Question

21)Review the medication Ketorolac (Toradol). What is its classification, when is it used, side effects, maximum dosage, and patient education?

22)Describe the pharmaceutical effects of Aspirin. When is it used? When is it not used?

23)Describe the pharmaceutical effects of Acetaminophen. When is it used? When is it not used? Treatment for medication overdose

24)What is the pharmaceutical differences between Aspirin and Acetaminophen?

25)Review aspirin overdose protocol

26)Review aspirin use in pediatrics and its link to Reyes syndrome

27)Review aspirin use in pregnancy

28)Review the side effects of Opioid use.

29)Review the signs and symptoms in Opioid withdrawal

30)Review the signs and symptoms of Opioid toxicity / overdose. What medication is given to counteract he opioid toxicity?

Answer 1

QUESTION 21

KETOROLAC

Ketorolac is a nonsteroidal antiinflammatory drug (NSAIDs) comming under nonselective COX inhibitors in which it is a Acetic acid derivatives.

USES -

1. Injected ketorolac is used in postoperative, dental and musculoskeletal pain.
2. May also used for for renal colic, migraine, pain due to bony metastasis.
3. Topical ketorolac in noninfective occular conditions.

ADVERSE EFFECTS

Nausea, abdominal pain, dyspepsia, ulceration, loose stools, drowsiness, headache, nervousness, pruritis, pain at injection site, rise in transaminase, fluid retention

MAXIMUM DOSAGE

Maximum dosage for injected ketorolac is 90 mg/day . ( normal dosage is 15-30mg i.m or i.v every 4-6 hours).

Orally it is given at a dose of 10-20mg 6 hourly. Continuous use for more than 5 days is not recommended due to risk of g.i and renal toxicity.

PATIENT EDUCATION

Should be taken only under the prescription by a doctor.

It shouldnot be taken more than prescribed dose.

The drug can cause side effects like nausea, abdominal pain, dyspepsia, ulceration, loose stools, drowsiness, headache, nervousness, pruritis, pain at injection site, rise in transaminase, fluid retention.

Continuous use for more than 5 days is not recommended due to risk of g.i and renal toxicity.

QUESTION - 22

ASPIRIN

Pharmaceutical effects of Aspirin

1.Analgesic, antipyretic, antiinflammatory actions

Analgesic actions is due to obtunding of peripheral pain receptors and prevention of prostaglandin mediated sensitization of nerve endings. A central subcortical action raising threshold to pain preception also contribute to analgesia.

Antipyretic action is due to resetting of hypothalamic thermostat by aspirin.

Antiinflammatory action is exerted at high doses and signs of inflammation is suppressed.

2.GIT

Irritates gastric mucosa, cause epigastric distress, nause and vomiting. At high dose stimulate CTZ.

Promote local back diffusion at gastric mucosa and cause focal necrosis of mucosal cells and capillaries.

3.Blood

Irreversibly inhibits TXA2 synthesis by platelets thereby inhibits platelet aggregation and prolongs bleeding time.

4.metabolic and other effects of high doses

Cellular metabolism is enhanced due to uncoupling of oxidative phosphorylation.

Hyperventilation followed by respiratory depression at toxic doses.

can produce respiratory alkalosis, compensated respiratory alkalosis and respiratory acidosis.

Toxic dose depresses vasomotor centre - BP falls.

USES

1. As a analgesic in - headache, back ache, myalgia, joint pain, pulled muscle, toothache, nuralgia and dysmenorrhoea.

2. As antipyretic - effective in fever of any orgin.

3. Acute rheumatic fever.

4. Rheumatoid arthritis.

5. Osteoarthritis.

6. Postmyocardial infraction and poststroke patients to prevent platelet aggregation to reduce the incidence of reifraction.

7. Prevention of preeclampsia.

8. Other conditions like - Familial colonic polyposis, prevention of colon cancer.

CONTRAINDICATIONS

Patients with peptic ulcer, bleeding tendencies and allergy to aspirin.

Avoided in diabetics.

Children, breast feeding mothers.

High dose is contraindicated in G-6-PD deficient individuals.

QUESTION 25

Aspirin overdose protocol

When serum salicylate level is morethan 50mg/dl it is said to be aspirin toxicity.

Symptomatic and supportive treatment is given.

IV fluid with Na+, K+, HCO3- and glucose under epeated monitoring sholud be given.

External cooling must be done.

For removing unabsorbed drug, gastric lavage and for removing absorbed drug alkaline diuresis or haemodialysis should be done.

If bleeding occurs, blood transfusion and Vitamin K should be given.

QUESTION 26

Aspirin is contraindicated in chlidren due to the risk of developing Reyes syndrome, which is a rare form of hepatic encephalopathy seen in children having viral infection.

QUESTION 27

An aspirin dose of 80 - 100mg per day is given for pregnancy - induced hypertension and preeclampsia which is caused due to the imbalance between TXA2 and PGI2. Here aspirin selectively supresses TXA2 production.

QUESTION 28

Adverse effects of opioids

1. Side effects like sedation, mental clouding, lethargy, constipation, respiratory depression, blurring of vision and urinary retention.

2. Idiosyncrasy and allergy - urticaria, lip swelling, pruritis.

3. Apnoea of the newborn.

4. Tolerance and dependence - on repeated administration.