Anti-inflammatory and Antigout drugs

Question 1

What are the activities of NSAIDs

Answer 1

Analgesic
Anti-inflammatory
Antipyretic
Aspirin-platelt inhibition

Question 2

What are the 7 uses of NSAIDs?

Answer 2

Mild to moderate headaches
Myalgia
Neuralgia
Arthralgia
Post op pain
Gout and hyperuricemia
Pain associated with arthritic disorders

Question 3

What properties do all NSAIDs share?

Answer 3

Antipyretic
Analgesic
Anti-inflammatory

Question 4

Name a salicylate NSAID

Answer 4

Aspirin

Question 5

Name 3 acetic acid derivatives

Answer 5

Diclofenac sodium
Indomethacin sulindac
Ketorolac

Question 6

Name one cyclo-oxygenase (COX)-2 inhibitors

Answer 6

Celecoxib

Question 7

Name 2 propionic acid derivatives

Answer 7

Ibuprofen
Naproxen

Question 8

Aspirin is shown to reduce ________ after a MI

Answer 8

Cardiac death

Question 9

What is the difference between COX-1 and COX-2?

Answer 9

COX-1 maintains the GI mucosa
COX-2 promotes synthesis of prostaglandins involved in the inflammatory process

Question 10

What is the MOA of NSAIDs?

Answer 10

Inhibition of leukotriene or prostaglandin pathway
Blocking the chemical activity of the enzyme COX

Question 11

What is the MOA of aspirin?

Answer 11

Reduces formation of thromboxane A2, a substance that promotes platelet aggregation. (antiplatelet)

Question 12

What is the only NSAID that has antiplatelet effects?

Answer 12

Aspirin

Question 13

What are the contraindications of NSAIDs?

Answer 13

Allergy
Conditions that place the pt at risk for bleeding. (i.e: Rhinitis, Vitamin K deficiency and PUD)

Question 14

What are the adverse effects of NSAIDs?

Answer 14

Heartburn to severe GI bleeding
Acute kidney injury
Noncardiogenic pulmonary edema
Altered hemostasis; bleeding doesn’t stop
Hepatotoxicity
Skin eruption, sensitivity reaction
Tinnitus, hearing loss

Question 15

What is the purpose of misoprostol in relation to NSAIDs?

Answer 15

Misoprostol is given to prevent NSAID-induced ulcers/GI bleeding

Question 16

Why can’t misoprostol be taken during pregnancy?

Answer 16

It induces uterine contractions

Question 17

Why can NSAIDs compromise kidney function?

Answer 17

Kidney function partly depends on prostaglandins

Question 18

What is the major health canada warning for all NSAIDs except aspirin?

Answer 18

There is an increased risk of adverse cardiovascular thrombotic events, including a fatal MI and stroke

Question 19

What is the difference regarding the administration of aspirin(once a day vs multiple times a day)

Answer 19

Once a day: Prevention of thrombotic events
Multiple times: Pain

Question 20

What is Reye’s syndrome?

Answer 20

Acute condition involving progressive neurological deficits that can lead to coma and may also involve liver damage

Question 21

What can trigger Reye’s syndrome?

Answer 21

Viral illnesses such as influenza, as well as by salicylate therapy itself in the presence of a viral illness

Question 22

What is chronic salicylate intoxication called?

Answer 22

Salicylism

Question 23

What are the signs of salicylate intoxication?

Answer 23

Increased HR
Tinnitus, hearing loss, dimness of vision, headache, confusion, drowsiness
Nausea, vomiting, diarrhea
Hypo or hyperglycemia, sweating, thirst, hyperventilation

Question 24

What are the uses and forms available for indomethacin?

Answer 24

RA
Osteoarthritis (OA)
Bursitis or tendonitis
ankylosing spondylitis
Acute gouty arthritis
Oral and rectal routes

Question 25

Why is ketorolac tromethamine primarily used for pain management?

Answer 25

Its analgesic effects are comparable to narcotic drugs such as morphine

Question 26

What is the indication and adverse effects of ketorolac tromethamine?

Answer 26

Short term use (5 to 7 days) to manage moderate to severe pain AE: Kidney impairment, edema, GI pain, dyspepsia and nausea

Question 27

What is the most commonly used NSAID and what are it's indications?

Answer 27

Ibuprofen RA, OA Dysmenorrhea Dental pain MSK disorders Antipyretic

Question 28

What is are the indications and AE and a CI for celecoxib?

Answer 28

ID: OA, RA, pain, Ankylosing spondylitis, primary dysmenorrhea AE: Headache, sinus irritation, diarrhea, fatigue, dizziness, edema, HTN CI: Sulpha allergy

Question 29

What are the renal and cardiovascular adverse effects of NSAIDs?

Answer 29

R: Decreased creatinine, acute tubular necrosis C: Noncardiogenic pulmonary edema

Question 30

What are possible interactions with NSAIDs?

Answer 30

Alcohol Anticoagulants ASA Biphosphonates Corticosteroids and ulcerogenic meds Protein-bound drugs Diuretics and ACE inhibitors

Question 31

What is gout?

Answer 31

A condition that results from inappropriate uric acid metabolism: Underexcretion of uric acid Overproduction of uric acid Uric acid crystals are deposited in tissues and joints, resulting in pain

Question 32

Name 3 antigout drugs

Answer 32

Allopurinol Colchicine Probenecid

Question 33

What are the indications and AE for allopurinol ?

Answer 33

ID: Prevention of uric acid production and prevention of acute tumour lysis syndrome AE: Exfoliative dermatitis, stevens-johnson syndrome and toxic epidermal necrolysis

Question 34

What are the indications for probenecid?

Answer 34

Inhibits the reabsorption of uric acid in the kidneys and thus increases the excretion of uric acid

Question 35

What are the indications for colchicine?

Answer 35

Reduces the inflammatory response to the deposits of urate crystals in join tissue AE: Short term leukopenia because it inhibits cell mitosis

Question 36

How is colchicine used prophylactically?

Answer 36

Prophylaxis of acute attacks

Question 37

What are glucosamine and chondroitin?(ID, AE, IE, CI)

Answer 37

Used to treat OA G AE: GI discomfort, drowsiness, headache and skin reactions C AE: GI discomfort IE: Warfarin and may increase insulin resistance Do not take w pregnancy

Question 38

Why should salicylates not be given to children or teenagers?

Answer 38

The risk for Reye's syndrome