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Brand Name: Aspilet Generic Name: Aspirin Indication:  Rheumatoid arthritis, osteoarthritis, or other polyarthritic or inflammatory conditions  Juvenile rheumatoid arthritis  Mild pain or fever  To prevent thrombosis  To reduce of MI in patients with previous MI or unstable angina  Kawasaki syndrome mucocutaneous lymph node syndrome  Acute Rheumatic Fever  To reduce the risk of recurrent transient ischemic attacks and stroke or death in patients at risk  Acute ischemic stroke  Acute pericarditis after MI Drug Classification: Antithrombotic, Anticoagulant, Fibrinolytic

Mechanism of Action: Produce analgesia by blocking pain impulses, probably by inhibiting synthesis or prostaglandin in the CNS or of other substances that sensitize pain receptors to mechanical or chemical stimulation. Relieve fever by central action in the hypothalamic heat regulating center. Drug exerts its anti inflammatory response as well. In low doses, aspirin also appears to impede clotting by blocking prostaglandin synthesis, which prevents information of the platelet- aggregating substance, thromboxane. Dosage:  Rheumatoid arthritis, osteoarthritis, or other polyarthritic or inflammatory conditions: Adults: initially, 2.4 -3.6 g P.O. daily in divided doses. Maintenance dosage is 3.2 to 6 g P.O daily in divided doses.  Juvenile rheumatoid arthritis: Children: 60 – 110 mg/kg daily P.O divided every 6 to 8 hours.  Mild pain or fever: Adults and children older than age 11: 325 to 650 mg P.O. or P.R. q 4 hours, p.r.n. Children ages 2 to 11: 10 to 15 mg/kg/dose P.O. or P.R. q 4 Hours, up to 80 mg/kg daily.  To prevent thrombosis: Adults: 1.3 g P.O daily in two to four divided doses.

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To reduce risk of MI in patients with previous MI or unstable angina: Adults: 75-325 mg. P.O. daily

(Continuation Aspilet)  Kawasaki syndrome (mucocutaneous lymph node syndrome): Adults: 80 to 180 mg/kg P.O. daily in four divided doses during febrile phase. When fever subsides, decrease 10 mg/kg once daily and adjust according to salicylate level.  Acute Rheumatic Fever: Adults: 5 to 8 g P.O. daily Children: 100 mg/kg daily P.O. for 4 to 6 weeks.  To reduce the risk of recurrent transient ischemic attacks and stroke or death in patients at risk: Adults: 50 to 325 mg P.O. daily.  Acute ischemic stroke: Adults: 160 – 325 mg P.O daily started within 48 hours of stroke onset and continue for up to 2 -4 weeks.  Acute pericarditis after MI: Adults: 160 to 325 mg P.O. daily. Higher doses (650 mg P.O. q 4 to 6 hours) may be needed. Special Precaution: 3rd trimester of pregnancy, lactation, and severe renal and hepatic insufficiency. Children with viral illnesses.

Pregnancy Risk Category: C (D in third trimesters) Adverse Reaction: EENT: tinnitus, hearing loss GI: nausea, GI distress, occult bleeding, dyspepsia, GI bleeding Hematologic: leukopenia, thrombocytopenia, prolonged bleeding time Hepatic: hepatitis Skin: rash, bruising, urticaria Other: angioedema, hypersensitivity reactions, Reye’s syndrome Contraindications: Contraindicated in patients hypersensitive to drug and in those with NSAIDinduce sensitivity reactions, G6PD deficiency, or bleeding disorders, such as hemophilia, von Willebrand’s disease, or telangiectasia. Form: Chewing gum: 227.5 g suppositories: 120 mg, 200mg, 300 mg, 600 mg Tablets: 325 mg, 500 mg Tablets (chewable): 81 mg Tablets (controlled release): 80 mg Tablets ( enteric-coated; 81 mg, 165 mg, 325 mg, 500 mg, 650 mg 975 mg Tablets (timed-release): 650 mgs

(Continuation Aspilet) Nursing Responsibility:  Use cautiously in patients with GI lesions, impaired renal function, hypoprothrombemia, vitamin K deficiency, thrombocytopenia, thrombotic thrombocytopenic purpura, or severe hepatic impairment.  Alert: because of epidemiologic link to Reye’s syndrome, the Centers for Disease Control and Prevention recommended not giving salicylates to children of teenagers with chickenpox or flu like illness.  For inflammatory conditions, rheumatic fever, and thrombosis, aspirin is administered on a schedule rather than p.r.n.  Because enteric coated tablets are slowly absorbed, they aren’t suitable for rapid relief of acute pain, fever, or inflammation. They cause less GI bleeding and may be better suited for long – term therapy, such as treatment of arthritis.

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For patient with swallowing difficulties crush non enteric – coated aspirin and dissolve in soft food or liquid. Administer liquid immediately after mixing because drug will break down rapidly. For patients who can’t tolerate oral drugs, ask prescriber about using aspirin rectal suppositories. Watch for rectal mucosal irritation or bleeding. Febrile, dehydrated children can develop toxicity rapidly. Monitor elderly patients closely because they may be more susceptible to aspirin’s toxic effects. Monitor salicylate levels. Therapeutic salicylate level in arthritis is 150 to 300 mcg ml. tinnitus may occur isn’t a reliable indicator of toxicity, especially in very young patients and those older than age 60. with longterm therapy, severe toxic effects may occur with levels of exceeding 400 mcg/ml During prolonged therapy, hematocrit ,hemoglobin, PT, INR, and renal function should be assessed periodically Aspirin irreversibly inhibits platelet aggregation. It should be discontinued 5 to 7 days before elective surgery to allow time fro production and release of new platelets.

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Monitor patient for hypersensitivity reactions such as anaphylaxis or asthma. Alert: Don’t confuse aspirin with Ascendin or Afrin.