Salicylic Acid (Aspirin)


Article Author:
Hasan Arif


Article Editor:
Sandeep Aggarwal


Editors In Chief:
Kranthi Sitammagari
Mayank Singhal


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Frank Smeeks
Kristina Soman-Faulkner
Radia Jamil
Patrick Le
Sobhan Daneshfar
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
6/1/2019 3:04:57 PM

Indications

Salicylates have been derived from the willow tree bark. The Sumerians were noted to have used remedies derived from the willow tree for pain management as far back as 4000 years ago. Hippocrates used it for managing pain and fever. He even utilized tea brewed from it for pain management during childbirth.

In a 1763 clinical trial, the first of its kind, Reverend Edward Stone studied the effects of willow bark powder for treating fever. About a 100 years later the effects of the willow bark powder were studied for acute rheumatism.

In 1828, Professor Johann Buchner used salicin, the Latin word for willow. Henri Leroux used it to treat rheumatism after isolating it in a crystalline form in 1829. In the 1800s, the Heyden Chemical Company was the first to mass produce salicylic acid commercially. It was not until 1899 when a modified version by the name of acetylsalicylic acid was registered and marketed by Bayer under the trade name aspirin.

Even though it has been available since the early 1900s, its real mode of action was not known until the late 1970s.

Some of the indications for aspirin use are as follows:

  • Angina pectoris
  • Angina pectoris prophylaxis
  • Ankylosing spondylitis
  • Cardiovascular risk reduction
  • Colorectal cancer
  • Fever
  • Ischemic stroke
  • Ischemic stroke: Prophylaxis
  • Myocardial infarction
  • Myocardial infarction: Prophylaxis
  • Osteoarthritis
  • Pain
  • Revascularization procedures: Prophylaxis
  • Rheumatoid arthritis
  • Systemic lupus erythematosus

Mechanism of Action

Aspirin is a cyclooxygenase-1 (COX-1) inhibitor. It is a modifier of the enzymatic activity of cyclooxygenase-2 (COX-2). Unlike other NSAIDs (ibuprofen/naproxen), which bind reversibly to this enzyme, aspirin binding is irreversible. It also blocks thromboxane A2 on platelets in an irreversible fashion preventing platelet aggregation.[1][2][3][4]

Researchers hypothesize that due to the blocking of the COX pathway, the arachidonic acids are shuttled into the lipoxygenase pathway. The production of anti-inflammatory lipoxins is a result of the modification of prostaglandin-endoperoxide synthase (PTGS2), also called COX-2, that results in the production of lipoxins, most of which are anti-inflammatory. These compounds are called aspirin-triggered lipoxins, aspirin-triggered resolvins, and aspirin-triggered maresins.

Administration

Aspirin can be administered via the oral, rectal, and intravenous (IV) route.

It is available in different doses, the lowest being 81 mg also called a baby aspirin.

  • Tablet: 325 mg, 500 mg
  • Delayed-release tablet: 81 mg, 325 mg, 500 mg, 650 mg
  • Chewable: 81 mg
  • Suppository: 60 mg, 120 mg, 200 mg, 300 mg, 600 mg
  • Intravenous: 250 mg, 500 mg

Pharmacokinetics

Aspirin absorption from the gastrointestinal (GI) tract depends on the formulation state. When consumed as a liquid preparation, it is rapidly absorbed as opposed to tablets. Its hydrolysis yields salicylic acid. Salicylic acid has a narrow therapeutic window. If maintained within that narrow range, it provides the appropriate anti-inflammatory effect.

Aspirins absorption is pH sensitive at the level of the small intestine. Absorption is higher through the small intestine than the stomach for the same pH range. At pH 3.5 or 6.5, aspirin's intestinal absorption is greater than the gastric absorption of the compound. The stomach does not absorb aspirin at pH 6.5.

Salicylate elimination occurs through two pathways via the creation of salicyluric acid and salicyl phenolic glucuronide. Salicylic acid is renally cleared which can be increased by raising the urinary pH. Medications like antacids can increase renal clearance as they raise urinary pH. It can cross the blood-placental barrier. It is also expressed in breast milk.

