Pain, Fever, Inflamation

aspirin

MOA:

• block prostaglandins → stop thromboxane A2

use:

• mild-mod pain

• cardiac risk reduction

• osteoarthritis

• fever

AE:

• GI bleed

• toxicity → salicylism

contraindication

• reyes syndrome

teaching

• no anticoagulants

• take with food

• avoid around surgery

thromboxane A2

decreased platelet

salicylism

tinnitus

reyes syndrome

< 18 yo

acetaminophen

non narcotic analgesic/antipyretic

4g max

MOA:

• act on hypothalamus

use:

• fever, mild pain

AE:

• hepatotoxicity → jaundice

antidote:

• acetylcysteine

NSAIDs

heart, stomach, kidney

nonselective

• 1st gen

• block COX-1 / 2

selective

• 2nd gen

• block COX-2

COX-1

protect

COX-2

inflammation

pain

ibuprofen

NSAID, propionic acid derivative

MOA:

• block COX-1 / 2

use:

• mild-mod pain

• fever, inflammation

• gout attack

AE:

• GI bleed

• respiratory

• BBW→ CV

• nephrotoxicity

contraindication

• hypersensitivity

ketorolac

NSAID

IV

5 days use

MOA:

• block COX-1 / 2

BBW:

• high risk bleed

• GI

naproxen

NSAID

MOA:

• block COX-1 / 2

use:

• migraine

nurse

• 2x daily → long-acting

• no for < 12 yo

meloxicam

NSAID

MOA:

• block COX-1 / 2

use:

• arthritis

AE:

• CV

• GI bleed → BBW

contraindication

• aspirin allergy

• hx GI bleed

idomethacin

acetic, NSAID

MOA:

• block COX-1 / 2

use:

• arthritis

• gout

• IV → close patent ductus arteriosus in premies

AE:

• BBW → CV

• GI bleed

• renal impairment

contraindication

• salicylate hypersensitivity

• hx GI bleed

celecoxib

selective COX-2 inhibit, NSAID

MOA:

• block COX-2

use:

• colorectal polyp reduction

• arthritis

BBW:

• cardiac

assess:

• chest pain, SOB

• confuse

• numbness

gout

increased uric acid → urate crystals in joint

common in big toe

colchicine

mitotic, gout

MOA:

• stop WBC from moving into areas containing urate crystal

use:

• acute treatment

• preventative

AE:

• GI

• hepatotoxicity

teach:

• no grapefruit juice or alcohol

• decrease B12

allopurinol

gout, uricosuric

MOA:

• inhibit xanthine oxidase to decrease uric acid

use:

• gout

• cancer

AE:

• kidney stones

teach:

• hydration

• take after meal