PAIN OTC DRUGS

1. PAIN OTC DRUGS Diana Jawhari Tamara Odeh Supervised by: Dr. Ikhlass Jarrar

2. Pathogenesis of pain

4. General Mechanism Of Action Salicylates , NSAIDs

5. Salicylates No prostaglandindins formation No pain impulses Uses : Analgesic (mild to moderate pain) & Anti-inflamatory: Decrease pain awareness

6. 2) Antipyretic: No prostaglandins Heat regulation center vasodilation • 3) Antiplatelet: Inh. COX in platelets no thromboxane A2 no aggregation Only Aspirin Inh. COX irreversibly

7. 4) Antithrombotic :At low dose Inh. COX Inh. Thromboxane A2No aggregation preserving prostacyclin action (aggregation inh.)

8. C/I • Pt with bleeding disorders • Peptic ulcer • Children or teenagers with viral illness to prevent Raye syndrome

9. Use with extreme caution in • Pregnancy during the last trimester to prevent: • Bleeding in mother & fetus • Prolong & complicating delivery

10. S/E 1) GI disturbances due to prostaglandin Inh • Solutions: • Using enteric coated tab. • Take with food • Take with antacids

11. 2) CNS disturbances at anti-inflammatory dose:Headachedizzinesstinnitus

12. 3) Salicysm (salicylate toxicity) At anti-inflammatory dose :respiratory alkalosis nauseahyperthermiaconfusion convulsions

13. Hypersensitivity to Aspirin • Allergic reaction Bronchoconstriction (esp. in people with nasal polyps) • Cross reactivity with NSAIDs & acetaminophen

14. Drug interactions 1) Salicylates potentiate the effect of : • Anticoagulants • Thrombolytic agents • Hypoglycemics (at anti-inflammatory dose) 2) Inh. Zidovudon metabolism

15. 3) Adverse GI rxn from chronic alcohol or NSAIDs use4) Caffeine with salicylates enhance analgesic effect

16. Ibuprofen Naproxen Ketoprofen Only available without prescription Celecoxib Etirocoxib Approved Not Approved

17. Uses Of NSAIDs No prostaglandindins formation No pain impulses Decrease pain awareness Analgesic (mild to moderate pain) & Anti-inflamatory: 2) Antipyretic: No prostaglandins Heat regulation center vasodilation NSAIDs can’t improve visceral pain

18. Use with extreme caution in: • Pregnancy during the last trimester to prevent: • Adverse effect s on fetal blood flow • Prolong pregnancy

19. S/E

20. Solutions: • Using enteric coated tab. • Take with food • Take with antacids

21. 2) Renal toxicity

22. 3) Reversible infertility • 4) Hepatotoxicity • 5) Photosensetivity • 6) Asthma • 7) Risk of Thromboimbolic disorders esp with selective COX2

23. Drug interactions 1) NSAIDS potentiates the effects of: - anticoagulants - thrombolytic agents. - hypoglysemics(at anti inflamatory dose). 2) GI disturbances 3) With Caffeine inhance analgesic effect 4) Hyper sinsitivity to aspirin can occur with NSAIDS use Not to be used with combinations of other NSAIDS

24. Acetaminophen Uses: 1) releivemild to moderate pain 2) reduce fever . 3) first line therapy for ostioarthritis of the knee and hip. has minimal anti inflamatoryactivty .

25. Dosage • For adults : 500 – 1000 mg 3 times daily as needed • For osteoarthritis :1000 mg 4 times as needed • For children :325 mg /4-6 hrs as needed

26. Routine use • Pt with GI disturbances by salicylates or NSAIDS • Bleeding disorders • Hypersinsitive to salicylates

27. Precautions • Pts withactive alcoholism ,hepatic disease or viral hepatitis. • Many otc products contain acetaminophen with other ing so it is important to counsel pts about these drugs. • EXA : (Relaxon) contains orphenadrine citrate + paracetamol