inhibition of PGI2 AND PGE2 in GI o Prostaglandin ↓ acid secretion NSAIDs inhibit this, so ↑ mucus and bicarb production you get the opposite effect: Modulate mucosal blood flow ↑acid, ↓mucus&bicarb **APAP or non-acetylated salicylates (choline, sodium, mg salicylates are preferred agents)** o Renal toxicity (Ibuprofen, Ketoprofen and Naproxen) ↓ Renal PG normally VD renal vessels to help maintain kidney perfusion and fxn NSAIDs cause renal PG to VC which causes retention of Na and fluid
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