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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Anti-inflamatory Drugs: NSAIDs & Acetaminophen - Ch. 75 > Flashcards

Anti-inflamatory Drugs: NSAIDs & Acetaminophen - Ch. 75 Flashcards

1
Q

What does tissue injury cause the release of?

A

Prostaglandins
bradykinin
histamine
leukotriennes
serotonin

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2
Q

What does the release of autacoids (e.g, histamine, bradykinin) cause?

A

Vasodilation, increased vascular permeability, chemotaxis, pain

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3
Q

What does NSAID stand for?

A

Non-Steroidal Anti-inflammatory Drugs

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4
Q

NSAIDs are what kind of inhibitor?

A

Cyclooxygenase inhibitors

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5
Q

What is the mechanism of action of NSAIDs?

A

Blocks either or both cyclooxygenase (COX) enzymes which limit the undesirable inflammatory effect of prostaglandins and related substances

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6
Q

What are the COX enzymes?

A

COX-1 and COX-2
Converts arachidonic acid into prostanoids (prostaglandins and other related compounds)

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7
Q

What properties do NSAIDs have?

A

Analgesic
Anti-inflammatory
Antipyretic

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8
Q

What are NSAIDs used for?

A

Relief of mild to moderate pain
Arthritis
Acute gout
Bone, joint, muscle pain
Dysmenorrhea
Fever

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9
Q

What do Non-selective NSAIDs do?

A

Inhibit COX-1 and COX-2, suppress inflammation but pose serious harm

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10
Q

What are Non-selective NSAIDs used for?

A

Alleviate mild to moderate pain
Inflammatory disorders (Rheumatoid arthritis, osteoarthritis, bursitis)

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11
Q

Examples of Non-selective NSAIDs?

A

Acetylsalicylic acid (ASA) - Aspirin
ketorolac (Toradol)
sodium salicylate
Ibuprofen (Motrin, Advil)
Naproxen (Aleve)
Diclofenac sodium (Voltaren)

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12
Q

What is the standard NSAID that others are compared to?

A

Acetylsalicylic acid (ASA) - Aspirin

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13
Q

Where is salicylic acid prepared from?

A

Willow bark and other plants

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14
Q

What plant does Aspirin come from?

A

Acetalation spirea

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15
Q

Propertoies of Aspirin?

A

Analgesic
Anti-inflammatory
Antipyretic
Antiplatelet

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16
Q

Why is ASA (Aspirin) different to other NSAIDs?

A

It irreversibly inhibits COX
-Other NSAIDs reversibly inhibit COX

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17
Q

Aspirin is the only NSAID used for what?

A

Antiplatelet purposes

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18
Q

What is treated with Aspirin for antiplatelet purposes?

A

MI, stroke and other thromboembolic events

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19
Q

What is the dose of aspirin for antiplatelet purposes?

A

*0-160 mg daily prophylactic

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20
Q

When is the use of aspirin contraindicated, or should it be used cautiously?

A

Pregnancy
Almost all bleeding disorders, hemophilia
Discontinue 1 week before operations
Caution in renal dysfunction

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21
Q

Why is aspirin use contraindicated during pregnancy?

A

In late trimester its use is connected to low weight, intracranial bleeds and death

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22
Q

ASA (Asprin) adverse effects?

A

-Gastrointestinal effects
-Influenza and chickenpox in kids/teens due to the possibility of Reye’s syndrome
-Renal problems

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23
Q

What Gastrointestinal adverse effects are associated with ASA (Aspirin)?

A

-Ulcerations and erosions
Dyspepsia, heartburn, epigastric distress, nausea
-GI bleeding

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24
Q

What symptoms are associated with Reye’s syndrome (ASA adverse effect)?

A

Vomiting
Liver damage
CNS problems (encephalopathy)
-Confusion, seizures, coma

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25
Q

What renal adverse effects are associated with ASA (Aspirin)?

A

Reductions in creatinine clearance (indicates kidney damage)
Acute tubular necrosis with renal failure

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26
Q

What NSAIDs can lead to Salicylate toxicity?

A

ASA, Na salicylate, Mg salicylate

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27
Q

Effects of Salicylate toxicity in adults?

A

Tinnitus and hearing loss

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28
Q

Effects of Salicylate toxicity in children?

A

Hyperventilation (CNS stimulation)

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29
Q

What drugs interact with ASA (aspirin)?

A

Anticoagulants
Glucocorticoids
Non-ASA NSAIDs

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30
Q

How does ASA (Aspirin) interact with anticoagulants?

A

Causes increased bleeding

31
Q

How does Aspirin interact with Glucocorticoids?

A

Causes gastric ulcers

32
Q

How does aspirin interact with Non-ASA NSAIDs?

A

Reduces antiplatelet effects of ASA
***Do not mix ASA and other NSAIDs is used for antiplatelet effects

33
Q

What are non-ASA NSAIDs?

A

ASA-like drugs with fewer GI, renal and hemorrhagic effects than ASA

20+ non-ASA NSAIDs available

34
Q

What is the emchanism of action of Non-ASA NSAIDs?

