6 Anti-platelet Effects Binds to COX-1 enzyme preventing production of thromboxaneAspirin binds permanently++ Decrease risk of heart attack & stroke-- Discontinue before surgery-- Bruising effects in athletes in contact sports
7 Aspirin (and other Salicylates) acetylsalicylic acidIn US since 1899Cheaper than other NSAIDSOther usesPrevent heart attack & strokesDecrease risk of colon & G.I. cancerUsually orally administeredNot banned …. but some combination products may beNo performance enhancing effect
8 Types of Aspirin Buffered aspirin Antacids added to neutralize stomach acid & GI effectsDelayed release aspirinSpecial coating delays dissolving action until in the small intestineWhat is also delayed?Aspirin with caffeineActs faster – enhances effects
9 Other Salicylates Choline salicylate (Arthropan) - liquid form - less potent – need moreMagnesium salicylate (Doan’s)- contains magnesiumTopical salicylates- methyl salicylate (Icy Hot,Ben-Gay)- trolamine salicylate (Aspercreme)Bismus Subsalicylate (Pepto Bismal)Salsalate- Disalcid is available only by Rx.
10 Dosing Recommendations Normal dose24 hr maxHow long before effect?Food1st sign of ODChildren’s AspirinReyes syndrome10 days for pain / 3 days for fever
11 Dose Protocols Acetylsalicytic acid 650 mg. 4000 mg. Every 4 hrs. 24 hr. maxAcetylsalicytic acid mg mg.Choline salicylate mg mg.Magnesium salicylate mg mg.Children’s doses mg. Tablets / # determined by wt.** initial loading dose of 975 mg. allowable but only one time!** No more than 10 consecutive days!!
12 Aspirin Precautions More side effects than other NSAIDs Bruising Not used w/ clotting disorders, etcGI side effectsNephrotoxicityNot w/ GoutAllergic RxnODDecreases effect of antacid
13 Avoid Aspirin if…. Child/Adolescent Pregnant Low back pain Bleeding disordersHx of GI problemsLong distance runnersAsthmaKidney or liver problems
14 Avoid Aspirin in combo w/… AnticoagulantsCorticosteroidsOther NSAIDSAlcohol
15 Aspirin Guidelines for the ATC Short termAlcohol?Recognize allergy / OD signsAppropriate for …?Reyes SyndromeBefore exerciseRunner’s bleed
16 Pros / Cons of Aspirin Very effective for mild – moderate pain relief Decreases risk of heart diseaseHas anti-inflammatory and analgesic effectsCheap and accessibleGI effectsVery powerful anti-platelet effectsNephrotoxicityAllergic reactionsReyes syndrome
17 Nonsalicylate NSAIDS Definition Table 4.1 and NSAID Handout Differentiated by:Availability - OTC vs prescriptionDuration of actionPotency
18 Indications and UsesAnti-inflammatory, analgesic, antipyretic, and anti-platelet1st analgesic then anti-inflammatoryMild to moderate pain, inflammationAnti-platelet effect less pronounced
19 Indications (con’t)….. Act similar to salicylates in body Not necessarily better than aspirin - but less side effects (Gentler on stomach)Arthritis, menstrual cramps, etc
20 Administration Orally – pills vs liquid Ophthalmic Injection Topicals – not in USAnalgesic vs. anti-inflammatory regimeLimit to 3 days for fever, 10 for pain
21 Dosing Protocols for OCT’s ***Stronger than aspirin so lower doseIbuprofen (Advil)2 tablets (400 mg) every 4-6 hrsNaproxen Sodium (Aleve)1 tablet (220mg) every 8-12Ketoprofen (Orudis KT)1 tablet (12.5mg) every 4-6 hrs
22 Side Effects / Adverse Reactions Similar to aspirinNephrotoxicityAnaphylatic reactionOverdose symptomsTinnitis, headache, nausea, dizzinessToxicityBreathing, irregular HB, tarry stools, hematuria, jaundice
23 Contraindications Aspirin intolerance Pregnancy Don’t take if allergic to aspirinIn combination withCorticosteroids, anticoagulants, aspirin, alcohol
24 Considerations for ATCs Long term use?Not on banned substances listDoes not interfere with energy metabolismMay have negative long term effect on collagen formationRegular liver testing for….Care with distance runners / alcoholUse w/ PRICE
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