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IBUPROFEN ACETAMINOPHEN CLASS Analgesic, Antipyretic, Anti-inflammatory Nonsteroidal anti-inflammatory drug (NSAID) ACTION Prostaglandins are naturally-occurring fatty acid derivatives that are widely distributed in the tissues. They are believed to be a common factor in the production of pain, fever, and inflammation. Prostaglandins are believed to sensitize tissues to pain- and inflammation-producing mediators such as histamine, 5-hydroxytryptamine, and kinins. The enzyme catalyzing the committed step in prostaglandin biosynthesis is prostaglandin endoperoxide synthase, also known as cyclooxygenase. There is significant evidence that the main mechanism of analgesic/antipyretic action of NSAIDs is prostaglandin biosynthesis inhibition. Other pharmacologic effects such as lysosome and plasma membrane stabilization have been observed, but the potential relevance of these effects to ibuprofen-induced analgesia and antipyresis is unclear. ONSET PEAK EFFECT DURATION 30 – 60 minutes 1 -2 hours INDICATIONS Mild to moderate pain CONTRAINDICATIONS NSAID or Ibuprofen use within previous 6 hours Allergy or sensitivity to ASA or NSAIDS Patient on anticoagulation therapy Current active bleeding History of peptic ulcer disease or GI bleed Pregnant If asthmatic, no prior use of ASA or other NSAIDs CVA or TBI in the previous 24 hours Known renal impairment Active vomiting Unable to tolerate oral medication PRECAUTIONS 4 – 6 hours DOSING As per medical directive Whenever possible, consider co-administration of acetaminophen and ibuprofen. CLASS Analgesic, antipyretic ACTION Analgesic action is through inhibition of prostaglandin synthetase in the CNS. Acetaminophen has minimal effect on peripheral prostaglandin synthesis, which may explain its relative lack of anti-inflammatory effect compared to ASA. Antipyretic action may involve a direct effect on the heat-regulating centres in the hypothalamus, leading to increased heat dissipation through vasodilation and sweating ONSET PEAK EFFECT DURATION Less than 1 hour 1 -2 hours INDICATIONS 4 – 6 hours Mild to moderate pain CONTRAINDICATIONS Acetaminophen in the last 4 hours Allergy or sensitivity to acetaminophen History of liver disease Active vomiting Unable to tolerate oral medication PRECAUTIONS Potentially fatal hepatotoxicity can result from acetaminophen overdose DOSING As per medical directive Whenever possible, consider co-administration of acetaminophen and ibuprofen. KETOROLAC MORPHINE CLASS CLASS Nonsteroidal anti-inflammatory drug (NSAID), analgesic ACTION Blocks prostaglandin formation thereby decreasing nociceptor stimulation ONSET PEAK EFFECT DURATION 10 minutes 2 – 3 hours INDICATIONS 6 – 8 hours Opioid analgesic ACTION Opioid agonist at specific opioid receptor sites in the CNS and other tissues modifies the perception of and emotional response to pain. ONSET PEAK EFFECT DURATION Mild to severe pain CONTRAINDICATIONS NSAID or Ibuprofen use within previous 6 hours Allergy or sensitivity to ASA or NSAIDs Patient on anticoagulation therapy Current active bleeding Hx of peptic ulcer disease or GI bleed Pregnant If asthmatic, no prior use of ASA or other NSAIDs CVA or TBI in the previous 24 hours Known renal impairment PRECAUTIONS Potentially fatal hepatotoxicity can result from acetaminophen overdose Ketorolac is not to be administered in conjunction with acetaminophen or ibuprofen In patients with isolated hip or extremity trauma, ibuprofen and acetaminophen is preferred to ketorolac except where the patient is unable to tolerate oral medications. DOSING As per medical directive 2-5 minutes 20 minutes INDICATIONS 1 hour Mild to severe pain CONTRAINDICATIONS Allergy or sensitivity SBP less than 100mmHg, and or greater than a 1/3 drop from the initial reading PRECAUTIONS Monitor patient for dizziness, sedation, nausea & vomiting, respiratory depression, apnea and hypotension. Pregnancy: benefits outweigh the potential risks to the fetus Caution with elderly and debilitated individuals and those with cardiac arrhythmias. DOSING As per medical directive