Talking About Salicylates

• Salicylate is a medication that controls pain, inflammation, and fever. 
• Salicylate is available over the counter without a prescription. 
• Aspirin and other salicylates remain essential agents, especially in the prevention of angina. 

Salicylates are pain medications used to control pain, fever and inflammation. They can be given over the counter without a doctor’s  prescription. Salicylates are cheap, easily available, and reliable drugs with a few tolerable adverse effects.  

The most commonly used salicylate is Aspirin.  

Others are: 

• Choline magnesium trisalicylate 
• Diflunisal  
• Olsalazine  

Salicylates have various effects due to their different mechanisms of action. Pain relief occurs primarily due to the inhibition synthesis of prostaglandins- the chemical mediators that sensitize nerve cells to pain.  

Inflammation is also reduced due to decreased prostaglandin synthesis and the release that occurs during inflammation.  

Salicylates Increase Sweating  & Decrease Temperature

Salicylates help lower fever by increasing sweating. They stimulate the hypothalamus and produce peripheral vasodilation. That promotes heat loss through the skin and cooling by evaporation. 

Prostaglandin E increases body temperature, which the salicylates inhibit. Eventually, the temperature lowers when prostaglandin E and other inflammatory mediators are not produced.  

Among all the salicylates, Aspirin inhibits platelet aggregation. It lowers the chances of blood clot formation by interfering with the production of Thromboxane A2– a substance necessary for platelet aggregation. Unlike Aspirin, other NSAIDs have a temporary effect on platelet aggregation.   

Administer salicylates in the lowest possible doses. 

Drug Interactions

Salicylates are highly protein-bound drugs and can displace other protein-bound drugs from the sites they bind normally. That eventually increases the serum concentration of the unbound active drug, resulting in their potentiated effects.  

Some drug interactions that can occur when taken with salicylates are: 

• Oral antidiabetic agents, oral anticoagulants, heparin, methotrexate, and insulin: might show increased effects and increased risk of toxicity. 
• Probenecid, sulfinpyrazone, and spironolactone: may have decreased effects. 
• Corticosteroids: can result in decreased plasma salicylate levels and an increased risk of ulcers.  
• Antacids and other alkalizing drugs: can reduce the efficacy of salicylates.  
• Beta-blockers, or beta receptor antagonists, and ACE inhibitors: can result in decreased antihypertensive effects. 
• NSAIDs: may have reduced therapeutic effects and an increased risk of GI effects.
  

Adverse Reactions of Salicylates

• Nausea and vomiting with gastric distress 
• Diarrhea 
• Increased thirst 
• Tinnitus 
• Impaired vision  
• Hyperventilation or rapid breathing 
• Bleeding tendencies- choline magnesium is the only salicylate that does not pose the risk of increased bleeding.  
• Hearing loss when taken for a long time 
• Reye’s syndrome when given to children with chickenpox or flu-like symptoms. Therefore as a nurse, you should never administer salicylate to children to lower body temperature. 
  

Due to increased side effects, prescribe Aspirin and other salicylates in the lowest possible dose. 

Adverse Reactions of Salicylates

Before you start the therapy, assess the patient extensively.  

• Assess the pain and inflammation the patient has before starting the therapy and monitor the reduction after taking the drug. It indicates the drug’s effectiveness. 
• Monitor the patient closely for any signs and symptoms of bleeding. Educate them to inform you as soon as possible if they notice blood in stool, vomit, cough, or from gums. Salicylates have a risk of increased bleeding time that can become life-threatening. Therefore,  advise the patient to use a soft brush and wear shoes to prevent injuries and bleeding.  
• If your patient has to undergo surgery, inform the doctor that they take salicylates and when they have taken the last dose. If the physician or the surgeon advises stopping the therapy, make sure the patient does not take it.  
• Salicylates, when taken for a long time, can result in ototoxicity. You should check the auditory functions of the patient before and during the therapy.  
• With salicylate therapy, periodically check the patient’s complete blood count, prothrombin time, platelet count, liver function tests, and renal tests to detect any abnormalities.  
• Be alert for any adverse drug reactions with salicylate therapy. Monitor the patient for bronchospasm, especially if they have aspirin sensitivity, asthma, nasal polyps, and allergies.  
• When the patient takes salicylates for a long time, check their serum salicylate levels as it can help prevent toxicity and adverse drug reactions. A therapeutic level in a patient with arthritis is 10 to 30 mg/mL. 
• Evaluate the patient’s and his family members’ knowledge about salicylates. Make sure to educate them.  

Key Nursing Diagnoses

The nursing diagnoses with salicylates therapy involve: 

• Acute pain due to any underlying health condition  
• Risk for injury due to adverse drug reactions  
• Deficient knowledge of the drug therapy 

Planning Outcome Goals for Salicylate Therapy

• • The patient will acknowledge a reduction in pain  
  • No serious drug interactions and complications will occur during the drug therapy 
  • The patient and their family have a complete understanding of the drug therapy.

Salicylates Nursing Implementations

• Do not give salicylates on an empty stomach.  
• If the patient has dysphagia or trouble swallowing the drug, crush the tablet and give it with food or fluid. Do not crush the enteric-coated tablets, as they will lose their protective covering that helps prevent adverse GI effects.  
• If any adverse drug reaction occurs, such as bleeding, tinnitus, hearing loss, or adverse GI effects, hold the salicylate therapy and inform the doctor soon.  

Salicylate Therapy Nursing Evaluation

• The patient acknowledges that the pain is relieved.  
• The patient does not have any adverse drug reactions, especially upset GI.  
• The patient and his family have a complete understanding of the drug therapy

The Bottom Line

Aspirin and other salicylates remain essential agents, especially in the prevention of angina. To overcome GI adverse effects, you can administer enteric-coated preparations.  

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