Salsalate

INTRODUCTION

Indications

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

Action

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

Adverse Reactions/Side Effects

EENT: tinnitus. GI: GI BLEEDING, dyspepsia, epigastric distress, nausea, abdominal pain, anorexia, hepatotoxicity, vomiting. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND LARYNGEAL EDEMA.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, dermatitis, exfoliation). Be especially alert for severe skin reactions that may indicate Stevens-Johnson syndrome or toxic epidermal necrosis. Notify physician immediately if these reactions occur. Allergic reactions are more common in people with asthma, nasal polyps, or aspirin-induced allergies.

• 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.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Salicylates and other NSAIDs can increase BP in certain patients.

• Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

Interventions

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

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

Patient/Client-Related Instruction

• 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 risks of gastric irritation. Instruct patient to notify health care professional of GI effects such as severe or prolonged nausea, vomiting, heartburn, indigestion, loss of appetite, and abdominal pain.

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

• Inform patient that salicylates and other NSAIDs may impair bone and cartilage healing. Advise patient to consult physician about salicylate use, especially after fractures, spinal fusion, and other bone surgeries.

• 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 ...