Pharmacodynamics

Almost 90% of COX inhibition can be achieved with administration of 160 to 325 mg of aspirin. These effects last for about 7 to 10 days which usually correspond with the lifespan of a platelet. Prostacyclin inhibition can be achieved with the use of higher doses. This inhibition occurs in the endothelial cells of blood vessels.

Adverse Effects

Aspirin has had multiple metanalyses which suggest that aspirin reduces the risk of major adverse cardiovascular events in patients who have diabetes without cardiovascular disease, while also causing a trend toward higher rates of bleeding and gastrointestinal complications.[5][6][7][8]

The most common side effect of aspirin is gastrointestinal upset ranging from gastritis to gastrointestinal bleed.

Hypersensitivity 

Hypersensitivity to NSAIDs is common among the general population. The rate is about 1% to 2%. Symptoms could be as mild as a simple rash to angioedema and anaphylaxis. Patients with asthma or chronic rhinosinusitis, the prevalence of these allergic symptoms could be as high as 26%. If this is accompanied by nasal polyps and inflammation of the respiratory tract with eosinophils, it is called the aspirin triad. NSAID-exacerbated respiratory disease (NERD) is a new term associated with this syndrome due to upper and lower respiratory mucosal inflammation.

Reye Syndrome 

Reye syndrome, named after the Australian pathologist, Dr. R.D. Reye was first described in 1963. It is a rare but fatal condition with an estimated mortality rate of between 30% to 45%. It is a form of encephalopathy secondary to fatty changes in an otherwise healthy liver. The clinical vignette of Reye syndrome constitutes a viral upper respiratory tract infection in children and concomitant administration of aspirin for the treatment of fever. It is thought that mitochondrial injury secondary to the preceding viral illness is the first hit to both the liver and the brain. Aspirin or similar compounds provide the second hit completing the syndrome. The incidence has dramatically decreased due to better awareness and use of acetaminophen for the management of fever in children instead of aspirin.

Even though the association between aspirin and Reye syndrome exists, some authors argue that at the time of diagnosis, salicylate levels were not routinely checked, biopsies were not obtained, and genetic/inborn errors of metabolism were not ruled out.

Intracerebral Hemorrhage

Aspirin increases the risk of intracranial bleeding (RR = 1.65; 95% CI, 1.06 to 5.99) versus placebo.

Contraindications

People who are allergic to ibuprofen should not take aspirin as there is cross-reactivity. Patients who have asthma should be cautious if they have asthma or known bronchospasm associated with NSAIDs.

Aspirin increases the risk of GI bleeding in patients who already suffer from peptic ulcer disease or gastritis. The risk of bleeding is still present even without these conditions if there is concomitant consumption of alcohol or if the patient is on warfarin. Patients who have inborn coagulopathies such as hemophilia should avoid all salicylates. Acquired diathesis as in the setting of dengue or yellow hemorrhagic fever should avoid the use of aspirin.

Patients who have glucose-6-phosphate dehydrogenase deficiency are at risk of acute intravascular hemolytic anemia. Many factors can precipitate these hemolytic episodes. Aspirin is one such know cause.

Avoid using aspirin in children who are suffering from a viral infection to avoid Reye syndrome.

Monitoring

Therapeutic Index and Toxic Doses 

Therapeutic drug levels for aspirin are 150 to 300 mcg/mL (salicylate).

Toxic Levels: Greater than 300 mcg/mL

Timing: 1 to 3 hours after the dose

Time to Steady State: 5 to 7 days

Plasma levels of aspirin can range from 3 to 10 mg/dL for therapeutic doses to as high as 70 to 140 mg/dL for acute toxicity. Due to delayed absorption of certain preparations, levels should be checked 4 hours after consumption and every 2 hours after that until maximum levels are reached.

Treatment needs to be individualized based on symptomatology as well as levels.

Aspirin levels do not need to be monitored in most cases. For certain diseases, serum creatinine at baseline, along with serum drug levels if patients have adult or juvenile rheumatoid arthritis, Kawasaki disease, or arthritis/pleurisy.

