TBL 1: Headache, Fever, and Musculoskeletal Pain OTC meds

acetaminophen dosage forms

-tablets (immediate-release, extended-release, chewable, effervescent)

-capsules

-liquid

-suppositories

-powder

acetaminophen

Tylenol

acetaminophen + diphenhydramine

Tylenol PM

acetaminophen + aspirin + caffeine

Excedrin Migraine

acetaminophen + caffeine

Excedrin Tension Headache

acetaminophen + aspirin + diphenydramine

Excedrin PM

325 mg

acetaminophen regular strength per dose

500 mg

acetaminophen extra strength per dose

650 mg

acetaminophen arthritis strength per dose

160 mg/5 mL

children's acetaminophen suspension strength per dose

10-15 mg/kg/dose every 4-6 hours

acetaminophen weight-based dosing for children under 12

480 mg

maximum strength per dose of acetaminophen for children under 12

2400 mg

maximum amount of acetaminophen per day for children under 12

325-1000 mg every 4-6 hours

adult dosing for immediate-release formulations of acetaminophen

3000-3250 mg/day

maximum dose per day for adult immediate-release formulations of acetaminophen

650-1300 mg every 8 hours

adult dosing for extended-release formulations of acetaminophen

3000 mg/day

maximum dose per day for adult extended-release acetaminophen formulations

hepatotoxicity, SCARs

adverse effects of acetaminophen

warfarin, alcohol

drug-drug interactions for acetaminophen

warfarin

may cause INR elevations if taken with acetaminophen (increased risk of bleeding)

alcohol

may cause hepatotoxicity if taken with acetaminophen

acetaminophen

________________ contraindications include hypersensitivity, severe hepatic impairment, and severe active liver disease

acetaminophen

use _________________ with caution with:

-liver disease

-concurrent use of hepatotoxic agents

-malnutrition

-dehydration

-3 or more alcoholic beverages per day

-G6PD deficiency

4000

acetaminophen black box warning: severe liver damage may occur if adult takes more than ____________ mg in 24 hours

5

acetaminophen black box warning: severe liver damage may occur if a child takes more than ______ doses in 24 hours

acetaminophen black box warning

Severe liver damage may occur if:

-an adult takes more than 4000 mg of acetaminophen in 24 hours

-a child takes more than 5 doses in 24 hours, which is the maximum daily amount

-the product is taken with other drugs containing acetaminophen

-an adult consumes 3 or more alcoholic drinks every day while using this product

0.5-24 hours

stage 1 onset for acetaminophen toxicity

24-48 hours

stage 2 onset for acetaminophen toxicity

3-4 days

stage 3 onset for acetaminophen toxicity

4 days

stage 4 onset for acetaminophen toxicity

1

stage ____ acetaminophen toxicity: may be asymptomatic or have nausea, vomiting, drowsiness, confusion, and abdominal pain

2

stage ____ acetaminophen toxicity: elevated liver enzymes (AST, ALT, Bilirubin), jaundice, prolonged PT time, obtundation

3

stage ____ acetaminophen toxicity: metabolic acidosis, encephalopathy, cerebral edema, renal failure

4

stage ____ acetaminophen toxicity: hepatic damage - reversible over weeks-months

NSAID dosage forms

-tablets (immediate-release, delayed-release, chewable)

-capsules

-liquid

-topical

ibuprofen

Advil

ibuprofen

Motrin IB

naproxen sodium

Aleve

diclofenac sodium

Voltaren Gel

200 mg

Advil strength

100 mg/5 mL

Children's Motrin Suspension strength

200 mg

Motrin IB strength

220 mg

Aleve strength

1%

Voltaren Gel strength

5-10 mg/kg/dose every 6-8 hours

weight-based ibuprofen dosing for children under 12

300 mg

maximum dose of ibuprofen for children under 12

1200 mg/day

maximum daily dose of ibuprofen for children under 12

200-400 mg every 4-6 hours

typical adult dosing for ibuprofen

1200 mg/day

maximum daily dose of ibuprofen per day for adults

220 mg every 8-12 hours

typical adult dosing for naproxen

440 mg

max strength of the first dose of naproxen

660 mg/day

maximum adult daily dose of naproxen

4 grams 4 times daily

adult (16+) dosing of diclofenac for lower extremities

16 g/day

maximum amount of diclofenac that can be applied to lower extremities in one day

2 grams 4 times daily

adult (16+) dosing of diclofenac for upper extremities

8 g/day

maximum amount of diclofenac that can be applied to upper extremities in one day

NSAIDs adverse effects

-dyspepsia

-nausea

-anorexia

-edema

-tinnitus

-NSAID related toxicity

Digoxin, antihypertensives, methotrexate

medications that have drug-drug interactions with NSAIDS that cause accumulation of the drugs

bisphosphonates

drugs that have drug-drug interactions with NSAIDs causing GI or esophageal ulceration

anticoagulants and antiplatelets

drugs that have drug-drug interactions with NSAIDs causing bleeding

NSAIDs

____________ contraindications include:

-hypersensitivity

-coronary artery bypass graft (CABG)

