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INTRODUCTION

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choline and magnesium salicylates (koe-leen mag-neez-ee-um sa-lis-i-lates)

Trilisate

Classification

Therapeutic: antipyretics, nonopioid analgesics

Pharmacologic: salicylates

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Indications
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Inflammatory disorders, including Rheumatoid arthritis, Osteoarthritis. Mild-to-moderate pain. Fever.

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Action
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Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins. Therapeutic Effects: Analgesia. Reduction of inflammation. Reduction of fever.

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Adverse Reactions/Side Effects
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EENT: tinnitus. GI: GI BLEEDING, dyspepsia, epigastric distress, nausea, abdominal pain, anorexia, hepatotoxicity, vomiting. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND LARYNGEAL EDEMA.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Report these signs to the physician immediately.

  • Be alert for signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

  • Watch for other signs of increased bleeding, such as excessive bruising, bleeding gums, and nosebleeds. Notify physician of these signs immediately.

  • Assess pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage the patient's pain and decreasing impairments.

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for salicylates.

  • Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

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Patient/Client-Related Instruction
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  • Advise patient that analgesics are usually more effective if given before pain becomes severe; emphasize that adequate pain control will allow better participation in physical therapy.

  • Advise patient about the likelihood of GI reactions (nausea, vomiting, indigestion, abdominal pain, loss of appetite). Instruct patient to report severe or prolonged GI problems or signs of liver toxicity (yellow skin or eyes, abdominal pain, severe nausea and vomiting, fever, sore throat, malaise, weakness, facial edema).

  • Advise patient to reduce alcohol intake because alcohol increases the risk of gastric toxicity.

  • Instruct patient to report excessive or prolonged headache or ringing/buzzing in the ears (tinnitus); these signs may indicate salicylate toxicity.

  • Caution patient about the use of over-the-counter products that contain aspirin, other NSAIDs, or acetaminophen while taking high doses of salicylates. Use of multiple NSAIDs increases the risk of toxicity and overdose.

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Pharmacokinetics
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Absorption: Well absorbed after oral administration.

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Distribution: Rapidly and widely distributed; crosses the placenta and enters breast milk.

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Protein Binding: 90–95%.

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Metabolism and Excretion: Extensively metabolized by the liver; inactive metabolites excreted by the kidneys. Amount excreted unchanged by the kidneys depends on urine pH; as pH increases, amount excreted unchanged increases from ...

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