Toxicity

Patients who have aspirin toxicity can have a myriad of symptoms. Symptoms of mild toxicity can be but not limited to tinnitus, dizziness, lethargy, nausea, and vomiting. For more severe toxicity the signs and symptoms include hyperthermia, tachypnea leading to respiratory alkalosis, high anion gap metabolic acidosis, hypokalemia, hypoglycemia, seizures, coma and cerebral edema. Death commonly occurs due to cardiopulmonary edema secondary to pulmonary edema.[9][10][11]

Treatment for salicylate toxicity is based on salicylate concentration, acid-base status, volume status, electrolytes, GI decontamination, airway protection and respiratory status, and to enhanced elimination.

Acuity of exposure, type of formulations, co-ingestions, comorbidities, and clinical status of the patient can affect salicylate levels in serum. Of all of these, particularly acid-base status can influence how the drug is handled by the body the most. Hence, initial and subsequent levels are recommended to assess trajectory. Different laboratories may report salicylate levels differently. One must pay attention to salicylate concentration units. The conversion is as follows:

  • 100 milligrams per deciliter (mg/dL) equals
  • 1000 milligrams per liter (mg/L), or
  • 7.24 millimoles per liter (mmol/L) 

One must draw serial salicylate levels to show that the levels are declining and thus also establishing a reduction in absorption.

Aspirin causes high anion gap metabolic acidosis and respiratory alkalosis. The high anion gap comes from the addition of salicylic acid as well as the generation of lactic acid (due to uncoupling of oxidative phosphorylation causing anaerobic respiration). The respiratory alkalosis is due to direct stimulation of the respiratory center. Acidemia worsens symptomology. Salicylate exists in the blood in both ionized as well as uncharged forms. Acidemia shifts salicylate from its ionized to unionized forms making it more lipophilic and allowing increased penetration into the central nervous system (CNS). Volume status and electrolyte monitoring are paramount as brain glucose utilization increases in the setting of aspirin toxicity even when serum glucose levels are normal. Hypokalemia worsens acidemia, and hence, supplementation may be required.

Alkalization of the urine can be achieved via a bicarbonate drip (3 ampules of 50 meq/50 ml for a total of 150 meq in 1000 ml of D5W). However, this may worsen hypokalemia, and hence, the special attention to potassium supplementation is required.

Activated charcoal and/or bowel irrigation are recommended in both acute as well as chronic ingestion because of extended-release preparations that are available on the market. In the setting of worsening mental status, one must exercise caution to avoid aspiration pneumonia.

Airway protection might be required in the setting of worsening mental status or acute injury to the lung.

Maintaining an alkaline pH is important to avoid CNS toxicity. This can be achieved by increasing the minute ventilation to avoid carbon dioxide (CO2) retention. Bicarbonate drips can be used to achieve a pH of no greater than 7.5 during the intubation process.

Hemodialysis is an efficient treatment of salicylate toxicity. Once the protein bound fraction is saturated, removal of the free fraction is effective through dialysis. Due to this efficiency, the clearance of salicylate is reduced to hours rather than days

Peritoneal dialysis does not efficiently remove salicylate.

Indications for hemodialysis are as follows

  • Aspirin levels in acute ingestions of 100 mg/dL with or without symptoms
  • Aspirin levels in chronic ingestions 40 mg/dL with or without symptoms
  • Any neurotoxicity (tinnitus, coma, seizures) with any level
  • Renal failure (as the drug needs to be cleared by the kidney)
  • Acute pulmonary edema
  • Cardiovascular compromise including volume overload

Hemodialysis does not only clear the drug from circulation but also restores the internal acid-base and electrolyte balance.

Enhancing Healthcare Team Outcomes

Aspirin is available over the counter and is commonly involved in pediatric overdoses. Healthcare workers including pharmacists and nurses should educate parents and caregivers about the potential toxicity of aspirin. The medication should be kept in a closed cabinet away from the reach of children.


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Salicylic Acid (Aspirin) - Questions

Take a quiz of the questions on this article.

