Nonopioid Analgesics

2015 ◽  
Author(s):  
Sean Rhyee ◽  
Katherine Boyle
Keyword(s):  
The United States ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Over The Counter ◽  
King's College ◽  
Definitive Therapy ◽  
King’S College Criteria ◽  
Toxic Ingestion ◽  
Nonopioid Analgesics ◽  
Pie Chart

Acetaminophen is the most common toxic ingestion in the United States, causing 400 deaths per year. Poisoning occurs both intentionally and unintentionally, with suicidal intent, overuse for treatment of pain, and ingestion of multiple medications containing acetaminophen all contributing. Aspirin poisoning remains a concern even though its popularity as an analgesic and antipyretic has decreased over time. Among nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), ibuprofen and naproxen are the most commonly encountered in overdose, likely due to their easy availability as over-the-counter medications. This review covers the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes related to acetaminophen, aspirin, and ibuprofen and other NSAIDs. Tables describe N-acetylcysteine dosing, King’s College criteria for acetaminophen-induced liver failure, and indications for hemodialysis in aspirin poisoning. Figures include a pie chart showing acetaminophen metabolization, the Rumack-Matthew nomogram, and a graph showing frequency of hepatotoxicity in patients receiving N-acetylcysteine. This review contains 3 highly rendered figures, 3 tables, and 97 references.

Suppository Preparation: Density Factor Determination for Some Over-the-Counter Analgesic Products

2009 ◽  
Vol 25 (5) ◽  
pp. 303-308
Author(s):  
Antoine Al-Achi ◽  
Sapana Patel ◽  
Krishna Cherukuri ◽  
Dinal Gandhi
Keyword(s):  
North Carolina ◽  
Practical Method ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Dosage Forms ◽  
Solid Dosage Forms ◽  
Antiinflammatory Drugs ◽  
Over The Counter ◽  
Solid Dosage ◽  
Porcelain Mortar ◽  
Density Factor

Background: The formulation of analgesic suppositories by the compounding pharmacist may offer an alternative to patients who cannot take medications orally. Objective: To determine the density factor (DF) for 9 nonprescription nonsteroidal antiinflammatory drugs, aspirin, and acetaminophen for use in compounding suppositories. Methods: Nine nonprescription analgesic products were purchased from local stores in North Carolina. All products were solid dosage forms (ie, tablets, caplets, or geltabs). The solid units were pulverized with a porcelain mortar and pestle and then incorporated into a cocoa butter base for formulating the suppository. The DF estimation was evaluated according to the Paddock method. Results: The highest DF value (mean ± SD) among the products tested was for St. Joseph Aspirin (1.45 ± 0.78); the lowest value was for Motrin IB (ibuprofen) (1.06 ± 0.23). Overall, 11.1% (40/360) of all compounded suppositories had some sort of defect. The most often encountered defect was chipping (3.6%; 13/360); the least encountered was sticking to molds (0.83%; 3/360). Conclusions: A practical method for preparing compounded suppositories provides a viable alternative for patients who require analgesic medications but cannot take them orally.

Necrotizing Fasciitis Associated with Nonsteroidal Antiinflammatory Drug Use

1998 ◽  
Vol 14 (2) ◽  
pp. 58-62 ◽  
Author(s):  
Michael P Rivey ◽  
Douglas R Allington ◽  
Amanda L Henry Dunham
Keyword(s):  
Necrotizing Fasciitis ◽  
Clinical Course ◽  
Causative Factor ◽  
Antiinflammatory Drug ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Nonsteroidal Antiinflammatory Drug ◽  
Antiinflammatory Drugs ◽  
Over The Counter ◽  
Medical Disorder ◽  
Case Summary

Objective: To describe a case of necrotizing fasciitis (NF) that occurred following minor clean surgery in a seemingly otherwise healthy man who was taking over-the-counter (OTC) ibuprofen 200 mg and aspirin 325 mg before surgery. Case Summary: A 71-year-old white man underwent an uncomplicated laparoscopic cholecystectomy. His only medical disorder prior to surgery was osteoarthritis, for which he took OTC-strength ibuprofen; his only other regular medication was one aspirin 325-mg tablet daily for prevention of cardiac disease. Within 48 hours of the surgery, the onset of NF was apparent, and extensive tissue excision and debridement was required 1 week after the operation. All nonsteroidal antiinflammatory drugs (NSAIDs) were withheld. The patient survived a complicated clinical course over the next month. Discussion: A review of proposed risk factors for the development of NF in the patient indicated surgery and NSAID use. Analysis of the probability of NSAID use as a causative factor for the adverse reaction of NF suggests a possible role. This case suggests that NSAID use in lower OTC dosages may contribute to the onset or course of NF. The case report adds to existing literature suggesting an association between NSAID use and the development or course of NF. Conclusions: NSAIDs are widely used drugs, and any association as a causative or provocative factor for NF is a rare finding. However, practitioners should be aware of the proposed association.

Recent Developments in Nonsteroidal Antiinflammatory Drugs in Cats

2005 ◽  
Vol 41 (6) ◽  
pp. 347-354 ◽  
Author(s):  
Gwendolyn L. Carroll ◽  
Stephanie M. Simonson
Keyword(s):  
United States ◽  
Chronic Pain ◽  
The United States ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Safety Concerns ◽  
Recent Developments

Pain, particularly chronic pain, is an underestimated ailment in cats. Veterinarians tend to under-diagnose and under-treat pain in this aloof and stoic species. Until recently, there was only one analgesic (i.e., butorphanol) approved in the United States for use in cats; but many analgesics, particularly opioids, have been used extra-label for this purpose. Nonsteroidal antiinflammatory drugs (NSAIDs) have been used sparingly in cats because of safety concerns, which are less of an issue with the newer agents. Meloxicam is the only NSAID labeled for use in cats in the United States, but other agents are available in this country and are labeled for use in cats in other countries.

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