Pediatric emergency medicine trisk 1078

may cause gastrointestinal bleeding, but this risk is very small These agents also cause renal and hepatic dysfunction; therefore, they should be used with caution in children with renal or hepatic disease They may prolong bleeding time, but their effect on platelets (inhibition of aggregation) is reversible There is some concern that NSAIDs may adversely affect bone fracture healing, but to date there is no definite evidence to support this Aspirin is one of the oldest analgesic medications, but it is rarely used now because of the better side effect profile of other analgesics and the perceived risk of Reye syndrome related to aspirin Ibuprofen is the most commonly used oral NSAID Ibuprofen is as effective as oxycodone for analgesia Ibuprofen is available in liquid form, making it suitable for use in children older than months The recommended dosage of ibuprofen is to 10 mg/kg given every hours The recommended dosage for ibuprofen in older children is 200 to 400 mg/dose given every hours (maximum 40 mg/kg/day) for mild to moderate pain As with acetaminophen, there are several different formulations of ibuprofen, so parents should be advised carefully about how to properly measure doses for their child Selective COX-2 inhibitors have not been shown to be more effective than nonselective NSAIDs, they are less likely to impair platelet function and cause gastritis, however data in children are limited These medications are most useful for older children who have a hypersensitivity to NSAIDs There is concern in adults that COX-2 inhibitors increase the risk of thrombotic cardiovascular events and they should be used with caution Currently, these medications are recommended for those who require long-term NSAID administration for chronic pain syndromes Opioids Codeine is an orally administered narcotic analgesic used for minor pain Significant effort has been invested in uncovering the pharmacogenetic effects of codeine in children When given the same dose, some children will have a suboptimal response, others will respond well and still others will have toxic manifestations In 2013, after several deaths in children receiving codeine for pain after tonsillectomy and adenoidectomy, the FDA placed a black box warning recommending that codeine be avoided in this population The children who died were found to be ultrarapid metabolizers of substrates of cytochrome CYP2D6 The FDA further revised this black box warning in 2017 listing age