-impaired renal function

-congestive heart failure

NSAIDs

use _____________ with caution for the following conditions:

-cardiovascular disease

-high-risk for cardiac events

-high-risk of GI complications

-hyperkalemia

-impaired renal function

-elderly

-3 or more alcoholic beverages per day

gastrointestinal, cardiovascular

NSAIDs FDA black box warnings include risk of serious ___________________ and ___________________ events

salicylate dosage forms

-tablets (immediate release, buffered, enteric coated, effervescent, chewable)

-capsules

-suppositories

aspirin

Bayer Low-Dose

aspirin

Ecotrin Enteric-Coated

magnesium salicylate

Doan's Extra Strength

81 mg

Bayer Low-Dose strength per dose

81 mg

St. Joseph Adult Aspirin strength per dose

325 mg

Bayer Aspirin strength per dose

325 mg

Ecotrin Enteric-Coated strength per dose

325-1000 mg every 4-6 hours

aspirin dose for individuals 6+

1160 mg every 6 hours

magnesium salicylate dose for individuals 6+

4000 mg/day

maximum dose of aspirin per day

4640 mg/day

maximum dose of magnesium salicylate per day

salicylates

have drug-drug interactions with the following:

-digoxin

-bisphosphonates

-anticoagulants and anti-platelets

-antihypertensives

-methotrexate

-sulfonylureas

-PPIs

salicylates

have the following adverse effects:

-dyspepsia

-upper GI bleeding

-edema

-tinnitus

-salicylate related toxicity

-NSAID related toxicity

salicylates

contraindications include:

-hypersensitivity

-use in children/teens recovering from varicella or influenza (Reye Syndrome)

-serious aspirin-respiratory intolerance (bronchospasms, laryngospasms, rhinorrhea)

salicylates

use ___________________ with caution with:

-peptic ulcer disease

-bleeding disorders

-high-risk of GI complications

-significant dehydration

-impaired renal function

-gout/hyperuricemia

-upcoming surgery

gastrointestinal bleeding

risk factors for _____________________________:

-history of stomach bleeding or ulceration

- >60 years old

-concomitant causative agent use

-H. pylori infection

-3 or more alcoholic beverages

-extended duration of use

gastrointestinal bleed

causative agents of ________________________:

-concurrent ASA + NSAID use

-anticoagulants

-antiplatelets

-bisphosphonates

-SSRIs

-systemic corticosteroids

GI bleed

signs and symptoms of ____________________:

-feeling faint

-bloody or "coffee ground" vomit

-bloody or black tarry stools

-stomach pain that doesn't dissipate

acetaminophen

only OTC pain medication that is safe during pregnancy at regular dosing

the rest should be avoided

aspirin

absolutely contraindicated in the 3rd trimester

30

avoid use of diclofenac during pregnancy specifically beginning at _______ weeks

ibuprofen and naproxen

contraindicated for use during the 3rd trimester of pregnancy

counterirritants

classification of topicals including methyl salicylate, camphor, menthol, methyl nicotinate, capsaicin

analgesics and anesthetics

classification of topicals including trolamine salicylate and lidocaine

rubefacients

group A counterirritants:

-allyl isothiocyanate

-ammonia water

-methyl salicylate

-turpentine oil

cooling sensation

Group B counterirritants:

-camphor

-menthol

vasodilators

Group C counterirritants:

-histamine dihydrochloride

-methyl nicotinate

irritants lacking rubefacients

Group D counterirritants:

-capsicum

-capsicum oleoresin

-capsaicin

methyl salicylate, camphor, menthol

directions for use: apply a minimum of 3-4 times daily as needed for a maximum of 7 days

10-60%

concentrations available for methyl salicylate

3-11%

concentrations available for camphor

1.25-16.0%

concentrations available for menthol

capsicum/capsaicin

concentrations available for 0.025-0.25%

trolamine salicylate

topical analgesic that aids in topical pain relief in those who dislike the localized irritation and scent associated with the counterirritants

lidocain

topical anaesthetic that aids in the treatment of neuropathic pain through inhibition of nerve impulse conduction

10-15%

concentrations available for trolamine salicylate