Salicylates and Aspirin Overview

Salicylates

• Common uses include pain relief, reducing fever, and anti-inflammatory effects.
• Aspirin is a type of salicylate.
• Inhibit prostaglandin synthesis, reducing the hypothalamic response to pyrogens, thereby lowering body temperature.
• Prostaglandins promote inflammation, pain, and fever. Salicylates reduce pain by inhibiting prostaglandin synthesis.
• Salicylates reduce inflammation and associated pain by blocking prostaglandin synthesis.
• Aspirin inhibits platelet aggregation, irreversibly blocking the enzyme COX-1 in platelets, reducing clot formation (effect lasts 7-10 days).
• Six uses of aspirin therapy include pain relief, fever reduction, anti-inflammation, heart attack prevention, stroke prevention, and treatment of rheumatoid arthritis.
• Common side effects of aspirin include nausea, stomach pain, and gastrointestinal bleeding.
• Signs of allergic reactions to salicylates may include rash, hives, breathing difficulties or anaphylaxis.
• Contraindications for aspirin therapy include peptic ulcer disease, bleeding disorders, children with viral infections (risk of Reye's syndrome), and third-trimester pregnancy.
• Salicylism is a condition caused by aspirin toxicity and presents with symptoms including tinnitus, dizziness, nausea, and vomiting.
• Foods containing salicylates (berries, tomatoes, almonds) may increase risk of salicylism if consumed excessively.
• Taking aspirin with an anticoagulant increases the risk of bleeding.
• Taking aspirin with NSAIDs increases the risk of GI bleeding and ulceration.

Nonsalicylates - Acetaminophen (Tylenol)

• Primary nonsalicylate analgesic.
• It is safer for patients with bleeding disorders than aspirin.
• Less likely to cause allergic reactions than aspirin.
• Relieves pain and reduces fever.
• Ineffective for inflammatory conditions because it has minimal anti-inflammatory effects.
• Safer choice than aspirin in patients with bleeding tendencies.
• Use for pain relief, fever reduction, and used in combination with other drugs.
• Overdosing can cause severe liver damage, especially in those with pre-existing liver conditions or who consume alcohol excessively.
• Avoid excessive doses, especially in diabetic patients.
• Early signs of toxicity include nausea, vomiting, and right upper quadrant pain.
• Treatment for toxicity includes N-acetylcysteine (NAC).

NSAIDs (Ibuprofen and Indomethacin)

• NSAIDs are anti-inflammatory, analgesic, and antipyretic.
• Inhibit cyclooxygenase enzymes (COX-1 and COX-2), reducing prostaglandin production.
• COX-1 maintains stomach lining; COX-2 is involved in inflammation and pain.
• Common adverse reactions include GI bleeding, ulcers, and kidney issues.
• Celecoxib is more selective for COX-2 than ibuprofen and may cause fewer GI side effects.
• Four uses include treating arthritis, musculoskeletal pain, fever, and menstrual cramps.

Opioid Analgesics

• Examples include codeine, morphine, fentanyl, oxycodone, hydromorphone, methadone, and Demerol.
• Act on opioid receptors in the brain, spinal cord, and other parts of the body reducing pain perception.
• Indications include acute and chronic pain relief, cough suppression, and diarrhea management.
• Adverse effects include CNS depression, nausea, vomiting, urinary retention, constipation, pupil constriction (miosis), and potential addiction.
• Tolerance and dependence can occur, requiring higher doses for same effect.
• Withdrawal symptoms can occur with abrupt discontinuation of use.

Non-opioid Analgesics

• NSAIDs (Nonsteroidal Anti-inflammatory Drugs) are examples of non-opioid analgesics.
• Inhibits COX enzymes which are involved in inflammation and pain.
• Common types include Ibuprofen, naproxen, diclofenac, meloxicam, and aspirin.
• Uses include pain relief, anti-inflammation, and antipyretic effects.
• Adverse effects include gastrointestinal issues such as nausea, ulcers and bleeding.
• Other adverse effects include central nervous system issues like dizziness and headaches.

Nursing considerations

• Educate patients on importance of adherence to dosing schedules and danger of mixing medications.
• Teach patients about potential side effects and signs of toxicity.
• Be prepared to administer reversal agents for opioid overdoses and provide supportive care.
• Ensure patients understand which medications to avoid, such as NSAIDs in kidney disease, and salicylates in children with viral infections.

Pediatric Pain Management

• Use age-appropriate pain scales (e.g., FLACC for infants).
• Use appropriate analgesics based on age.
• Non-pharmacological interventions like distraction, imagery, relaxation can be helpful.

Core Pharmacokinetic Processes

• Absorption: Drug entry into bloodstream, influenced by route and solubility.
• Distribution: Transport of drugs to target tissues, influenced by blood flow, membrane permeability, and protein binding.
• Metabolism: Primarily in the liver, transforming drugs into active or inactive metabolites.
• Excretion: Primarily through the kidneys, removal of drugs from the body.

Pharmacodynamics

• Agonists activate receptors to produce physiological responses.
• Antagonists block receptors, inhibiting actions.
• Synergistic effects occur when combined drugs increase each other's effects.
• Toxicity results from excessive drug accumulation, leading to harmful side effects.

Medication Administration Routes and Techniques

• Oral administration is convenient but may be affected by digestive factors (e.g., acidity).
• Useful for drugs with low first-pass metabolism.
• Other routes include topical, transdermal, intramuscular, subcutaneous, and intravenous. These routes vary in speed of onset and duration of effect.

Key Considerations for Medication Dosage Calculations

• Half-life is critical in determining the timing and frequency of doses for maintaining therapeutic levels without toxicity.
• Metric conversions are often required.

High-risk Medications and Patient Safety Practices

• Rights of medication administration (right patient, drug, dose, time, route, documentation, and right to refuse) are essential for safe practices.
• High-alert medications (e.g., anticoagulants, insulin) require double-checking.
• Documentation of medication administration is mandatory and part of continuity of care.

Drug Effects and Misuse

• Adverse and side effects are unintended drug responses that vary in severity.
• Nurses must monitor patients for these effects and manage them appropriately.
• Drug tolerance means a greater dose is required for the same effect.
• Drug dependence means withdrawal is caused by discontinuing. (often related to opioids).

This quiz covers the uses, effects, and mechanisms of salicylates, focusing on aspirin. Learn about how they relieve pain, reduce fever, and their anti-inflammatory properties. Additionally, explore the side effects and contraindications associated with aspirin therapy.