Analgesics 3

Question 1

NSAIDS induced ulcer can be prevented and treated with?

Answer 1

misoprostol {synthetic PGs analogue, PGE1
analogue}

Question 2

Measures to minimize GIT adverse effects?

Answer 2

I. Use of aspirin with a suitable buffering (after meal followed by glass of water or antacids).

II. Use of enteric coated aspirin, (dissolved and absorbed mainly from the intestine).

III. Use of misoprostol (synthetic analog of PGE1) with aspirin.

IV. Use of H2-antagonists or proton pump inhibitors with aspirin.

Question 3

Mention the result of action of aspirin and NSAIDs on kidney?

Answer 3

inhibition of renal PGs synthesis
which cause reduction in renal blood flow=>
result in:
> Renal impairment on chronic use of large doses (Analgesic nephropathy)
> Salt and H2o retention (edema)
> Antagonize antihypertensive action of
diuretics, ACE inhibitors => cause hypertension

Question 4

Mention the only NSAIDs that have anti-platelet effect on Small doses?

Answer 4

Aspirin

Question 5

Mention the action of small dose of aspirin on blood?

Answer 5

Small dose of aspirin (75-150/320 mg/day) produce:

1. Anti-platelet effect by selective irreversible inhibition of platelet cox-I which inhibit formation of TXA2
2. Inhibition of platelet aggregation
3. prolong bleeding time
4. Duration of anti-platelet effect of Aspirin equal to life span of the platelet (8 days )as it can’t synthesize new cox enzyme.

Question 6

Explain how the large dose of aspirin has no anti-platelet effect?

Answer 6

1. Effect on blood vessels: inhibit COX-II synthesis => No PGI2 => cause aggregation
2. Effect on platelet: inhibit COX-I synthesis=> decreases thromboxane A2 (TXA2) => no aggregation

> In large dose produce opposite effect which cancel the effect of each other.

Question 7

Toxic doses of aspirin on CVS cause?

Answer 7

Non-cardiogenic pulmonary edema

Question 8

Mention the effect of aspirin on small and large doses on CVS?

Answer 8

> Low dose of aspirin has cardioprotective effect and reduce incidence of myocardial infarction.

> Large and toxic doses of aspirin cause salt and H2o retention => decrease efficacy of anti-hypertensive agents

Question 9

Effect of large dose of analgesics on liver?

Answer 9

Large dose cause hyperglycemia/ reversible hepatic injury

Question 10

Give short note about Reye’s syndrome?

Answer 10

If salicylates are given to febrile children with viral infection (Influenza, chicken pox), causing Hepatitis and Encephalopathy

Question 11

Mention the drug that can be given to children with fever caused by viral infections?

Answer 11

paracetamol is the safe antipyretic

Question 12

Mention the effect of different doses of aspirin on Urate excretion?

Answer 12

1- Small doses (1-2 gm/day): inhibit active tubular secretion of uric acid which reduce renal excretion of urates => Hyperuricemia

2- Large doses of aspirin (>5gm/day): inhibit tubular reabsorption of urates which increase renal excretion of urates => Uricosuric effect

3- Moderate doses (2-4 gm/day): inhibition of active secretion and reabsorption are balanced => No change in urate excretion