a.        

                                                               i.      all derived from salicylic acid; analgesic, antipyretic and anti-inflammatory; originally derived from Willow Bark (less potent/effective though less adv rxs)

                                                             ii.      Lower body temp by dilating peripheral vessels to release heat

                                                            iii.      Inhibits PROSTAGLANDIN productions – are fatty acids everywhere in body, their release increases sensitivity to pain – leading to analgesia and antiinflam.  Aspiring is the most potent progtaglandin inhibitor and anti-inflam of the salicyaltes.  Aspirin also has greatest effect on platelet aggregation (lowers clotting) and prolongs bleeding time.

1.      pt might notice extra bleeding and even extra bruising.

                                                               i.      Mild/moderate pain

                                                             ii.      Aspirin only – decreases risk of MI and TIA (men only)

                                                            iii.      Help maintain pregnancy by increasing blood flow to uterus (low dose aspirin)

                         i.      aspirin = acetylsalicylic acid – Bayer

                                                             ii.      diflunisal – Dolobid

                                                            iii.      magnesium salicylate – Bufferin

                                                           iv.      salsalate – Amigesic

                                                               i.      GI – upset, heartburn, nausea, vomiting, bleeding

                                                             ii.      Generally safe, occasionally loss of blood in GI is taken over long period, even at regular dose – could notice blood in stool

                                                            iii.      Allergic reactions – urticaria, rash, angioedema, bronchospasms, asthma like, anaphylaxic

                                                               i.      Those with hypersensitivities to these and NSAIDS

                                                             ii.      Bleeding disorders

                                                            iii.      On anticoags or antineoplastics

                                                           iv.      PREGNANCY CATEGORY D-Aspirin and C-rest (not good for pregnancy)

                                                             v.      Kids with flu or pox b/cassock with REYE’s SYNDROME – life threatening, vomiting, lethargy to coma

a.        

                                                               i.      Lactation

                                                             ii.      Hepatic/renal disease (may use smaller dose e.g.)

                                                            iii.      Hypo-prothrombin-emia

                                                           iv.      Vit k deficiency

                                                             v.      GI irritation like ulcer

                                                           vi.      Mild diabetes WHY?????

                                                          vii.      Gout

                                                        viii.      SALICYLISM – too much leading to toxic effects; includes tinnitus, diff hearing, dizziness, nausea, vomiting, diarrhea, confusion,CNS depression, headache, sweating, hyperventilation, thirst and flushing.  Moste sever respiratory alkilosis, hemorrhage, asterixis (invol jerking), pulmonary edema, convuslsions, tetany, fever, coma, chock, renal and respiratory failure

a.       if these drugs are needed, maybe take spaced out

                                                               i.      Food with salicylates like curry, paprika and tea may increase adv rxs

                                                             ii.      Anticoags – increase bleeding

                                                            iii.      NSAIDS – increases NSAID blood level

                                                           iv.      Activated Charcoal – descreasesd salicylate absorb

                                                             v.      Antacids – decreases effectiveness salicylate

                                                           vi.      Carbonic anhydrase inhibitors – increases salicylism

I.                    NONSALICYLATES = Acetaminophen = paracetamol = acetyl-para-aminophenol APAP

a.        

                                                               i.      UNKNOWN! 

                                                             ii.      An antipyretic but NO ANTI-INFLAM!

• Mild/moderate pain
•  To decrease a fever
•  Arthritic disorders
• Those on anticoag, bleeding disorders, ulcer, GI problems, etc can’t take aspirin
• After surgery b/c no bleeding risk
• for kids with fever/flulike/pox
• for those with bleeding disorders

                                                               i.      rare when UAD (used as directed)

                                                             ii.      May lower blood glucose (know this for diabetics, gives false low reading)

                                                            iii.      if used chronically or too much can cause

1.      hives

2.      PANCYTOPENIA – all cellular components of blood are reduced

3.      hypoglycemia

4.      HEPATOXICITYAND FAILURE (with JAUNDICE too)

                                                           iv.      Acute poisoning at 10-15 g; can be fatal at 20-25 g from liver failure

1.      people do commit suicide with APAP

2.      There is a drug to block OD on APAP

3.      APAP poisoning is a bigger problem – people assume safety and is everywhere

4.      Daily APAP max is 4g.  A regular dose is 325-1000mg

5.      Be careful of drugs containing APAP like vicodin or percocet

                                                             ii.      Hepatoxicity with alcohol habitual

                                                            iii.      Avoid taking with salicylates and NSAIDS

                                                           iv.      Pregnancy Category B

                                                               i.      Barbituates – increased toxicity of APAP and decresases action of APAP

                                                             ii.      Hydantoins – same as above

                                                            iii.      Isoniazid and rifampin – same as above

                                                           iv.      Loop diuretics – decreased effectiveness of the diuretic

a.       Preadmin – pain scale rating, location, type, onset, intensity; examine joints if needed for joint pain and document limited mobility; evaluate ability to ADLs; assess alcohol usage and malnourishment could lead to greater chance of hepatotoxicity; also assess patient’s behavior

                                                               i.      Subjective data can be lacking in an assessment b/c of barriers like trust, language; may be hiding information, esp. in pain assessment (abuse cases, pt wants to be discharged, etc)

• monitor for relief 
• reassess pain rating 30-60 min after
• document severity, location, etc.  
• Monitor vitals every 4 hours or more freq if needed  
• If high temp, dehydration can occur. 
• Assess for decreased joint inflame and greater mobility. 
• Note adv rxs like prolonged bleeding, dark stools and report toPCP.

SALICYLATES

• Give with food/milk to prevent upset
• watch for GI distress, s/s ulceration, bleeding
• check stools for blood
• Avoid 1 wk before surgery/dental procedure until healed. 
• Assess for tinnitus/impaired hearing lidicating high blood salicylate levels; withhold drug and report
• Children with pox or flu DO NOT GIVE SALICYLATES, give APAP

APAP

• no regard to food
• monitor for adv rxs of nausea vomiting disphoresis and general malaise; abdom pain, confusion, liver tenderness, hypotension, arrythmias, jaundice
• toxicity treatment
• no more than 3g per day