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| • Analgesics e.g. Anadin, Disprin, De Witt's, Syndol, Solpadeine, etc. • Cold and `flu preparations e.g. Beechams Hot Lemon, Lemsip, Benylin Day & Night, Night Nurse, etc. • `Hangover'/stomach remedies e.g. Alka-Seltzer, Resolve, etc. Check BNF or with a community pharmacist for full list. |
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| The association between NSAIDs and GI complications is well established. A systematic review compared the relative risks of serious GI complications reported in people using NSAIDs.16 While low dose ibuprofen (less than 1.6g per day) was associated with the lowest relative risk, aspirin was associated with a risk similar to that of indomethacin and naproxen but less than that of other NSAIDs such as piroxicam and ketoprofen. While nurses cannot prescribe ibuprofen, it should always be considered as a treatment option, either for patients to purchase OTC or as prescribed by their GP. Aspirin should be used with caution in the elderly because of the age related decline in renal function. This is evident even in healthy elderly patients. NSAIDs should not be prescribed in high, anti-inflammatory doses without some knowledge of the patient's renal function.17 Aspirin can also cause salt and water retention, which may lead to inappropriate prescribing of diuretics.17 Following a full assessment and medication history, prescribing nurses should consider the benefits and risks of prescribing aspirin, deciding whether paracetamol is a safer alternative, or if referral to a GP is appropriate. When prescribing paracetamol and aspirin, nurses must caution patients and carers not to exceed the recommended dose. Advice about OTC products containing paracetamol and aspirin should be given to avoid accidental overdose. Prescribing in palliative careAnalgesics form the mainstay of managing cancer pain, with
the choice of drug based on the severity of the pain rather than the stage of disease.18
Both aspirin and paracetamol are effective in treating mild
pain in palliative care.18 They can be used to relieve minor aches, pains,
headaches and breakthrough pain when the patient is already receiving opioids. Aspirin (or
other NSAIDs) may also help control bone pain,10 where there is an inflammatory
component. Simple analgesics should be continued throughout all steps of the pain ladder (see figure 1). Analgesics are more effective if started at the earliest stage in the development of pain rather than for the relief of established pain.10 A regular analgesic regimen rather than `when necessary' (PRN or pro re nata) use, will also benefit the patient. While there may be occasions when a community nurse prescribes analgesics for the terminally ill, the NPF is limited in what to prescribe for these patients. Shared care with the palliative care team, GPs, oncologists and carers will best benefit these patients and enable effective management of pain. ConclusionsAspirin and paracetamol are often prescribed or purchased OTC as antipyretics and analgesics. Due to aspirin's association with the potentially fatal Reye's syndrome, nurses should not prescribe it for children under the age of twelve years. Paracetamol is the drug of choice for children. |
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Resource The Oxford Pain Internet Site - a useful internet site produced by the authors of Bandolier can be found at: |
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Prescribing aspirin in the elderly requires special consideration as the risk of ADRs and interactions with concurrent drugs is high (see table 1). Paracetamol is a safer alternative to aspirin when taken in therapeutic doses, but can be extremely toxic in overdose. Prescribers, patients and carers must be aware of any OTC preparations the patient is using. Advice should be given on the dangers of accidental overdose when using OTC products which contain aspirin or paracetamol. References 1
Dollery C. Aspirin. In: Therapeutic Drugs, Volume 1. Churchill Livingstone, Edinburgh
1991: A146-A150 |
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