Lecture Notes: Analgesic Medications

Antipyretics: Acetaminophen (Tylenol)

Uses:
- Mild to moderate pain relief
- Fever reduction
Mechanism of Action:
- Inhibits prostaglandin synthesis in the CNS
Side Effects:
- Hepatotoxicity at high doses
- Black box warning for hepatotoxicity
Dosage:
- Do not exceed 4 grams per day
- Caution with OTC cold products containing acetaminophen
Overdose:
- Antidote: Acetylcysteine

Common Medications:
- Ibuprofen
- Naproxen
- Katorlac
- Indomethacin
Uses:
- Mild to moderate pain
- Fever
- Inflammation (Indomethacin also used for PDA in premature babies)
Mechanism of Action:
- Inhibits prostaglandin synthesis
Side Effects:
- GI upset and bleeding
- Renal toxicity
- Rash
- Headache
Contraindications:
- Peptic ulcer disease
- Bleeding disorders
- Alcohol consumption increases GI bleed risk

Uses:
- Osteoarthritis
- Rheumatoid arthritis
Mechanism of Action:
- Inhibits COX-2 enzyme
- Decreases prostaglandin synthesis
Side Effects:
- Increased risk of thrombosis (MI or stroke)
- GI bleeding
- Rash
Contraindications:
- Allergy to aspirin, NSAIDs, or sulfonamides

Uses:
- Pain, inflammation, fever
- Kawasaki disease
- Prevention of myocardial infarction (MI)
Mechanism of Action:
- Inhibits prostaglandin synthesis
- Decreases platelet aggregation
Side Effects:
- Tinnitus
- GI upset and bleeding
- Rash
Contraindications:
- Peptic ulcer disease
- Bleeding disorders
- Children with fever (risk of Reye's syndrome)
Monitoring:
- Signs of salicylism: tinnitus, nausea, vomiting, respiratory alkalosis
Mnemonic for Side Effects (Aspirin):
- A: Abdominal pain/GI upset
- S: Salicylism
- P: Peptic ulcer disease
- I: Intestinal blood loss (GI bleed)
- R: Reye's syndrome
- I: Itchy rash
- N: Noise (tinnitus)