Aspirin
Aspirin, or acetylsalicylic acid, is a widely used nonsteroidal anti-inflammatory drug (NSAID) with antipyretic, analgesic, anti-inflammatory, and antiplatelet properties, commonly prescribed for pain relief, fever reduction, and cardiovascular disease prevention.
Mechanism of Action:
- Irreversibly inhibits cyclo-oxygenase enzyme, resulting in a decreased formation of prostaglandin precursors.
- Irreversibly inhibits formation of thromboxane, resulting in inhibiting platelet aggregation.
Indications:
- Mild to moderate pain
- Reduces inflammation related to rheumatoid arthritis (RA), juvenile arthritis, osteoarthritis, rheumatic fever.
- Used as platelet aggregation inhibitor in the prevention of transient ischemic attacks (TIAs), cerebral thromboembolism, MI or reinfarction.
- OFF-LABEL: Prevention of preeclampsia
- Alternative therapy for preventing thromboembolism associated with atrial fibrillation when warfarin cannot be used; pericarditis associated with MI; prosthetic valve thromboprophylaxis.
- Complications associated with autoimmune disorders, colorectal cancer.
| Aspirin |
| Availability (OTC) Caplets: 325 mg, 500 mg. Suppositories: 300 mg, 600 mg. Tablets: 325 mg. Tablets (Chewable): 81 mg. Capsule, Extended-Release: 162.5 mg. Tablets (Enteric-Coated): 81 mg, 325 mg, 500 mg, 650 mg. |
| Administration/handling: PO • Do not break, crush, dissolve, or divide enteric-coated tablets or extended-release capsule. • May give with water, milk, meals if GI distress occurs. Rectal • Refrigerate suppositories; do not freeze. • If suppository is too soft, chill for 30 min in refrigerator or run cold water over foil wrapper. • Moisten suppository with cold water before inserting well into rectum. |
| Analgesia, Fever PO: Adults, elderly, children 12 yrs and older and weighing 50 kg or more: 325–650 mg q4–6h or 975 mg q6h prn or 500–1,000 mg q4–6h prn. Maximum: 4 g/day. Rectal: 300–600 mg q4h prn. Infants, children weighing less than 50 KG: 10–15 mg/kg/dose q4–6h. Maximum: 4 g/day or 90 mg/kg/day. |
| Revascularization PO: Adults, elderly: 80–325 mg/day. |
| Kawasaki’s Disease PO: Children: 80–100 mg/kg/day in divided doses q6h up to 14 days (until fever resolves for at least 48 hrs). After fever resolves, 1–5 mg/kg once daily for at least 6–8 wks. |
| MI, Stroke (Risk Reduction) PO: Adults, elderly: (Durlaza): 162.5 mg once daily. |
| Dosage in Renal/Hepatic Impairment : Avoid use in severe impairment. |
Cautions & Contraindications:
- Active peptic ulcer
- Hemophilia
- Bleeding diathesis
- Hypersensitivity
- Asthma, rhinitis, nasal polyps.
- Avoid use in pregnancy, especially third trimester
Side- effects:
- Bronchospasm
- GI and another hemorrhage
- GI disturbance
- Reye’s syndrome in children with recent viral infections
Metabolism And Half- life:
- Rapidly and completely absorbed from GI tract; enteric-coated absorption delayed; rectal absorption delayed and incomplete.
- Half-life: 15–20 min (aspirin); 2–3 hrs (salicylate at low dose); more than 20 hrs (salicylate at high dose).
Drug Interactions:
- Use of aspirin and anticoagulants increases the risk of bleeding.
- Increased risk of GI side- effects with corticosteroids
NURSING CONSIDERATIONS
Baseline assessment
- Do not give to children or teenagers who have or have recently had viral infections (increases risk of Reye’s syndrome).
- Do not use if vinegar-like odor is noted (indicates chemical breakdown).
- Assess history of GI bleed, peptic ulcer disease, OTC use of products that may contain aspirin.
- Assess type, location, duration of pain, inflammation. Inspect appearance of affected joints for immobility, deformities, skin condition.
Intervention/Evaluation
- Monitor urinary pH (sudden acidification, pH from 6.5 to 5.5, may result in toxicity).
- Assess skin for evidence of ecchymosis.
- If given as antipyretic, assess temperature directly before and 1 hr after giving medication.
- Evaluate for therapeutic response: relief of pain, stiffness, swelling; increased joint mobility; reduced joint tenderness; improved grip & strength.
Patient/Family Teaching
- Do not, chew, crush, dissolve, or divide enteric-coated tablets.
- Avoid alcohol, OTC pain/cold products that may contain aspirin.
- Report ringing of the ears or persistent abdominal GI pain, bleeding.
- Therapeutic anti-inflammatory effect noted in 1–3 wks.
- Behavioral changes, persistent vomiting may be early signs of Reye’s syndrome, contact physician.
Important Points:
- Low dose aspirin (75mg) used for long term prophylaxis. High dose (300mg) is given if an ischemic event is suspected.
- If at high risk of GI bleed, give a proton pump inhibitor in conjunction with aspirin.
- Can cause Reye’s syndrome (hepatic and CNS disorder) in children under 16 years old.
- An overdose may cause a respiratory alkalosis (adults) due to hyperventilation and metabolic acidosis (children) due to salicylate load and accumulation of lactic, pyruvic and aceto-acetic acid.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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