GENERIC NAME- Aspirin MECH.

OF ACTION- The analgesic,

INDICATIONS

antipyretic, and anti-inflammatory effects of acetylsalicylic acid are due to actions by both the acetyl and the salicylate portions of the intact molecule as well as by the active salicylate metabolite. Acetylsalicylic acid directly and irreversibly inhibits the activity of both types of cyclooxygenase (COX1 and COX-2) to decrease the formation of precursors of prostaglandins and thromboxanes from arachidonic acid. This makes acetylsalicylic acid different from other NSAIDS (such as diclofenac and ibuprofen) which are reversible inhibitors. Salicylate may competitively inhibit prostaglandin formation. Acetylsalicylic acid's antirheumatic (nonsteroidal antiinflammatory) actions are a result of its analgesic and antiinflammatory mechanisms; the therapeutic effects are not due to pituitary-adrenal stimulation. The platelet aggregation-inhibiting effect of acetylsalicylic acid specifically involves the compound's ability to act as an acetyl donor to cyclooxygenase; the nonacetylated salicylates have no clinically significant effect on platelet aggregation. Irreversible

For use in the temporary relief of various forms of pain, inflammation associated with various conditions (including rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, and ankylosing spondylitis), and is also used to reduce the risk of death and/or nonfatal myocardial infarction in patients with a previous infarction or unstable angina pectoris.
CONTRAINDICATION

SIDE EFFECTS, ADVERSE EFFECT

NURSING RESPONSIBILITY

Adverse effects of aspirin Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage, excitement, confusion, asterixis, pulmonary edema, seizures, tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure (dose related, 2025 g in adults, 4 g in children) Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with nasal polyps, asthma, rhinitis) GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia,

Nursing considerations of aspirin Assessment of aspirin History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation Physical: Skin color, lesions; T; eighth cranial nerve function, orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver evaluation, bowel sounds; CBC, clotting times, urinalysis, stool guaiac, LFTs, renal function tests Interventions of aspirin

Contraindications of aspirin Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency

BLACK BOX WARNING: Do not use in children and teenagers to treat chickenpox or flu symptoms without review for Reyes syndrome, a rare but fatal disorder. Give drug with food or after meals if GI upset occurs. Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus. Do not crush, and ensure that patient does not chew SR

acetylation renders cyclooxygenase inactive, thereby preventing the formation of the aggregating agent thromboxane A2 in platelets. Since platelets lack the ability to synthesize new proteins, the effects persist for the life of the exposed platelets (7-10 days). Acetylsalicylic acid may also inhibit production of the platelet aggregation inhibitor, prostacyclin (prostaglandin I2), by blood vessel endothelial cells; however, inhibition prostacyclin production is not permanent as endothelial cells can produce more cyclooxygenase to replace the non-functional enzyme.
DOSE, FREQ, ROUTE- Dosage & Route of aspirin Available in oral and suppository forms. Also available as chewable tablets, gum; enteric coated, SR, and buffered preparations (SR aspirin is not recommended for antipyresis, short-term analgesia, or children < 12 yr.) CLASSIFICATIONAnticoagulants Cyclooxygenase Inhibitors Platelet Aggregation Inhibitors Fibrinolytic Agents Salicylates

(increased risk of bleeding) Use cautiously with impaired renal function; chickenpox, influenza (risk of Reyes syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage, prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late pregnancy has been associated with the following adverse fetal effects: low birth weight, increased intracranial hemorrhage, stillbirths, neonatal death); lactation.

hepatotoxicity Hematologic: Occult blood loss, hemostatic defects Hypersensitivity: Anaphylactoid reactions to anaphylactic shock Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, lassitude (dose related)

preparations. Do not use aspirin that has a strong vinegar-like odor. WARNING: Institute emergency procedures if overdose occurs: Gastric lavage, induction of emesis, activated charcoal, supportive therapy. Teaching points of aspirin Take extra precautions to keep this drug out of the reach of children; this drug can be very dangerous for children. Use the drug only as suggested; avoid overdose. Avoid the use of other over-the-counter drugs while taking this drug. Many of these drugs contain aspirin, and serious overdose can occur. Take the drug with food or after meals if GI upset occurs. Do not cut, crush, or chew sustained-release products. Over-the-counter aspirins are equivalent. Price does not reflect effectiveness. You may experience these side effects: Nausea, GI upset, heartburn (take drug with food); easy bruising, gum bleeding (related to aspirins effects on blood clotting). Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting, bloody stools.