Pain and Fever Fall 2012 (1)

Dosing pediatric ibuprofen weight based 75 mgkgdose

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Dosing Pediatric Ibuprofen: Weight based (7.5 mg/kg/dose) Every 6-8 hours, max: 4 doses/24 hrs Naproxen: Not recommended Adult: (12 years and older) Drug Dosing Max Dose (24 hours) Ibuprofen 200-400 mg every 4- 6 hours 1200 mg Naproxen 220 mg every 8-12 hours 660 mg
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NSAIDs Avoid in Patients with history of intolerance to aspirin or any other NSAID High incidence of cross-reactivity Unless patient has previous history of tolerating NSAID therapy Renal dysfunction (may worsen by decreasing renal blood flow) Heart failure (can cause/worsen edema) Uncontrolled HTN (can increase BP) Active ulcer disease
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NSAIDs Adverse effects Gastric irritation/ulceration/bleeding Dyspepsia, heartburn, nausea, anorexia Bleeding Fluid retention May  risk of cardiovascular and cerebrovascular events (e.g. myocardial infarction, stroke) Drug interactions  risk of bleeding with warfarin May  effects of antihypertensive agents
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NSAIDs Counseling points Maximum daily dose (numerical AND tablets) Take with food, milk, or antacids if GI upset occurs Take with a full glass of water Do NOT crush or chew sustained release products Avoid alcohol Increases risk of GI bleeding
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Salicylates MOA: Inhibits both forms of the enzyme, cyclooxygenase (COX-1 and COX-2) Results in inhibition of formation of prostaglandins, thromboxane A2, and prostacyclin Prostaglandins cause tissue inflammation  Pain Prostaglandins released in brain  Fever Properties Analgesic Antipyretic Anti-inflammatory
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Salicylates Acetylated salicylate – Aspirin (ASA) Irreversibly inhibits platelet aggregation Bayer’s Aspirin Aspirin 81-325 mg Non-acetylated salicylate – Magnesium salicylate Does NOT inhibit plate aggregation Doan’s Extra Strength
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Aspirin Used for: Mild-moderate pain Fever Prevention and treatment of various cardiovascular diseases (e.g. myocardial infarction, stroke) Used for its antiplatelet effects Low dose = 81-325 mg/day (depending on indication) Avoid in Children with concurrent viral illness (e.g. influenza or chicken pox)  risk of Reye’s syndrome 3rd trimester of pregnancy
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Aspirin Dosage forms: Tablets (immediate-release, enteric-coated, buffered, chewable, effervescent), caplets, suppositories, chewing gum Enteric-coated  Intended to  GI irritation ( bleeding) Delay in absorption and time to effect Should not be used if immediate pain relief needed Buffered  Absorbed more rapidly
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Salicylates Dosing: Pediatric – Aspirin: Weight based (mg/kg/dose) Drug Dosing Max Dose (24 hours) Aspirin 650 - 1000 mg every 4-6 hours 4000 mg Magnesium Salicylate 650 mg every 4 hours or 1000 mg every 6 hours 4000 mg
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Salicylates Dosing considerations 4000-6000 mg/day needed to produce anti-inflammatory effects (adults) Usually not used for this purpose unless under the guidance of health care provider  risk of bleeding Salicylate toxicity is possible Tinnitus, headache, dizziness, confusion, N/V
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Dosing Pediatric Ibuprofen Weight based 75 mgkgdose Every 6...

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