Anti Inflammatory Drugs: NSAIDS & Acetaminophen (75) Flashcards by Ella Thorsteinson

Tissue injury causes the relapse of (5)

-prostaglandins
-bradykinin
-histamine
-leukotriennes
-serotonin

How well did you know this?

Not at all

Perfectly

Most importantly tissue injury causes release of…

Prostaglandins

How well did you know this?

Not at all

Perfectly

What are signs of inflammation

-vasodilation
-increased vascular permeability
-chemotaxis
-pain

How well did you know this?

Not at all

Perfectly

A stimulus like damage causes release of phospholipase A2 which interacts with ____ to create ___

Interacts with PHODPHOLIPIDS to create ARACHIDONIC ACID

How well did you know this?

Not at all

Perfectly

ARACHIDONIC acid is metabolized by _____ to create PGH2 or different variations

Cyclooxygenase

How well did you know this?

Not at all

Perfectly

What are the two versions of cyclooxygenase

COX-1 and COX-2

How well did you know this?

Not at all

Perfectly

PG stands for

Prostaglandin

How well did you know this?

Not at all

Perfectly

What does COX-1 do

Physiological functions
-GI, renal, platelet function, blood vessels

How well did you know this?

Not at all

Perfectly

What does COX-2 do

Inflammation

How well did you know this?

Not at all

Perfectly

Which of the COX is inhibition undesirable?

COX-1 since it is related to regular physiological functions

How well did you know this?

Not at all

Perfectly

NSAIDS stands for

Non steroidal anti inflammation drugs

How well did you know this?

Not at all

Perfectly

Where do NSAIDS work in the action of creating prostaglandins?

NSAIDS stop the metabolism of ARACHIDONIC acid, by competition inhibition of COX

How well did you know this?

Not at all

Perfectly

Is the inhibition of COX reversible or permanent?

Reversible

How well did you know this?

Not at all

Perfectly

NSAIDS can block

Either one or both COX

How well did you know this?

Not at all

Perfectly

What are the properties of NSAIDS groups

-analgesic
-anti inflammatory
-antipyretic

How well did you know this?

Not at all

Perfectly

Indications of NSAIDs

-relief of mild to moderate pain
-fever
-gout, RA, osteoarthritis

How well did you know this?

Not at all

Perfectly

Non selective NSAIDs target

Inhibitbition of both COX 1 and 2

How well did you know this?

Not at all

Perfectly

Non selective NSAIDs are used for

-alleviating mild to moderate pain
-inflammatory disorders

How well did you know this?

Not at all

Perfectly

The downside of non selective NSAIDs are

That they suppress inflammation but pose risks of serious harm

How well did you know this?

Not at all

Perfectly

Examples of non selective NSAIDs

-acetylsalicylic acid (ASA or ASPRIN)
-ibuprofen (Advil)
-naproxen (Aleve)

How well did you know this?

Not at all

Perfectly

NSAIDs can be used in

Combination
-codeine, caffeine

How well did you know this?

Not at all

Perfectly

Acetylsalicylic acid is the

Standard NSAID agains which all others are compared

How well did you know this?

Not at all

Perfectly

Acetylsalicylic acid is created from

Salicylic acid- Willow bark, and other plants ‘

Acetyl- added on in that era to create a drug

How well did you know this?

Not at all

Perfectly

Where does the name ASPRIN come from

Acetalation spiraea

How well did you know this?

Not at all

Perfectly

Acetylsalicylic acid properties

-anti inflammatory -analgesic -antipyretic -antiplatelet

Antiplatelet properties of Acetylsalicylic acid

A special property of Acetylsalicylic acid -COX will be inhibited for the life time of the platelet (eight days)

Positives of Acetylsalicylic acid being an antiplatelet

Heart attack -prolonged use can reduce the risk of heart attack

Acetylsalicylic acid is different to other NSAIDs because it

Irreversibly inhibits COX

Daily dose for prophylactic use of Acetylsalicylic acid

80 to 160mg

Contraindications and cautions Acetylsalicylic acid

-pregnancy -bleeding disorders -operations -renal dysfunction -gastrointestinal

Contraindications and cautions Acetylsalicylic acid: pregnancy

In late trimester connected with low weight, intracranial bleed, and even death

Contraindications and cautions Acetylsalicylic acid: bleeding disorders

Hemophilia, as it is an ntiplatelet

Contraindications and cautions Acetylsalicylic acid: operations

Discontinue one week before operations (antiplatelet)

Contraindications and cautions Acetylsalicylic acid: renal

Renal dysfunction -relies on PG in kidney dysfunction -can exacerbate function

Contraindications and cautions Acetylsalicylic acid: gastrointestinal

Increases ulcerations and bleeding

How does Acetylsalicylic acid cause bleeding and ulcers

-increases acidity in stomach -deeper ulcer causes bleeding -can vomit up coffee grounds or have dark stool

