ROLAN J. BULANDOS JR.

BSN3-1

DRUG STUDY
 GENERIC NAME : ibuprofen

 BRAND NAME: Advil, Advil Liqui-Gels, Advil Migraine, Apo-Ibuprofen (CAN),

Children’s Advil, Children’s Motrin, Genpril, Infants’ Motrin, Junior Strength Advil,
Junior Strength Motrin, Menadol, Midol, Midol Maximum Strength Cramp Formula,
Motrin, Motrin IB, Motrin Migraine Pain, Novo-Profen (CAN), Nuprin, PediaCare
Fever, Pediatric Advil Drops 

 CLASSIFICATION: NSAID, Analgesic (nonopioid), Propionic acid derivative

 Pregnancy Category B
 Pregnancy Category D (third trimester) 

DOSAGE & ROUTE

ADULTS
Do not exceed 3,200 mg/day.

 Mild to moderate pain: 400 mg q 4–6 hr PO.

 Osteoarthritis or rheumatoid arthritis: 1,200–3,200 mg/day PO (300 mg qid or
400, 600, 800 mg tid or qid; individualize dosage. Therapeutic response may occur
in a few days, but often takes 2 wk).
 Primary dysmenorrhea: 400 mg q 4 hr PO.
 OTC use: 200–400 mg q 4–6 hr PO while symptoms persist; do not exceed
1,200 mg/day. Do not take for more than 10 days for pain or 3 days for fever,
unless so directed by health care provider.

PEDIATRIC PATIENTS
 Juvenile arthritis: 30–40 mg/kg/day PO in three to four divided doses; 20
mg/kg/day for milder disease.
 Fever (6 mo–12 yr): 5–10 mg/kg PO q 6–8 hr; do not exceed 40 mg/kg/day.

THERAPEUTIC ACTIONS
 Ibuprofen exhibits anti-inflammatory, analgesic and antipyretic activities. Its
analgesic effect is independent of anti-inflammatory activity and has both central
and peripheral effects. It potently inhibits the enzyme cyclooxygenase resulting in
the blockage of prostaglandin synthesis. It also prevents formation of thromboxane
A2 by platelet aggregation.

INDICATIONS
 Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis
 Relief of mild to moderate pain
ROLAN J. BULANDOS JR.
BSN3-1

 Treatment of primary dysmenorrhea

 Fever reduction
 Unlabeled uses: Prophylactic for migraine; abortive treatment for migraine
ADVERSE EFFECTS
 Oral: Dyspepsia, vomiting, abdominal pain, heartburn, nausea, diarrhoea,
epigastric pain, oedema, fluid retention, dizziness, rash, tinnitus. Parenteral:
Intraventricular haemorrhage, skin irritation, hypocalcaemia, hypoglycaemia, GI
disorders, anaemia, apnoea, respiratory infection, sepsis.
 Potentially Fatal: Severe CV thrombotic events. Severe GI bleeding, ulceration
and perforation.

CONTRAINDICATIONS
 Active peptic ulcer; hypersensitivity. Neonates with congenital heart disease,
suspected necrotising enterocolitis and active bleeding (parenteral).

NURSING CONSIDERATIONS
ASSESSMENT
 History: Allergy to ibuprofen, salicylates or other NSAIDs; CV dysfunction,
hypertension; peptic ulceration, GI bleeding; impaired hepatic or renal function;
pregnancy; lactation
 Physical: Skin color, lesions; T; orientation, reflexes, ophthalmologic evaluation,
audiometric evaluation, peripheral sensation; P, BP, edema; R, adventitious
sounds; liver evaluation, bowel sounds; CBC, clotting times, urinalysis, LFTs, renal
function tests, serum electrolytes, stool guaiac

INTERVENTIONS
 BLACK BOX WARNING: Be aware that patient may be at increased risk of CV
event, GI bleeding, monitor accordingly.
 Administer drug with food or after meals if GI upset occurs.
 Arrange for periodic ophthalmologic examination during long-term therapy.
 Discontinue drug if eye changes, symptoms of hepatic impairment, or renal
impairment occur.
 WARNING: Institute emergency procedures if overdose occurs: Gastric lavage,
induction of emesis, and supportive therapy.