Take Quiz
A healthy 75-year-old female is seen in the clinic for follow up of her hypertension. Her blood pressure has been well controlled for the past three decades with a diuretic. She has no complaints. She has been a one pack per day smoker for the past four decades. She has no allergies. She has never had a surgery. Which of the following preventive interventions is most appropriate for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the mechanism of action of aspirin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the half-life of high dose aspirin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient with chronic coronary disease is scheduled for surgery in the next few hours. It is not possible to know with certainty when he took his last aspirin. What test could be done as a pre-op evaluation of bleeding risk?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is responsible for an aspirin intolerance?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the mechanism of action of aspirin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following drugs used in the prevention of thrombosis inhibits the enzyme cyclooxygenase?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Aspirin is a non-opioid analgesic. Which enzyme does it inhibit?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which pharmacologic property of aspirin is important in the treatment of myocardial infarction?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is most likely to cause tinnitus?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following about the inhibition of cyclooxygenase (COX) enzymes by aspirin is true?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which analgesic medication also has anticoagulant properties?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which anticoagulant inhibits cyclooxygenase?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following drugs undergoes zero-order kinetics?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following drugs is better absorbed in an acidic environment?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the mechanism of action of topical salicylic acid?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which medication is most likely to cause prolonged bleeding time?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following statements are correct regarding acetylsalicylic acid?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
How long does aspirin affect the cyclooxygenase pathway?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In adults without diabetes mellitus, what is the daily prophylaxis dose of aspirin for coronary artery disease?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is a salicylate?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is a property of aspirin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Aspirin affects the conversion of arachidonic acid to prostaglandins and thromboxanes. Aspirin affects platelets via this mechanism. How long does the effect last?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the mechanism of action of aspirin for pain?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Aspirin is used in the management of which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the active ingredient in aspirin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Where is the majority of aspirin absorbed?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which medication is most commonly associated with heartburn?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which medication has the most rapid anti-inflammatory effect when given orally?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the mechanism of action of aspirin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the purpose of topical salicylic acid?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following drugs is most likely to cause stomach ulcers?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient on arrival in the emergency department is ordered a chewable aspirin for immediate administration. Before tests have given a conclusive diagnosis, the presumption is that the patient is having a myocardial infarct. What is the reason for administering the aspirin in this situation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Through which of the following substances does aspirin exert its anti-clotting effect?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Aspirin typically is prescribed to clients for which of the following reasons? Select all that apply.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Salicylic Acid (Aspirin) - References

References

Zimmermann P,Curtis N, The effect of aspirin on antibiotic susceptibility. Expert opinion on therapeutic targets. 2018 Nov;     [PubMed]
Willow Bark 2006;     [PubMed]
Choline Magnesium Salicylate 2006;     [PubMed]
Salsalate 2006;     [PubMed]
Aspirin 2006;     [PubMed]
Handa O,Takayama S,Mukai R,Suyama Y,Majima A,Fukui A,Omatsu T,Naito Y, A review of the mechanism and prophylaxis of acetyl salicylic acid-induced injury of the small intestine. Free radical research. 2018 Dec;     [PubMed]
Kosinski P,Sarzynska-Nowacka U,Fiolna M,Wielgos M, The practical use of acetylsalicylic acid in the era of the ASPRE trial. Update and literature review. Ginekologia polska. 2018;     [PubMed]
Navaratnam K,Alfirevic Z,Pirmohamed M,Alfirevic A, How important is aspirin adherence when evaluating effectiveness of low-dose aspirin? European journal of obstetrics, gynecology, and reproductive biology. 2017 Dec;     [PubMed]
Blanca-Lopez N,Perez-Alzate D,Canto G,Blanca M, Practical approach to the treatment of NSAID hypersensitivity. Expert review of clinical immunology. 2017 Nov;     [PubMed]
Kristensen DM,Mazaud-Guittot S,Gaudriault P,Lesné L,Serrano T,Main KM,Jégou B, Analgesic use - prevalence, biomonitoring and endocrine and reproductive effects. Nature reviews. Endocrinology. 2016 Jul;     [PubMed]
Patrignani P,Patrono C, Cyclooxygenase inhibitors: From pharmacology to clinical read-outs. Biochimica et biophysica acta. 2015 Apr;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of PA-Hospital Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for PA-Hospital Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in PA-Hospital Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of PA-Hospital Medicine. When it is time for the PA-Hospital Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study PA-Hospital Medicine.