Nervous System Medications: Analgesics

Antipyretics

Uses: Mild to moderate pain, fever.
Mechanism: Inhibits prostaglandin synthesis in the CNS.
Side Effects:
- Major concern: Hepatotoxicity with large doses.
- Black-box warning due to hepatotoxicity risk.
- Limit to 4 grams per day.
- Over-the-counter products may contain acetaminophen.
Antidote for Overdose: Acetylcysteine.

Examples: Ibuprofen, Naproxen, Ketorolac, Indomethacin.
Uses: Mild to moderate pain, fever, inflammation. Indomethacin can close PDA in premature infants.
Mechanism: Inhibits prostaglandin synthesis.
Side Effects:
- GI upset, GI bleeding.
- Renal toxicity, rash, headache.
Contraindications: Peptic ulcer disease, bleeding disorders.
Important Advice: Avoid alcohol to reduce GI bleeding risk.

Example: Celecoxib (Celebrex).
Uses: Osteoarthritis, rheumatoid arthritis.
Mechanism: Inhibits COX-2 enzyme, reducing prostaglandin synthesis.
Side Effects: Increased risk of thrombosis (leading to MI or stroke), GI bleeding, rash.
Contraindications: Allergies to aspirin, NSAIDs, or sulfonamides.

Uses: Pain, inflammation, fever, Kawasaki disease; prevents myocardial infarction (MI).
Mechanism: Inhibits prostaglandin synthesis, decreases platelet aggregation.
Side Effects:
- Tinnitus, GI upset, GI bleeding, rash.
- Risk for Reye's syndrome in children.
Contraindications: Peptic ulcer disease, bleeding disorders, children with fever.
Signs of Salicylism: Tinnitus, nausea and 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)

Next video will cover more analgesics. Thank you for watching!