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herb underlined ndash top prescribed drug

aspirinHIGHALERT

(acetylsalicylicacid ASA)

as-pir-in(Asaphen EC Ascriptin BayerBufferin Ecotrin Entrophen Halfprin Novasen ZORprin)Do not confuse aspirin or As-criptin with Afrin Aricept or

Asendin Ecotrin with Epogen

or ZORprin with ZyloprimFIXED-COMBINATION(S)

Aggrenox aspirindipyridamole(an antiplatelet agent) 25 mg200mg Fiorinal aspirinbutalbitalcaf-feine (a barbiturate) 325 mg50mg40 mg LortabASA aspirinhy-drocodone (an analgesic) 325 mg5mg Percodan aspirinoxycodone(an analgesic) 325 mg225 mg325 mg45 mg Pravigard aspirin pravastatin (a cholesterol-loweringagent) 81 mg20 mg 81 mg40 mg81 mg80 mg 325 mg20 mg 325

mg40 mg 325 mg80 mg

983157 CLASSIFICATION

PHARMACOTHERAPEUTIC Nonste-roidal salicylate CLINICAL Anti-inflammatory antipyretic anticoagu-lant (see pp 32C 127C)

ACTION

Inhibits prostaglandin synthesis acts on thehypothalamus heat-regulating center inter-feres with production of thromboxane A asubstance that stimulates platelet aggrega-

tion Therapeutic Effect Reduces inflam-matory response intensity of pain de-creases fever inhibits platelet aggregation

PHARMACOKINETICS

Route Onset Peak Duration

PO 1 hr 2ndash4 hrs 4ndash6 hrs

Rapidly and completely absorbed fromGI tract enteric-coated absorption de-layed rectal absorption delayed and in-complete Protein binding High Widelydistributed Rapidly hydrolyzed to salicy-late Half-life 15ndash20 min (aspirin)

2ndash3 hrs (salicylate at low dose) morethan 20 hrs (salicylate at high dose)

USES

Treatment of mild to moderate pain feverReduces inflammation related to rheuma-toid arthritis (RA) juvenile arthritis os-

teoarthritis rheumatic fever As plateletaggregation inhibitor in the prevention oftransient ischemic attacks (TIAs) cere-bral thromboembolism MI or reinfarc-tion Adjunctive treatment of Kawasakirsquosdisease OFF-LABEL Prevention of pre-eclampsia alternative therapy for prevent-ing thromboembolism associated withatrial fibrillation where warfarin cannot beused pericarditis associated with MIprosthetic valve thromboprophylaxis

PRECAUTIONS

Contraindications Hypersensitivity to sa-licylates NSAIDs asthma rhinitis nasal

polyps inherited or acquired bleedingdisorders use in children for viral infec-tions pregnancy Cautions Platelet bleeding disorders severe renalhepaticimpairment dehydration erosive gastri-tis peptic ulcer disease sensitivity totartrazine dyes

LIFESPAN CONSIDERATIONS

PregnancyLactation Readily crossesplacenta distributed in breast milk Mayprolong gestation and labor decreasefetal birth weight increase incidence ofstillbirths neonatal mortality hemor-

rhage Avoid use during last trimester(may adversely affect fetal cardiovascu-lar system premature closure of ductusarteriosus) Pregnancy Category C (D iffull dose used in third trimester of

pregnancy) Children Caution in those with acute febrile illness (Reyersquos syn-drome) Elderly May be more suscep-

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Canadian trade name Non-Crushable Drug High Alert drug

tible to toxicity lower dosages recom-mended

INTERACTIONS

DRUG Alcohol NSAIDs may increaserisk of GI effects (eg ulceration) Ant-

acids urinary alkalinizers increaseexcretion Anticoagulants heparin

thrombolytics increase risk of bleed-ing Platelet aggregation inhibitors

valproic acid may increase risk ofbleeding May increase toxicity of meth-otrexate zidovudine Ototoxic med-

ications vancomycin may increaseototoxicity May decrease effect of pro-benecid sulfinpyrazone HERBAL

Avoid catrsquos claw dong quai evening primrose feverfew garlic gingerginkgo ginseng green tea horsechestnut red clover (possess anti-platelet activity) FOOD None knownLAB VALUES May alter serum AST ALTalkaline phosphatase uric acid prolongsprothrombin time (PT) bleeding timeMay decrease serum cholesterol potas-sium T3 T4

AVAILABILITY (OTC)

