Name: Acetylsalicylic Acid/Aspirin
Class: Salicylate
Mechanism: Irrevers. acetylation of cyclooxygenase ® inhib. of prostaglandin synth. ® ¯ prostaglandins, thromboxanes, & prostacyclins ® analgesia, inhib. of platelet aggregation, anti-inflammatory effects, anti-pyresis, stim. of central resp. center.
Absorption: Rapidly absorbed in stomach and upper intestine. Also absorbed through skin. pKa = 3.5, so gastric acid ® absorption. Enteric coating may delay absorption.
Dist.: pH-dependent passive (non-ionic) diffusion. Active transport in renal tubules. 90% bound to albumin.
Metabolism.: Hydrolyzed by tissue/blood esterases. Conjugated in liver.
Excretion, t½: Salicylate & Metabolismolites excreted in urine. pH-dependent—30% excretion in alkaline urine, 2% in acidic urine. Low doses (600 mg) = 1st order; t½ = 3-5 hr. High doses (4 g/d) = 0 order, t½ = 15 hr.
Utility: Analgesia—mild-mod. pain, somatic pain. No dependence or tolerance. Low efficacy for visceral pain. Anti-inflammatory—also a Mechanism of analgesia. Anti-pyresis—inhib. bacterial pyrogens in CNS; blocks hypothalamic response to IL-1. ¯ Platelet aggregation—2° to inhib. of thromboxane synth.
Toxicity/S.E.s: GI bleeding and ulceration—usu. due to high doses, but may occur w/lower doses. Painless bleeding may cause iron-deficiency anemia. Hypersensitivity—usu. in patients w/nasal polyps, asthma, or chronic urticaria ® urticaria, angioedema, hypotension. Bleeding—C/i w/severe hepatic damage, vit. K deficiency, hemophilia. Hepatotoxicity w/CT disorders. May be involved in Reye’s Synd.; not recommended for kids w/chicken pox or influenza. Pregnancy—reduced birth weight, perinatal mortality, ante/post-partum hemorrhage, prolonged gestation. Renal effects—low doses ® ¯ uric acid excretion; high doses ® uric acid excretion. Poisoning—acute ® resp. alkalosis (hyperventilation), Metabolismolic acidosis (fixed anion). Correlates w/plasma conc. Chronic ® higher brain conc. than in acute poisoning; greater toxicity than plasma conc. would suggest. More resistant to treatment than acute poisoning.
Drug Interactions: Alcohol ® gastric bleeding. Displacement of oral hypoglycemia drugs, NSAIDS, methotrexate, phenytoin, oral anti-coagulants, & sulfonamides from protein binding sites.
Special Features: May exacerbate acute gout attacks.