Scientific animation demonstrating the clinical implications of the Mechanisms of Action (MOAs) of acetaminophen (TYLENOL®) and NSAIDs. Commentary explores how to counsel patients on their selection and use of OTC analgesics in pain management.
Hello i’m dr. bruce nicholson for the past 20 years i’ve specialized in the treatment of patients with a wide variety of pain conditions for generalists and specialists alike one of our most important responsibilities is to help patients make analgesic choices that are both effective and safe most of your patients are making choices about otc analgesics on a
Regular basis many may not know that there are differences between acetaminophen and nsaids and that these differences may have important implications for their health let’s review the mechanistic differences between acetaminophen and nsaids differences that you may want to keep in mind when counseling your patients about otc analgesics in the central nervous
System both acetaminophen and non-steroidal anti-inflammatory drugs or nsaids are thought to provide analgesia through inhibition of cyclooxygenase and the consequent reduction in prostaglandin synthesis thereby elevating the pain threshold at peripheral locations nsaids also inhibit cyclooxygenase and reduce prostaglandin production these peripheral actions
Account for their local analgesic effects as well as for some of the unintended health consequences nsaids can potentially cause in the heart stomach and kidneys let’s look at three important examples of these potential consequences and the implications they may have for some of your patients you likely have many patients in your practice who are on aspirin
Heart therapy for these patients use of ibuprofen can interfere with aspirins cardio protective mechanism here’s how cyclooxygenase one plays a role in platelet function aspirin interaction with platelet cox-1 receptors mediates the cardioprotective benefits of aspirin therapy in patients on such therapy ibuprofen may compete with aspirin to occupy platelet cox-1
Receptors potentially compromising aspirins cardioprotective benefits the potential gastrointestinal risks of nsaid use are well documented keep in mind the following mechanism in the stomach cyclooxygenase one plays an important role in gastric mucosal protection nsaid inhibition of cox-1 can diminish this cox-1 mediated protective mechanism this can lead to gi
Side effects such as irritation and bleeding in fact the second most common cause of peptic ulcers is regular use of insects note that the gi risks of otc nsaids are even greater in certain patients including those on aspirin heart therapy those taking prescription nsaids and those on antiplatelet therapy take these factors into consideration when you recommend
Otc analgesics to your patients many patients in your practice may be on antihypertensive therapy less commonly you may also manage patients who have some degree of renal dysfunction in these patients the possible real effects of nsaids therapy can result in unintended clinical consequences let’s take a closer look cyclooxygenase one and cyclooxygenase to play a
Role in renal function nsaids can affect both cox-1 and cox-2 in the kidneys in people with some compromised of renal blood flow and set inhibition of cox-1 in afferent renal arterioles can result in reduced renal perfusion in distal tubules nsaid inhibition of cox 2 can result in altered tubular sodium and water handling in your patients with some degree of renal
Dysfunction these renal effects of nsaids can potentially further compromise renal function and promote fluid retention in your patients on antihypertensive therapy these renal effects with prescription and seds may be more pronounced and may result in undesirable blood pressure elevation and a potential loss of blood pressure control in closing let’s talk about
Some acetaminophen safety considerations when taken as directed acetaminophen is safe for a wide range of patients including those who are at risk for gi irritation those with kidney dysfunction and those on aspirin heart therapy in fact acetaminophen is recommended by the american heart association as a first-line otc analgesic for patients with cardiovascular
Disease however when taken in over dose amounts acetaminophen can cause liver damage accidental overdose can happen when patients unknowingly take multiple otc s and/or prescription medications that include acetaminophen as an active ingredient given that more than 600 medications contain acetaminophen it is important to counsel patients on appropriate use key
Tips include always read and follow the label of all medications know the active ingredients in both otc and prescription medications be aware that acetaminophen is sometimes labeled as a path on prescription bottles never take and one acetominophen containing medication at the same time and never take more than the recommended dose of any medication because
Patients may not be aware of the differences between acetaminophen and nsaids your guidance is crucial your counseling can help patients better appreciate that their choice of otc analgesics does matter and can have a significant impact on their health
Transcribed from video
MOAs of Acetaminophen & NSAIDs | TYLENOL® Professional By TYLENOLOFFICIAL