Caplets (Bayer) 81 mg 325 mg 500 mgSuppositories 300 mg 600 mg Tablets 162 mg (Halfprin) 325 mg (Bayer) 500mg (Bayer) Tablets (Chewable [Bayer St

Joseph]) 81 mg

Tablets (Enteric-Coated [Bayer Eco-

trin St Joseph]) 81 mg 325 mg 500

mg 650 mg

ADMINISTRATIONHANDLING

PO

bull Do not crush or break enteric-coatedtablets bull May give with water milk

meals if GI distress occurs

Rectal

bull Refrigerate suppositories do notfreeze bull If suppository is too soft chillfor 30 min in refrigerator or run cold

water over foil wrapper bull Moisten sup-pository with cold water before inserting

well into rectum

INDICATIONSROUTESDOSAGE

Analgesia Fever

PO RECTAL ADULTS ELDERLY 325ndash650mg q4ndash6h CHILDREN 10ndash15 mgkgdoseq4ndash6h Maximum 4 gday

Anti-InflammatoryPO ADULTS ELDERLY Initially 24ndash36 gday in divided doses then 36ndash54gday CHILDREN Initially 60ndash90 mgkg day in divided doses then 80ndash100 mg kgday

Platelet Aggregation InhibitorPO ADULTS ELDERLY 80ndash325 mgday

Kawasakirsquos Disease

PO CHILDREN 80ndash100 mgkgday in di- vided doses q6h After fever resolves3ndash5 mgkg once a day

SIDE EFFECTSOccasional GI distress (including ab-dominal distention cramping heart-burn mild nausea) allergic reaction(including bronchospasm pruritus urti-caria)

ADVERSE EFFECTS TOXIC REACTIONS

High doses of aspirin may produce GIbleeding andor gastric mucosal lesionsDehydrated febrile children may ex-perience aspirin toxicity quickly Reyersquossyndrome may occur in children with

chickenpox or flu Low-grade toxicitycharacterized by tinnitus generalizedpruritus (may be severe) headache diz-ziness flushing tachycardia hyperventi-lation diaphoresis thirst Marked toxic-ity characterized by hyperthermiarestlessness seizures abnormal breath-

ing patterns respiratory failure coma

NURSING CONSIDERATIONS

BASELINE ASSESSMENT

Do not give to children or teenagers whohave flu or chickenpox (increases risk ofReyersquos syndrome) Do not use if vinegar-like odor is noted (indicates chemical

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breakdown) Assess type location dura-tion of pain inflammation Inspect ap-pearance of affected joints for immobilitydeformities skin condition Therapeuticserum level for antiarthritic effect 20ndash30 mgdl (toxicity occurs if level is

greater than 30 mgdl)INTERVENTIONEVALUATION

Monitor urinary pH (sudden acidification

pH from 65 to 55 may result in toxicity) Assess skin for evidence of ecchymosis Ifgiven as antipyretic assess temperaturedirectly before and 1 hr after giving medi-

cation Evaluate for therapeutic responserelief of pain stiffness swelling increasedjoint mobility reduced joint tendernessimproved grip strength

PATIENTFAMILY TEACHING

bull Do not crush or chew enteric-coated

tablets bull Avoid alcohol bull Report tinnitusor persistent abdominal GI pain bleedingbull Therapeutic anti-inflammatory effectnoted in 1ndash3 wks bull Behavioral changes

vomiting may be early signs of Reyersquos syn-drome Contact physician

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Canadian trade name Non-Crushable Drug High Alert drug

tible to toxicity lower dosages recom-mended

INTERACTIONS

DRUG Alcohol NSAIDs may increaserisk of GI effects (eg ulceration) Ant-

acids urinary alkalinizers increaseexcretion Anticoagulants heparin

thrombolytics increase risk of bleed-ing Platelet aggregation inhibitors

valproic acid may increase risk ofbleeding May increase toxicity of meth-otrexate zidovudine Ototoxic med-

ications vancomycin may increaseototoxicity May decrease effect of pro-benecid sulfinpyrazone HERBAL

Avoid catrsquos claw dong quai evening primrose feverfew garlic gingerginkgo ginseng green tea horsechestnut red clover (possess anti-platelet activity) FOOD None knownLAB VALUES May alter serum AST ALTalkaline phosphatase uric acid prolongsprothrombin time (PT) bleeding timeMay decrease serum cholesterol potas-sium T3 T4

AVAILABILITY (OTC)

