The Science of OTC Analgesics

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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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Ian L., Dr -

Another side effect particularly in Hypertensive Elderly patients (>65 minimum ) is the rise in systolic BP .
A Dutch study Floor-Schreudering A et al in Eur J Prev Cardiology found 10% raised systolic BP by > 10mmHg or > 140 at one week in patients prescribed NSAIDS .
So Blood Pressure ought be checked and rechecked from the start

David C. -

Revision - There is a risk of cardiovascular adverse event. Patients taking aspirin and ibuprofen have increased mortality compared to patients just taking ibuprofen. (rev - .... just taking aspirin, not ibuprofen).

Jeremy V. -

When will the US get a combination ibuprofen/acetaminophen pill, that is prescription only, letting physicians write "for something stronger than OTC meds" to treat people seeking pain relief?

Bryan D. -

One thing missing from this overview is the NSAIDS/bone healing controversy. Any thoughts or new literature out there on this specific issue? I hear different things from different services and from different EM
attendings. Some seem to think this only has been proven in non-human basic science studies, others say there's good orthopedic patient-centered literature out there proving either harm or a lack thereof. What's the answer? :-)

Rob O -

Hey Bryan! The answer seems to be somewhere in the middle of all those strong opinions. Boy genius Adam Rowh discusses it at some length here http://blog.ercast.org/spring-2017-journal-club/. As far as good patient centered data answering the question, I'd say.. not really. It sounds like we need an EMRAP deeper dive on this. I'll put it in the queue for Bryan Hayes for our next pharmacology rounds recording session.

Bryan D. -

Thanks Rob - I'm a long time listener and did greatly enjoy that episode. My intuition agrees with what you and Adam concluded in that episode, but we (as always) need better data. I look forward to hearing what Brian Hayes thinks!

Matthew Z. -

I was under the impression that naproxen was the safest NSAID.

SHIH-CHIN C. -

I think Naproxen is the safest NSAID also. Naproxen is safer for cardiovascular complications.
This podcast discusses GI risk only, in which case, ibuprofen is 1.19, and naproxen is 1.83.
http://www.medscape.com/viewarticle/537837#vp_2

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