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Hepatic toxicity may be serious, and acute overdose with 10 to 15 g can cause fatal hepatic necrosis (see Chapter 19, Liver Diseases, and Chapter 27, Medical Emergencies). Aspirin Effects: Aspirin has analgesic, antipyretic, anti-inflammatory, and antiplatelet effects. Preparations and dosages 325 to 650 mg PO q4h PRN (maximum dose, 4 g/d). Acute Inpatient Care • Pain 9 Rectal suppositories, 300 to 600 mg q3–4h may be irritating to the mucosa and have variable absorption. Enteric-coated tablets may cause less injury to the gastric mucosa than buffered or plain aspirin.
Celecoxib is contraindicated in patients with allergic-type reactions to sulfonamides. Opioid analgesics Effects: Opioid analgesics are pharmacologically similar to opium or morphine and are the drugs of choice when analgesia without antipyretic action is desired. Preparations and dosages: Table 1-1 lists equianalgesic dosages. Constant pain Constant pain requires continuous (basal) analgesia with supplementary, PRN doses for breakthrough pain at doses of roughly 5% to 15% of the daily basal dose.
Cultures are ideally obtained prior to initiation of antibiotics; however, antibiotics should not be delayed if serious infection is suspected. TREATMENT Not all fevers require treatment. Antipyretic drugs may be given to decrease associated discomfort. Aspirin, 325 mg, and acetaminophen, 325 to 650 mg PO 8 Chapter 1 • Patient Care in Internal Medicine or per rectum q4h, are the drugs of choice. Aspirin should be avoided in adolescents with possible viral infections because this combination has been associated with Reye syndrome.