TEACHING POINTS
 Use drug only as suggested; avoid overdose. Take the drug with food or after
meals if GI upset occurs. Do not exceed the prescribed dosage.
 Avoid over-the-counter drugs. Many of these drugs contain similar medications,
and serious overdosage can occur.
ROLAN J. BULANDOS JR.
BSN3-1

 You may experience these side effects: Nausea, GI upset, dyspepsia (take drug
with food); diarrhea or constipation; drowsiness, dizziness, vertigo, insomnia (use
caution when driving or operating dangerous machinery).
 Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers,
changes in vision, black or tarry stools.

GENERIC NAME: acetaminophen (N-acetyl-p-aminophenol)

BRAND NAME:
 Suppositories: Abenol (CAN), Acephen
 Oral: Aceta, Apacet, Atasol (CAN), Genapap, Genebs, Liquiprin, Mapap,
Panadol, Tapanol, Tempra,Tylenol
Classification: Antipyretic, Analgesic (nonopioid)
Pregnancy Category B

DOSAGES
ADULTS
 PO or PR
 By suppository, 325–650 mg q 4–6 hr or PO, 1,000 mg tid to qid. Do not exceed
4 g/day.

PEDIATRIC PATIENTS

 PO or PR
 Doses may be repeated 4–5 times/day; do not exceed five doses in 24 hr; give
PO or by suppository.
 Age  Dosage (mg)

 0–3 mo  40

 4–11 mo  80

 12–23 mo  120

 2–3 yr  160

 4–5 yr  240

 6–8 yr  320

 9–10 yr  400

 11 yr  480

THERAPEUTIC ACTIONS
ROLAN J. BULANDOS JR.
BSN3-1

 Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating

center to cause vasodilation and sweating, which helps dissipate heat.
 Analgesic: Site and mechanism of action unclear.

INDICATIONS

 Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances,

bleeding diatheses, upper GI disease, gouty arthritis
 Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks
clinically significant antirheumatic and anti-inflammatory effects)
 Common cold, flu, other viral and bacterial infections with pain and fever
 Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce
incidence of fever and pain

ADVERSE EFFECTS

 CNS: Headache
 CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are
ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr
 GI: Hepatic toxicity and failure, jaundice
 GU: Acute kidney failure, renal tubular necrosis
 Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria,
anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia
 Hypersensitivity: Rash, fever

CONTRAINDICATIONS

 Contraindicated with allergy to acetaminophen.

 Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy,
lactation.

NURSING CONSIDERATIONS
ASSESSMENT
 History: Allergy to acetaminophen, impaired hepatic function, chronic alcoholism,
pregnancy, lactation
 Physical: Skin color, lesions; T; liver evaluation; CBC, LFTs, renal function tests

INTERVENTIONS

 Do not exceed the recommended dosage.

 Consult physician if needed for children < 3 yr; if needed for longer than 10 days;
if continued fever, severe or recurrent pain occurs (possible serious illness).
 Avoid using multiple preparations containing acetaminophen. Carefully check all
OTC products.
ROLAN J. BULANDOS JR.
BSN3-1

 Give drug with food if GI upset occurs.

 Discontinue drug if hypersensitivity reactions occur.
 Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should
be available as a specific antidote; basic life support measures may be necessary.
Teaching points
 Do not exceed recommended dose; do not take for longer than 10 days.
 Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
 Avoid the use of other over-the-counter preparations. They may contain
acetaminophen, and serious overdosage can occur. If you need an over-the-
counter preparation, consult your health care provider.
 Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in
voiding patterns.