A

Inhibit COX-1 and COX-2 but inhibition is reversible

35
Q

What are non-ASA NSAIDs unable to protect against?

A

MI and stroke
-No antiplatelet properties

36
Q

In general, what adverse effects are associated with NSAIDs?

A

Gastrointestinal ulceration
Blockade of platelet aggregation -bleeding problems
Inhibition of prostaglandin-mediated renal function
Hypersensitivity reactions

37
Q

In general, when is NSAID use contraindicated?

A

Conditions with bleeding as a risk
e.g, Vitamin K deficiency, peptic ulcer disease

Severe renal or hepatic disease
Breastfeeding

38
Q

What is COX-2 responsible for?

A

Inflammatory mediators

39
Q

Examples of selective COX-2 inhibitor NSAIDs?

A

Celecoxib (Celebrex)
Rofecoxib (Vioxx) -Withdrawn in 2004

40
Q

Selective COX-2 inhibitors are just as effective as traditional NSAIDs in supressing what?

A

Inflammation and pain

41
Q

Selective COX-2 inhibiots might lower the risk for what?

A

GI adverse effects but not really

42
Q

What can selctive COX-2 inhibitors impair?

A

Renal function and cause hypertension and edema

43
Q

Selective COX-2 inhibitors increase the risk for what?

A

MI and stroke

44
Q

How is NSAID GI ulceration reduced?

A

Mistoprostol (Cytotec)

45
Q

What is Mistoprostol?

A

SYnthetic prostaglandin
Used in combination with NSAIDs to reduce ulceration

46
Q

What does Antipyretic mean?

A

Reduces fever

47
Q

How do NSAIDs produce antipyretic effects?

A

Inhibit prostaglandin E2 production within the area of the brain that controls temperature

48
Q

Before begining NSAID therapy the nurse should?

A

Assess for conditions that may be contraindications to therapy, especially:
-GI lesions or peptic ulcers
-Bleeding disorders

49
Q

The client should notify or watch for if what occurs when using NSAIDs?

A

GI pain or evidence of GI bleeding
Occurance of any unusual bleeding such as in stool

50
Q

What does bleeding in stool look like?

A

Dark or black colour, tarry

51
Q

Enteric-coated NSAID tablets should not be _________ or ________?

A

Crushed or chewed

52
Q

Salicylates are not given to children under which age and why?

A

Age 12
-Reye’s syndrome

53
Q

What are the properties of Acetaminophen (Tylenol)

A

Analgesic
Antipyretic

54
Q

What properties do NSAIDs have that acetaminophen doesn’t?

A

Anti-inflammatory
Anti-platelet

55
Q

Acetaminophen is an alternative to what?

A

NSAIDs

56
Q

What is the mechanism of action of Acetaminophen (Tylenol)?

A

Inhibits COX that is only present in CNS

57
Q

What kind of sites of action does Acetaminophen NOT have?

A

Peripheral therapeutic sites

58
Q

What is absent with acetaminophen use?

A

Adverse effects associated with NSAIDs like GI ulceration and excessive bleeds

59
Q

How does Acetaminophen produce antipyretic effects?

A

Same as NSAIDS
-Inhibits prostaglandin E2 production within the area of the brain that controls temperature

60
Q

What is the maximum amount an adult can take of acetaminophen per day?

A

4000mg

61
Q

What is the maximum amount of acetaminophen that children ages 11-12 can take per day?

A

2400mg
-Is a sliding scale bc its Based on age and weight

62
Q

Who should take extreme caution when taking acetaminophen?

A

Alcohol abusers

63
Q

Single-ingredient acetaminophen tabs are provided. In what doses are they provided?

A

325mg, 500mg and 650mg

64
Q

Single-ingredient acetaminophen tabs reach what very quickly?

A

Maximum

65
Q

Tylenol 1,2,3 or 4 in combination with codeine is supplied in what doses?

A

Codeine 8.15, 30, 60mg
Acetaminophen 300mg

66
Q

When is acetaminophen use contraindicated?

A

Severe hepatic disease
Severe renal disease
Alcoholism
Drug allergy

67
Q

What does acetaminophen toxicity overdose cause?

A

Hepatic necrosis (drug-induced hepatitis)
Long-term ingestion of large doses also causes nephropathy

68
Q

What is the reccomended antidote for Acetaminophen overdose?

A

Acetylcysteine (Mucomyst)

69
Q

How does Acetylcysteine (Mucomyst) work?

A

Protects the liver from acetaminophen-induced damage

70
Q

When is the max protection of Acetylcysteine (Mucomyst)?

A

within 8-10 hours (IV or PO)

71
Q

When can Acetylcysteine (Mucomyst) be given?

A

Anytime, even in late presentation at 24hours

72
Q

Dangerous interactions of acetaminophen may occur if taken with what?

A

Alcohol

73
Q

Acetaminophen should not be taken in the presence of?

A

Liver dysfunction, chronic alcoholism
Possible liver failure or sever renal disease
When taking other hepatotoxic drugs

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (15 decks)

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