Why does someone develop ulcers on Acetylsalicylic acid

The stomach has ow pH but intact stomach wall -this is due to PGE2 and PGI2 which increase protective mucus and dilate blood to increase cell health -the loss of PG in the Acetylsalicylic acid properties will get rid of this stomach wall health

AE of Acetylsalicylic acid

-Reyes syndrome -renal

Reye’s syndrome

Viral infections, being young, and taking Acetylsalicylic acid can increase risk of Reye’s syndrome -which causes vomiting, liver damage, CNS encephalopathy

AE of Acetylsalicylic acid: renal

Reduction in creatinine clearance

AE of Acetylsalicylic acid: renal

Reduction in creatinine clearance

Salicylate toxicity

Use of several NSAIDs -adults: tinnitus, hearing loss -children: hyperventilation

Acetylsalicylic acid is not given too

Children generally

Interactions with Acetylsalicylic acid

-anticoagulants increase bleeding -glucocorticoids increase gastric ulcers -non ASA NSAIDs can reduce antiplatelet effects

Important not to mix NSAIDs if Acetylsalicylic acid is being used for

Antiplatelet effect

Non Acetylsalicylic acid NSAIDs have fewer

-fewer GI, renal, hemorrhagic effects -many different types

Non ASA NSAIDs inhibit COX 1 and 2, is it reversible or permanent

Reversible unlike ASA

Non ASA NSAIDs do not

Protect against MI and stroke

Selective NSAIDs are able to target just one COX, which one is that

COX 2, which is good because this will stop inflammation and hopefully not affect the physiological functions with COX 1 inhibition

What was the purpose of creating selective NSAIDs

Hoping to solve GI problems associated with non selective NSAIDs

COX 2 inhibitors example

Celecoxib

Selective NSAIDs are just as effective as

Traditional NSAIDS in suppressing inflammation and pain

Selective NSAIDs have a lower risk of

GI adverse effects -but would be better to just not take the drug in general

Selective NSAIDs can impair

Renal function and cause hypertension and edema

Selective NSAIDs can increase the risk of

MI and stroke

How can someone reduce GI ulceration when using NSAIDs

Misoprostol

How are NSAIDs antipyretic

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

Before beginning NSAID therapy, nurses should assess for

-GI lesions or peptic ulcer disease -bleeding disorders —> especially long term

Clients taking NSAIDs long term, for the occurrence of

Any unusual bleeding -dark or black, color, tarry stool

Enteric coated tablets should not

Be crushed or chewed

Salicylates are NOT to be given to

Children under age 12

Non opioid analgesics

Acetaminophen

Analgesic and antipyretic -but is NOT an anti inflammatory -no antiplatelet

Mechanism and action of acetaminophen

We dont really know

acetaminophen inhibits

COX -but only in the CNS

acetaminophen has no

-peripheral therapeutic sites of action -no AE associated with NSAIDs like GI ulceration or excessive bleeding

Maximum dosage of acetaminophen per day for an adult

4000 mg

Maximum acetaminophen for 11 to 12 year olds

2400

acetaminophen should be used in extreme caution in

Alcohol absorbers

Single tablet amount of acetaminophen

325, 500, 650mg

Tylenol combinations with codeine

All have 300mg of acetaminophen

Contraindications of acetaminophen

-severe hepatic disease -renal disease -alcoholism -drug allergy

Toxicity of acetaminophen

OTC prescription which can risk overdose both intentionally or unintentional use

Overdose is usually due to

Hepatic necrosis -drug induced hepatitis

Long term ingestion of large doses also causes

Nephropathy

acetaminophen should not be used with other drugs containing

acetaminophen -easy to overdose since many drugs need/contain acetaminophen

What other warning is found on acetaminophen bottles

Liver warning- severe or possibly fatal liver damage if -taking more than recommend dose -other drugs with acetaminophen -while drinking thee or more alcoholic drinks every day

Symptoms of liver damage may include

-yellowing of skin, eyes, dark urine -sweating, nausea, vomiting, stomach pain -unusual tiredness, loss of appetite

How is acetaminophen metabolized normally

acetaminophen had a major pathway which creates non toxic metabolites

How is acetaminophen metabolized when taken with alcohol

when taking alcohol with acetaminophen, it creates toxic metabolites that are broken down by glutathione creating a non toxic metabolite

How are toxic metabolites turned into nontoxic metabolites

Glutathione

What do toxic metabolites do

-alter proteins -damage DNA -death of cells

Glutathione is depleted by

Alcohol and acetaminophen overdose

What can be done when someone is overdosing on acetaminophen

Take acetylcysteine to increase amounts of glutathione

Acetylcysteine must be taken in what amount of time

8 to 10 hours

Dangerous interactions may occur if acetaminophen is taken with

Alcohol

Acetaminophen should not be take in the prescience of

-liver dysfunction, chronic Alcoa is -possible liver failure or severe renal disease -taking other hepatotoxic drugs