Caplets (Bayer) 81 mg 325 mg 500 mgSuppositories 300 mg 600 mg Tablets 162 mg (Halfprin) 325 mg (Bayer) 500mg (Bayer) Tablets (Chewable [Bayer St

Joseph]) 81 mg

Tablets (Enteric-Coated [Bayer Eco-

trin St Joseph]) 81 mg 325 mg 500

mg 650 mg

ADMINISTRATIONHANDLING

PO

bull Do not crush or break enteric-coatedtablets bull May give with water milk

meals if GI distress occurs

Rectal

bull Refrigerate suppositories do notfreeze bull If suppository is too soft chillfor 30 min in refrigerator or run cold

water over foil wrapper bull Moisten sup-pository with cold water before inserting

well into rectum

INDICATIONSROUTESDOSAGE

Analgesia Fever

PO RECTAL ADULTS ELDERLY 325ndash650mg q4ndash6h CHILDREN 10ndash15 mgkgdoseq4ndash6h Maximum 4 gday

Anti-InflammatoryPO ADULTS ELDERLY Initially 24ndash36 gday in divided doses then 36ndash54gday CHILDREN Initially 60ndash90 mgkg day in divided doses then 80ndash100 mg kgday

Platelet Aggregation InhibitorPO ADULTS ELDERLY 80ndash325 mgday

Kawasakirsquos Disease

PO CHILDREN 80ndash100 mgkgday in di- vided doses q6h After fever resolves3ndash5 mgkg once a day

SIDE EFFECTSOccasional GI distress (including ab-dominal distention cramping heart-burn mild nausea) allergic reaction(including bronchospasm pruritus urti-caria)

ADVERSE EFFECTS TOXIC REACTIONS

High doses of aspirin may produce GIbleeding andor gastric mucosal lesionsDehydrated febrile children may ex-perience aspirin toxicity quickly Reyersquossyndrome may occur in children with

chickenpox or flu Low-grade toxicitycharacterized by tinnitus generalizedpruritus (may be severe) headache diz-ziness flushing tachycardia hyperventi-lation diaphoresis thirst Marked toxic-ity characterized by hyperthermiarestlessness seizures abnormal breath-

ing patterns respiratory failure coma

NURSING CONSIDERATIONS

BASELINE ASSESSMENT

Do not give to children or teenagers whohave flu or chickenpox (increases risk ofReyersquos syndrome) Do not use if vinegar-like odor is noted (indicates chemical

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breakdown) Assess type location dura-tion of pain inflammation Inspect ap-pearance of affected joints for immobilitydeformities skin condition Therapeuticserum level for antiarthritic effect 20ndash30 mgdl (toxicity occurs if level is

greater than 30 mgdl)INTERVENTIONEVALUATION

Monitor urinary pH (sudden acidification

pH from 65 to 55 may result in toxicity) Assess skin for evidence of ecchymosis Ifgiven as antipyretic assess temperaturedirectly before and 1 hr after giving medi-

cation Evaluate for therapeutic responserelief of pain stiffness swelling increasedjoint mobility reduced joint tendernessimproved grip strength

PATIENTFAMILY TEACHING

bull Do not crush or chew enteric-coated

tablets bull Avoid alcohol bull Report tinnitusor persistent abdominal GI pain bleedingbull Therapeutic anti-inflammatory effectnoted in 1ndash3 wks bull Behavioral changes

vomiting may be early signs of Reyersquos syn-drome Contact physician

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breakdown) Assess type location dura-tion of pain inflammation Inspect ap-pearance of affected joints for immobilitydeformities skin condition Therapeuticserum level for antiarthritic effect 20ndash30 mgdl (toxicity occurs if level is

greater than 30 mgdl)INTERVENTIONEVALUATION

Monitor urinary pH (sudden acidification

pH from 65 to 55 may result in toxicity) Assess skin for evidence of ecchymosis Ifgiven as antipyretic assess temperaturedirectly before and 1 hr after giving medi-

cation Evaluate for therapeutic responserelief of pain stiffness swelling increasedjoint mobility reduced joint tendernessimproved grip strength

PATIENTFAMILY TEACHING

bull Do not crush or chew enteric-coated

tablets bull Avoid alcohol bull Report tinnitusor persistent abdominal GI pain bleedingbull Therapeutic anti-inflammatory effectnoted in 1ndash3 wks bull Behavioral changes

vomiting may be early signs of Reyersquos syn-drome Contact physician