Acetaminophen + NSAIDs Lecture

Question 1

what is step 1 of the WHO Pain Ladder?

Answer 1

when a pt rates their pain 1-3/10
they can take NSAIDs

Question 2

what is step 2 of the WHO Pain Ladder?

Answer 2

when a pt rates their pain around 4-7/10
can take weak opioids

Question 3

what is step 3 of the WHO Pain Ladder?

Answer 3

when a pt rates their pain around 8-10/10
can take strong opioids

Question 4

what is step 4 of the WHO Pain Ladder?

Answer 4

typically surgery, pts have nerve blocks, epidurals, etc. *not anything with PT

Question 5

difference in dosing with aspirin for pain vs. platelets?

Answer 5

higher dose for pain, lower for platelets

Question 6

Characteristics of COX-1?

Answer 6

physiological housekeeping role (whole body maintenance)
- vascular homeostasis
- GI blood flow
- renal blood flow/function
- proliferation of intestinal mucousa
- platelet function

Question 7

Characteristics of COX-2?

Answer 7

as needed role
- inflammation
- fever
- pain
- ovulation
- placental function
- uterine contractions

Question 8

if someone has/had cardiovascular issues, what NSAID should they take and why?

Answer 8

Naproxen as it has the lowest cardiotoxicity risk of all NSAIDs

Question 9

which NSAIDs have potentially less GI toxicity?

Answer 9

Cox-2 semi selective (Diclofenac + Nabumetone)

Question 10

what is the most common NSAID used for OA and RA?

Answer 10

Celecoxib
decreases pain/swelling and increases function

Question 11

ADRs to keep in mind for all NSAIDs?

Answer 11

Blackbox warning - GI and cardiovascular toxicity. Renal toxicity.
Cox 1 = GI, renal, cardio hematologic, kidneys - increases salt excretion
Cox 2 = pregnancy concerns, can put someone into labor

Question 12

Pharm prevention treatment for NSAID-induced ulcers?

Answer 12

Histamine-2 Receptor Antagonists or Proton Pump Inhibitors

Question 13

Monitoring sequence for NSAID-induced nephrotoxicity?

Answer 13

get baseline levels before starting NSAID treatment
monitor urine output, serum creatinine, BUN

Question 14

Why should NSAIDs be avoided in those with previous cardiovascular issues?

Answer 14

can cause an increased risk of cardiovascular thrombotic events including MI and stroke. even with short term use and may begin within a few weeks of starting NSAID treatment. greater for those who already have heart disease.

Question 15

Drug interactions with NSAIDs ?

Answer 15

DIs with:
- anticoagulants (bleeding risk)
- corticosteroids (increased GI toxicity)

Question 16

special considerations / who should avoid NSAIDs?

Answer 16

heart disease
pre-existing renal dysfunction
pregnancy (avoid in 3rd trim, consider avoiding in 1st trim.)
elderly

Question 17

what topical NSAIDs can be used for OA or RA?

Answer 17

Diclofenac - likely decreased toxicity due to minimal systemic asorption and acts on COX-2 locally