###### Created: 2023-10-18 09:28 ###### Areas & Topics: #medicine #pharmacology ###### Note Type: #permanent ###### Connected to: [[Non-Steroidal Anti-Inflammatory Drugs (NSAID's)]] - Around 4000 years ago, ancient Sumerians and Egyptians began using willow tree bark as a remedy for pain management. - Hippocrates was also noted to make tea from willow tree bark to control pain during childbirth. - In 1828, willow tree bark was refined into yellow crystals and named Salicin (from the genus for willow tree). - It was then be further processed to create salicylic acid. - Acetylation of salicylic acid was then what would lead to the creation of Aspirin as we know it today. - Today, Aspirin is an NSAID (see [[Non-Steroidal Anti-Inflammatory Drugs (NSAID's)]] for general mechanism of action) used for analgesia ### Mechanism of Action - What differentiates aspirin from the other NSAIDs is the way it binds to COX-2 and interacts with [[Thromboxane]] A2. - Unlike the other NSAIDs, Aspirin binds irreversibly to COX-2 - Additionally, low-dose, long-term aspirin use also irreversibly blocks the formation of thromboxane A2 in platelets, producing an inhibitory effect on platelet aggregation, causing it to thin blood. ### Adverse Effects - The adverse effects of Aspirin are shared with the other NSAIDs, mainly being exacerbation of asthma (bronchospasm) and increased risk of GI bleeding. ### Contraindications - [[Reye's Syndrome]] - Aspirin Hypersensitivity (Aspirin Exacerbated Respiratory Disease) ### Aspirin Exacerbated Respiratory Disease (AERD) - AERD, also known as Aspirin-Induced Asthma or Aspirin Hypersensitivity, is a condition characterised by the three key features of [[Asthma]], [[Nasal Polyps]] and NSAID/Aspirin Intolerance, leading to an acute asthma attack and symptoms similar to anaphylaxis (including rhinorrhoea, periorbital oedema and facial flushing). - This triad is also known as Samter's Triad, and is important to consider when starting patient's on aspirin or other NSAIDs as those with Samter's Triad have around a 30% risk of having AERD. - Patient's with Samter's Triad will usually initially present to services with complaints of anosmia or nasal obstruction. ### Resources https://pubmed.ncbi.nlm.nih.gov/16579869/ https://bnf.nice.org.uk/drugs/aspirin/ https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.14520 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951071/ https://app.pulsenotes.com/medicine/respiratory/notes/asthma-adults