NSAIDS & Paracetamol PDF

Breakthrough Here is where your presentation begins Doaa Zaghloul Mohammad Shebl * Lecturer, Clinical Pharmacology Department, Faculty of Medicine, Menoufia University, Egypt.  Introduction Non-Steroidal Anti-inflammatory Drugs...

Breakthrough Here is where your presentation begins Doaa Zaghloul Mohammad Shebl * Lecturer, Clinical Pharmacology Department, Faculty of Medicine, Menoufia University, Egypt.  Introduction Non-Steroidal Anti-inflammatory Drugs (NSAIDs) - They are analgesic, antipyretic, and anti-inflammatory. - Acetylsalicylic acid (Aspirin) is the prototype of the group. Other NSAIDs: ibuprofen indomethacin  01 Aspirin Pharmacodynamic ✓ Mechanism of action. ✓ Pharmacological Non-selective COX- inhibitors Actions. ✓ Selective COX-2 Therapeutic inhibitors uses. ✓ Adverse effects. ✓ Contraindications.  Acetylsalicylic acid (Aspirin) Mechanism of action - NSAIDS are inhibitors of prostaglandin E synthesis and therefore they reduce pain (analgesic effect), fever (antipyretic effect) , and inflammation (anti-inflammatory).  Pharmacological Actions (are dose-dependent) - Antiplatelet aggregation. Small dose (75 to 150 mg) → post-Myocardial infarction (MI) prophylaxis. - Analgesic and antipyretic effects. Moderate dose. – Anti-inflammatory. High doses. – Uric acid elimination. o Low to moderate doses: → hyperuricemia. o High doses: → uricosuria.  Therapeutic uses ( indications) Systemic uses Local uses 1- Analgesic uses: used to treat common 5- Salicylic acid is used topically to conditions (for example, headache, arthralgia, treat acne, corns, calluses, and warts myalgia) (Keratolytic). 2- Antipyretic uses: used to treat fever. 3- Anti-inflammatory uses: used in the treatment of acute rheumatic fever and rheumatoid arthritis (RA). 4- Cardiovascular applications: Aspirin (Small dose) is used to inhibit platelet aggregation (Post- Myocardial infarction (MI) prophylaxis). Anti- Antithrombotic  Adverse effects & Contraindications Adverse effects Contraindications 1- Gastrointestinal irritation: gastritis, ulcers, bleeding. 1. Peptic ulcer. 2- Renal dysfunction & hepatotoxicity. (Chronic use) 2. Renal & hepatic diseases. 3- Hypersensitivity: especially asthma, rhinitis. 3. Allergy to aspirin. 4- Salicylism (Large dose / long duration): tinnitus, vertigo, ↓ hearing—often first signs of toxicity. 5 -Reye’s Syndrome: 4. Children during viral infections such as varicella (A syndrome that can cause sever fulminating hepatitis and (chickenpox) or influenza. cerebral edema in children often leading to death). Important nurse implication during aspirin treatment : Assess for history for gastric ulcer  Adverse effects & Contraindications Q) Explain Aspirin is contraindicated as an antipyretic in children with viral infection? For fear of Reye's syndrome (A syndrome that can cause fulminating hepatitis and cerebral edema in children often leading to death). N.B: Acetaminophen (Paracetamol) is recommended as a substitute for children with fever of unknown etiology.  04 Comparison - Acetaminophen (Paracetamol) Definition  Acetaminophen (paracetamol) Comparisons with ASA: Aspirin (ASA) Paracetamol (acetaminophen) USES Analgesic, antipyretic and anti-inflammatory. Analgesic, antipyretic No anti-inflammatory effects A/E Can induce gastric irritation, peptic ulceration. No gastric irritation or peptic ulceration GRUP Contraindicated in children to avoid Reye’s Syndrome. Not Contraindicated (Safe in children) No specific antidote if toxicity occur. N-acetylcysteine is antidote  Acetaminophen (paracetamol) Overdose and management: – Hepatotoxicity—Acetaminophen is metabolized mainly by liver to form inactive conjugate. A minor pathway (via P450) results in formation of a reactive metabolite (NABQI) which is inactivated by glutathione (GSH). – In overdose situations........the stores of GSH are depleted. Once this happens, the metabolite reacts with hepatocytes, causing nausea and vomiting, abdominal pain, and ultimately liver failure – Management of the hepatotoxicity: N-acetylcysteine (supplies –SH groups), is most effective when used within the first 12 hours following acetaminophen overdose. Beyond 12 hours, irreversible damage starts to occur, and the effectiveness of the antidote is limited. N.B. Glutathione itself cannot be used as it does not penetrate cell membranes.  Acetaminophen (paracetamol) Overdose (Hepatotoxicity) and management: Let us practice Let us practice Q1) Which of the following is the mechanism of action of acetyl salicylic acid (aspirin)? A. Inhibition of prostaglandin E synthesis B. Inhibition of folic acid metabolism C. Inhibition of alpha receptors D. Inhibition of peptidase enzyme E. Inhibition of beta receptors Let us practice Q2) Which of the followings is one of the aspirin actions? A. Antiemetic B. Antihyperglycemic C. Antithyroid D. Anti-inflammatory E. Antacids Let us practice Q3) Aspirin is used in treatment of which one of the following conditions? a) Salicylism. b) Headache. c) Peptic ulcer. d) Bronchial asthma. e) Bleeding. Let us practice Q4) Which of the following is the most important nurse implication during aspirin treatment? A. Proper handling of the patient B. Teach the patient to count the heart rate C. Avoid over the counter drugs D. Assess for history for gastric ulcer E. Take the drug on empty stomach Let us practice Q5) Which of the following is an analgesic drug without anti-inflammatory effects? a) Indomethacin b) Ibuprofen. c) Paracetamol. d) Aspirin. e) N-acetylcysteine. Let us practice Q6) Which of the following is the antidote that is used in treatment of paracetamol toxicity ? a) Aspirin. b) Indomethacin c) Adrenaline. d) N-acetylcysteine. e) Ibuprofen. Thanks