Anti-Inflammatory Drugs

Question 1

acute vs chronic pain (duration)

Answer 1

acute lasts less than 3 months

chronic lasts more than 6 months

Question 2

allodynia

Answer 2

exaggerated pain response to a normally no-noxious stimulus (sunburn and tshirt)

Question 3

functional characteristics of NSADS

Answer 3

analgesia, antipyretic, anti-inflamm

Question 4

Acetaminophen

Answer 4

NOT AN NSAID

has antipyretic and analgesic effects but does not have anti-inflammatory effects

Question 5

Cox enzymes

Answer 5

cox enzymes convert arachidonic acid to prostaglandins
cox 1 = protective, needed in body at all times
cox 2 = inflammatory, only present when inflammation occurs
NSAIDs block cox enzymes to decrease pain, inflammatoion and fever

Question 6

NSAIDs

Answer 6

can be selective or non-selective

inhibit prostaglandin synthesis

Question 7

original (prototype) NSAID

Answer 7

aspirin

Question 8

Aspirin low and high dose function

Answer 8

low dose = 600 mg/day, analgesic and antipyretic effects
high dose = >4000 mg/day, anti-inflamm effects
aspirin has a high potential for drug interactions

Question 9

Anti-inflammatory/analgesic effects of aspirin are due to

Answer 9

inhibition of cox 2 and inhibition of PG synthesis

Question 10

anti-pyretic effects of aspirin are due to

Answer 10

blocks production of PG in CNS to reset temp control at hypothalamus. temp falls due to superficial blood vessel dilation

Question 11

anti-coagulant effects of aspirin

Answer 11

increases bleeding time

Question 12

adverse effects of aspirin

Answer 12

GI tract upset due to inhbiting cox 1
GI irritation due to inhibiting PGs
platelet inhbition (increases bleeding time)

Question 13

Non-selective COX inhibitors

Answer 13

aspirin, ibuprofen, naproxin, indomethacin, oxaprozin, piroxicam, sulindac, ketorolac

Question 14

cox 2 selective inhbitiors

Answer 14

effects = analgesic, antipyretic, anti-inflammatory w/o GI effects
don’t use if pt has heart issues! (black box warning = celecoxib)

Question 15

How to choose an NSAID

Answer 15

no 1 best NSAID for each person, rather 1-2 best choices for each individual
balance efficacy, cost-effectiveness, safety, other drugs, etc

Question 16

Acetaminophen (tylenol)

Answer 16

commonly used in kids and elderly
no anti-inflammatory properties
not an NSAID!

Question 17

safety of acetaminophen

Answer 17

hepatotoxicity at high doses
narrow therapeutic index!! risk of liver necrosis and liver failure! failure at 350 mg/kg
interacts with ethanol

Question 18

mechanism of action of capsaicin

Answer 18

binding and activation to TRPV1 leads to release of substance P. Prolonged activation of these neurons due to capsaicin depleates and prevents substance P from reaccumulating in the SC
used to treat RA, OA

Question 19

DMARDs

Answer 19

disease modifying anti-rheumatic drugs
Methotrexate! = Immunosuppressive
used to treat RA
slows disease development

Question 20

mechanism of action for NSAIDS vs narcotics

Answer 20

NSAIDs = enzyme inhibition
Opioids = opiate receptor agonist

Question 21

When would you prescribe a cox 2 inhibitor?

Answer 21

if patient has no pre existing heart conditions and maybe if they have GI issues (cox 1 inihbitor may be too hard on stomach)

Question 22

Non-selective NSAIDs inhibit?

Answer 22

cox 1 and cox 2

aspirin (acetylsalicylic acid), ibuprofen, indomethacin

Question 23

Selective NSAIDs inhibit?

Answer 23

cox 2

Celecoxib

Question 24

Ibuprofen (advil)

Answer 24

often prescribed in lower does with analgesic but not anti-inflammatory efficacy (non-selective NSAID)

Question 25

therapeutic dose of acetaminophen

Answer 25

15 mg/kg (4x per day)

liver necrosis = 150 mg/kg