Self Care & Non-Rx

APAP (Acetaminophen) - Adult Dose

• 325 mg-1,000 mg IR q 4-6 hr.

• 650 mg -1,300 mg ER q 8 hr.

APAP (Acetaminophen) - Adult Max Dose

• 4,000 mg/day per FDA

APAP (Acetaminophen) - Adult “Lower” Max Dose

• 3,000 mg -3,250 mg (product label)

APAP (Acetaminophen) - Ok for children?

Any aged infant/child can use (even though box says “ask Dr. when children are <2 yo)

APAP (Acetaminophen) - Pediatric Dose

• 10-15 mg/kg q. 4-6 hr.

APAP (Acetaminophen) - Pediatric Max Dose

• Max = 5 doses in 24 hr.

APAP (Acetaminophen) -Pediatric Liquid Dose

• 160mg/5mL

APAP (Acetaminophen) - MOA

• Inhibits Prostaglandin synthesis (PGE2- for fever)- in CNS!

APAP (Acetaminophen) - How long it will take to work?

• Onset 30 min. -1 hr.

• Reduction in fever by 1-2 degrees.

• Max temp. reduction @ 2 hr.

APAP (Acetaminophen) - Dose Caution!

• Start off by using lower dose.

• Max to use = 2,000 g/day.

• Pts with following should NOT take:

  -Chronic liver disease

  -Alcoholism (3+ drinks/day consistently)

  -Concurrent use of other hepatotoxic drugs

  -Poor nutritional intake

APAP (Acetaminophen) - Pros

• Safe for most people.

• Can be taken by pregnant & breastfeeding women (safe during all trimesters).

• Can be used by children of any age.

Ibuprofen (Advil, Motrin) - Adult Doses

• 200 mg = OTC

• 200 mg - 400 mg q 6-8 hr

Ibuprofen (Advil, Motrin) - Adult Max Doses

• Max OTC dose = 1,200 mg/day

Ibuprofen (Advil, Motrin) - Adult Lower and Higher Doses do what?

• Lower = reduce pain & fever.

• Higher = reduce inflammation & high fever.

Ibuprofen (Advil, Motrin) - Pediatric Doses

• 5-10 mg/kg q 6-8 hr.

Ibuprofen (Advil, Motrin) - Pediatric Max Doses

• 4 doses q 24 hr.

Ibuprofen (Advil, Motrin) - Liquid Dose amt. (2 types)

• 100 mg/5mL

• 50 mg/1.25 mL

Ibuprofen (Advil, Motrin) - MOA

• Inhibits COX-1 & COX-2 in CNS;

• In the PNS it reduces Prostaglandin E2 synthesis (to reduce fever)

Ibuprofen (Advil, Motrin) - How long it takes to work?

• Onset 30 min. -1 hr.

• Reduction in fever by 1-2 degrees.

• Max temp. reduction @ 2 hr.

Ibuprofen (Advil, Motrin) - Counsel

• Take cc/milk

• Might worsen heart fail/fluid retention

• Incr. risk of MI (heart attack) & stroke

• Might cause stomach ulcer bleeding.

Ibuprofen (Advil, Motrin) - CON

• Do not take if ASA allergy.

• Do not take if using drugs that cause incr. bleeding (warfarin, lithium, etc.)

• Pregnant women should cautiously take after 20 weeks & completely avoid after 30 weeks.

• Avoid if breastfeeding.

• GI warning w/3+ drinks/day.

• Incr. risk of ALL s/e in elderly pts, including GI bleed (age 60)

Ibuprofen (Advil, Motrin) - CAUTION (Adults)

• Pts with CV disease or high risk of cardiac events (hyperlipidemia, Hypertension, diabetes). Risk may incr. w/ duration of use.

• Pts with renal impairment/heart fail/ edema

Ibuprofen (Advil, Motrin) - CON (Pediatrics)

• Do NOT use in infants <6 months old (risk of kidney/GI adverse effects).

• So, use only in children 6 months and older. Not less than 6 months.

Naproxen (Aleve) - Doses (Adults & Children)

• Pts > 12 yo can take.

• Initial: 440 mg —> then 220 mg q 8-12 hr.

• Max Dose = 660mg/day

Naproxen (Aleve) - Consult

• Lower CV risk than ibuprofen.

• Only take if 12 years and older.

Naproxen (Aleve) - CON

• Don’t take if breast feeding

ASA - Aspirin (Ecotrin, Bayer) - Doses

• 81 mg (low dose) = CV protection

• 325 mg - 1,000 mg (pain, fever, inflammation)

ASA - Aspirin (Ecotrin, Bayer) - Max Dose

4,000 mg/day

ASA - Aspirin (Ecotrin, Bayer) - Children WARNING!

Cerebral Damage in children less than 12-15 yo (Reye’s Syndrome)

ASA - Aspirin (Ecotrin, Bayer) - MOA

• Inhibits COX-1 and COX-2 (CNS)

• Reduces prostaglandin (PGE2) synthesis for reducing fever (PNS)

ASA - Aspirin (Ecotrin, Bayer) - PRO

Only good for CV protection!

ASA - Aspirin (Ecotrin, Bayer) - S/E

• irriversible antiplatelet effect = causes BLEEDING!

ASA - Aspirin (Ecotrin, Bayer) - CONS

• Contraindicated (CI) in pregnant women (all trimesters) & breast feeding.

• Drug interactions (warfarin, lithium, methotrexate) = cause bleed

• Chronic S/E occur even with low dose (like NSAIDs, minus CV risk)

• GI warning w/3+drinks/day

ASA - Aspirin (Ecotrin, Bayer) - CAUTION!

• 10% asthmatics have aspirin sensitivity

• If pt is allergic to ASA, avoid all NSAIDs