Acetaminophen and NSAIDs

Viscosupplementation is a clinical procedure that is being used increasingly in the treatment of osteoarthritis. This technique uses a substance known as hyaluronan to restore the lubricating properties of synovial fluid in osteoarthritic joints.6,41 Hyaluronan is a polysaccharide that can be injected into an arthritic joint to help restore the normal viscosity of the synovial fluid.6 This treatment helps reduce joint stresses, thus limiting the progression of articular destruction seen in osteoarthritis.106 Viscosupplementation has therefore been shown to reduce pain and improve function in osteoarthritis.1,95 

When used to treat osteoarthritis, viscosupplementation typically consists of 2 to 10 weekly injections of hyaluronan Hyalgan, Synvisc, others. Patients often experience a decrease in pain within days after injection, and pain continues to diminish within the first weeks after treatment. Duration of relief is variable, but most patients who respond to viscosupplementation experience beneficial effects for 6 months to 1 year after a series of injections.74 

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Acetaminophen and NSAID around the clock for fever and chills add meperidine if chills are severe clindamycin or cefazolin to prevent infection. 

The National Kidney Foundation strongly discourages the use of over-the-counter combination analgesic products (e.g., acetaminophen and NSAIDs) because this is associated with an increased prevalence of renal failure. Finally, patients should be warned about potential toxicity if they inadvertently ingest more than the recommended dose when using both nonprescription and prescription products containing acetaminophen. 

Non-narcotic analgesics (see chart) are used to treat mild to moderate pain. Many of these medications are not addictive and available over-the-counter. Non-narcotic analgesics are used to treat headaches, menstmal pain (dysmenor-rheal), pain from inflammation, minor abrasions, muscular aches and pain, and mild-to-moderate arthritis. Non-narcotic analgesics also lower elevated body temperature (antipyretic). Non-narcotic analgesics include acetaminophen and NSAIDs (aspirin, ibuprofen, and COX-2 inhibitors), which were discussed in Chapter 12. 

Acetaminophen (paracetamol) probably produces its analgesic effect by inhibiting central prostaglandin synthesis with minimal inhibition of peripheral prostaglandin synthesis [30,31 ]. Often labeled as an NSAID, acetaminophen and NSAIDs have important differences such as acetaminophen s weak anti-inflammatory effects and its generally poor ability to inhibit COX in the presence of high concentrations of peroxides, as are found at sites of inflammation [30,31], nor does it have... 

Cross-reactions with aspirin and NSAIDs are of practical importance. Typically, AIA patients are sensitive to all NSAIDs that preferentially inhibit COX-1 (table 2). Acetaminophen (paracetamol), a weak inhibitor of COX-1, is regarded as a relatively safe therapeutic alternative for almost all patients with AIA. High doses of the drug (>1,000 mg) have been reported to provoke mild, easily reversed bronchos-pasm in some AIA patients [13]. Some rare, well-documented cases of coexistence of aspirin and paracetamol sensitivity have been described. However, according to a recent meta-analysis, less that 2% of asthmatics are sensitive to both aspirin and paracetamol [14]. 

Simple analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line agents for treating OA (Table 55-2). 

Evaluate for adverse effects and drug interactions. For patients on topical therapy, evaluate for local adverse effects. For patients on acetaminophen or NSAIDs, inquire about alcohol use. 

Fever, rigors, chills, malaise headaches, myalgia Nausea, emesis Neutropenia Hepatic enzyme elevation Cutaneous—alopecia, transient, mild rashlike reaction Acetaminophen (APAP). NSAID if APAP is not effective. Meperidine for severe chills and rigors. Bedtime administration. 5-HT3 antagonist, prochlorperazine, metoclopramide, fluids Weekly complete blood count reduce dose by 30-50% Liver function tests (LFTs) weekly withhold treatment until LFTs normalize restart at 30-50% dose reduction reversible on dose reduction or cessation. Interferon is contraindicated in patients with psoriasis because exacerbation of psoriasis has been noted during IFN therapy. 

Flu-like symptoms complex Flu-like symptoms, including headache, fever, fatigue, rigors, chest pain, back pain, and myalgia, have been commonly reported with interferon beta therapy. Symptoms usually occur 4 hours after injection and subside within 24 hours. Acetaminophen or NSAIDs prior to and/or following injection may... 

The most prominent mixed Ai/A2 receptor antagonist is caffeine which is currently used clinically as an adjunctive analgesic in combination with acetaminophen and other NSAIDs. Its adjuvant activity has been demonstrated in both clinical and preclinical studies and it is extremely successful on the OTC market. Other mixed Ai/A2 receptor antagonist are currently being investigated in preclinical studies (Akahane et al. (Fujisawa Pharm Co), 2001). 

Individuals take drugs prescribed by physicians for various diagnoses. Some drugs can be taken without a prescription and are listed as safe to use. These drugs are called nonprescription or over-the-counter (OTC) drugs. There are many different drugs that contain aspirin, acetaminophen, and various NSAIDs (Table 13-3). 

Opioids, NSAIDs, acetaminophen, and COX-2 inhibitors (all discussed in previous chapters) are the most commonly used pain relievers, but they do not relieve all types of pain. Neuropathic pain (also called neuropathy) and migraine headaches are for the most part unaffected by these pain relievers, so different medications are used to treat these conditions. 

Rahme and Nedjar conducted a retrospective study from 1999-2002, of people over 65 years old of which were 158, 910 acetaminophen users, 55, 867 rofecoxib users, 81, 932 celecoxib users, 102, 021 non-selective NSAIDs users, 14, 843 rofecoxib and aspirin users, 20, 421 celecoxib and aspirin users, 22, 374 non-selective NSAIDs and aspirin users, and 54,503 acetaminophen and aspirin users. Again the risk of cardiovascular disease was noted in all patients taking NSAIDs but the combination of rofecoxib and aspirin pose the greatest risk of AMI for users. 

In the event of NSAID-induced renal failure, the NSAID should be discontinued promptly. The patient should receive supportive care, including temporary dialysis if needed. Beware that after stabilization of renal function, rechallenge with the same or even a structurally different NSAID is likely to reproduce the undesirable side effect. Hence, if anti-inflammatory therapy is essential, underlying risk factors should be identified and eliminated. If this is not possible, as in the case of old age or chronic kidney or liver failure, the patient may require alternative therapy using corticosteroids or other supportive drugs, such as acetaminophen and/or opioids. 

Simple analgesics (alone or in combination with caffeine) and NSAIDs are effective for the acute treatment of mild to moderate tension-type headache. Acetaminophen, aspirin, ibuprofen, naproxen. 

After women have tried lifestyle changes, nutritional supplements, and nonpharmacologic treatment approaches, some may require pharmacologic therapies if there is limited response. Women with less severe PMS generally self-treat headaches and cramps with aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAlDs). NSAIDs, such as naproxen and ibuprofen, are the treatments of choice for dysmenorrhea, menstrual headaches or migraines, and mastalgia. 

The nonnarcotic analgesics are a group of dni used to relieve pain witliout the possibility of causing physical dependency, which can occur witli the use of the narcotic analgesics. The nonnarcotic analgesics can be divided into the salicylates, nonsalicylates (acetaminophen), and tlie nonsteroidal anti-inflammatory dru (NSAIDs). There are a number of combination nonnarcotic analgesics tliat are available over the counter and by prescription. The NSAIDs have emerged as important dru in the treatment of the... 

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