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Pharm Exam 4 > 56: NSAIDs and Treatment of Gout > Flashcards

56: NSAIDs and Treatment of Gout Flashcards

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1
Q

4 classic inflammatory symptoms

A

redness/rubor
swelling/tumor
heat/calor
pain/dolor

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2
Q

molecular inflamamtory mediators

A 
bradykinin
substance 
histamine
5HT
arachidonic acid metabolites: prostaglandin, thromboxanes, prostacyclin
cytokine TNF-a
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3
Q

functional characteristics of NSAIDs

A

analgesia
antipyretic
anti-inflammatory
target prostaglandin production

therefore… acetaminophen is not and NSAID because it is not anti-inflammatory

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4
Q

convert arachindonic acid to prostaglandins

A

COX

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5
Q

consituitve, protective COX

v.

inducible, inflammatory COX

A

COX-1

COX-2

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6
Q

what can be used for antipyretic in children and viral diseases?

A

acetaminophen

aspirin and other PG synthesis inhibitors NOT recommended; can be used in adults

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7
Q

MOA aspirin

A

irreversible COX inhibitor and therefore inhibitor of PG synthesis

significant portion hydrolyzed to salicylic acid (reversible COX inhibitor)

travels bound to plasma prtns

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8
Q

low dose v. high dose aspirin

A

low dose: analgesic antipyretic

high dose: antiinflammatory

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9
Q

how does aspirin produce an anti-pyretic effect?

A

blocks production of PG in CNS to reset temperature control at hypothalamus, facilitating heat dissipation by vasodilatation

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10
Q

ASA ______- bleeding time

A

prolooongs

anti-thrombotic and anti-coagulant effects

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11
Q

phophylactic uses of ASA

A

inhibit platelet hyperaggregaion

protective against CAD, MI, DVT post op

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12
Q

adverse effects ASA

A
  • GI tract upset due to COX1 inhibition **
  • GI irritation due to inhibition of cytoprotective PG (PGE2 and PGI2 decrease acid secretion)
  • platelet inhibition –> prolonged bleeding time
  • hepatic and renal toxicity
  • hypersensitivity (pruritus)
  • tinnitus
  • reye’s syndrome (encephalopathy)
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13
Q

what kinds of hepatic and renal toxicity may occur with ASA?

A

aymptomatic hepatitis

decreased kidney function with chronic use

  • decreased renal blood flow
  • sodium retention/edema
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14
Q

NSAID for gout and ankylosing sponylitis

A

indomethacin

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15
Q

have analgesic, antipyretic, and anti-inflammatory effects but with less GI adverse effects

A

COX2 inhibitors

no impact on platelet aggregation (COX1) - incidence of thrombotic events associated with COX2 inhibitors

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16
Q

celecoxib is FDA approved for ..

A

RA and osteoarthritis

black box warning- cardiovascular

17
Q

actions of acetaminophen

A

pain reliever and fever reducer (analgesic and anti-pyretic only) not anti-inflammatory

18
Q

acetaminophen might react with

A

ethanol, isoniazid etc

because metabolized by cP450

19
Q

therapeutic dose of acetaminophen

A

15mg tid

narrow therpeutic index, 150 - liver necrosis, 350 - liver failure

20
Q

how is capsaicin used to treat RA, osteoarthritis, and neuralgia?

A

topically

binds and activates vanilloid receptor –> release substance P
prolonged activation of these neurons depletes and prevent re-accumulation of substance P

21
Q

limitations for each NSAID

A

ketorlac- GI and renal adverse effects limit use
Indomethacin and tolmetin - greatest toxicity
Salicylate, ASA and ibuprofen - least toxic
Diclofenac and sulindac - increased liver function abnormalities
celecoxib - safest for pts with high risk GI, more risk CV toxicity and $

22
Q

metabolic disease characterize dby recurrent episodes of acute arthritis due to deposits of monosodium urate (uric acid crystals) in joints and cartilage

A

gou

usually associated with hyperuriciemia

23
Q

first line treatment gout

A

NSAIDs - indomethacin

can use other NSAID (not asa), corticosteroids or intra-articular steroid injection as well

24
Q

how does colchicine treat gout?

A

reduces pain and inflammation without altering metabolism or excretion of uric acid
(inhibits leukocyte migration and phagocytosis)

adverse effect = diarrhea

25
Q

xanthine oxidase inhibitors

A

allopurinol
febuxostat

reduce production of UA

26
Q

uricosuric drugs

A

probenecid
sulfinpyrazone

increase renal excretion of UA

Pharm Exam 4 (12 decks)

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