1st generation NSAIDS (aspirin: ibuprofen; aleve)
Classification: antipyretics, nonopioid analgesics, salicylates
Therapeutic uses: Inflammatory disorders including: Rheumatoid arthritis, Osteoarthritis. Mild to moderate pain. Fever. Aspirin: Prophylaxis of transient ischemic attacks and MI.
Action: Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins. Inhibits COX-1 and COX-2
Adverse effects:tinnitus. GI BLEEDING, dyspepsia, epigastric distress, nausea, abdominal pain, anorexia, hepatotoxicity, vomiting. EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS. Anemia, hemolysis, increased bleeding time.ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS AND LARYNGEAL EDEMA.
Drug interactions: Aspirin may ↑ the risk of bleeding with warfarin, heparin, heparin-like agents, thrombolytic agents, ticlopidine, clopidogrel, abciximab, tirofiban, or eptifibatide, although these agents are frequently used safely in combination and in sequence.
Ibuprofen may negate the cardioprotective antiplatelet effects of low-dose aspirin.
Aspirin may ↑ risk of bleeding with cefoperazone, cefotetan, and valproic acid.
May ↑ activity of penicillins, phenytoin, methotrexate, valproic acid, oral hypoglycemic agents, and sulfonamides.
May ↓ beneficial effects of probenecid or sulfinpyrazone.
Corticosteroids may ↓ serum salicylate levels.
Urinary acidification ↑ reabsorption and may ↑ serum salicylate levels.
Alkalinization of the urine or the ingestion of large amounts of antacids ↑ excretion and ↓ serum salicylate levels.
May blunt the therapeutic response to diuretics, and antihypertensives.
↑ risk of GI irritation with NSAIDs.
↑ anticoagulant effect and bleeding risk when using aspirin with arnica, chamomile, clove, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.
Contraindications: Hypersensitivity to aspirin, tartrazine (FDC yellow dye #5), or other salicylates
Cross-sensitivity with other NSAIDs may exist (less with nonaspirin salicylates)
Bleeding disorders or thrombocytopenia (more important with aspirin)
Children or adolescents with viral infections (may increase the risk of Reye's syndrome)
Peri-operative pain from coronary artery bypass graft (CABG) surgery.
Nursing Implications: Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at an increased risk for developing hypersensitivity reactions. Assess pain and limitation of movement; note type, location, and intensity before and at the peak after administration. Assess fever and note associated signs (diaphoresis, tachycardia, malaise, chills).