analgesic- antipyretic-anti-inflm and related drugs Flashcards
what conditions are treated by ANA, NSAIDS, and acetaminophen?
Bursitis Dysmenorrhea Fibromyalgia Gout Migraine Osteoarthritis RA Juvenile RA
what are some Analgesic–antipyretic–anti-inflammatory drug group
ASA, NSAIDS, tylenol, drugs used to prevent or treat gout and migraines
NSAIDs are very hard on what organ?
the kidneys
what is COX 1?
enzyme that stimulates physiologic prostaglandins. Gi protection, renal protection, relaxes smooth muscle tone and regulates prlatelet aggregation
what is COX 2?
enzyme that stimulates pathologic prostaglandins causing inflm and leukocytosis, activation of white blood cells to release inflm cytokines
where do nonselective and selective NSAIDs inhibit?
selective- COX 2
nonselective- COX 1
what is primary dysmenorrhea?
most common type of dysmenorrhea that is due to the production of prostaglandins -causing uterine contractions. If excessive prostaglandins are produced, the woman may have excessive pain or dysmenorrhea with her menstrual cycle. Prostaglandins can also cause headaches, nausea, vomiting and diarrhea.
treatment for dysmenorrhea?
NSAIDs (prostaglandin inhibitor) and extended cycle oral contraceptive (prevents excessive growth of uterine lining)
Medication for dysmenorrhea may involve two complementary strategies: ______
decreasing prostaglandin production and hormonal alteration
what is the half life of NSAIDs generally?
can range from 1-12 hours
are NSAIDS heavily bound to plasma proteins? what %?
yes. 60-90%
virtually all NSAIDS can cause __ and __
dyspepsia (stomach upset) and GI toxicity including ulceration.
all except that nonactylated salicilates can effect what hemodynamically?
bleeding time. reversible except for aspirin which lasts to life oft he platelet.
COX 1 is formed in ___
all tissues and cells, especially platelets, endothelial cells, GI tract, and kidneys
COX -2 is present ___
brain, bone, kidneys, GI tract and female reproductive system
what kinds of meds effectively block prostaglandin formation?
Aspirin, NSAIDs and acetaminophen inactivate cyclooxygenases,
MOA of aspirin?
Acts both centrally and peripherally to block pain impulses
Act on hypothalamus to decrease temperature and reset thermostat
Prevents prostaglandins from increasing pain and edema
Antiplatelet effects by preventing synthesis of throboxane A2
MOA of NSAIDS?
Act peripherally to block pain impulses
Act on hypothalamus to decrease temperature and reset thermostat
Prevents prostaglandins from increasing pain and edema
Antiplatelet effects bind reversibly with platelet COX-1 (shorter acting than aspirin)
indications for use of NSAIDS and aspirin?
Treat mild-moderate pain (may be combined with oral opioid)
Anti-inflammatory
Antipyretic
Antiplatelet - low dose cardioprotective
Celecoxib used to treat familial adenomatous polyposis
NSAIDs may be used for eye disorders – (but can cause dry eye)
contraindications for NSAIDS and aspirin?
GI disorders
Hypersensitivity
Renal disease
Aspirin is contraindicated for children in presence of viral infection due to association with Reye’s Syndrome
Celecoxib contraindicated if allergic to sulfonamides
example of propionic acid derivative?
ibuprogen
example of acetic acid derivative? SE of these?
indomethacin (induced) and sulindac (clinoril). Potentially serious adverse effects include GI ulcer-ation, bone marrow depression, hemolytic anemia, mental con-fusion, depression, and psychosis.
what are some concerns reg: Celebrex?
concerns about iincreased risk of adverse cardiovascular events such as MI and stroke with COX-2 inhibitors.
what are some drugs used to treat gout and hyperuricemia?
Allopurinol (Zyloprim)
Colchicine
Probenecid (Benemid)
Sulfinpyrazone (Anturan)
drugs to treat migraines?
triptans, ergot preparations
what are ergotamines
they narrow and constrict blood vessels in the brain. not clear on how it stops migraines.
when is ergotamine contraindicated?
ischemic heart disease, pregnant or breastfeeding
what is feverfew?
natural health product used for migraines
what is the only drug of choice for pain or fever in children?
tylenol
use in older adults- things to watch out for?
higher incidence of OA, watch for GI bleeding, dose carefully
use in pt with renal impairment- things to look out for?
Acetaminophen, ASA, and other NSAIDs can cause or aggravate renal impairment
use in pt with hepatic impairment- things to watch out for?
the effects of NSAIDs on liver function and the effects of hepatic impairment on most NSAIDs are largely unknown, dose carefully
