Aspirin, NSAIDs, Acetaminophen and Gold

Question 1

Prostacyclin’s actions on circulation (2):

Answer 1

• Powerful vasodilator.

- Inhibits platelet aggregation.

Question 2

Prostacyclin’s actions on airways:

Answer 2

Powerful bronchodilator.

Question 3

Prostacyclin’s actions on GI (2):

Answer 3

• Inhibits gastric acid secretion.

- Increases mucus secretion.

Question 4

Prostacyclin’s actions on renal function (2):

Answer 4

• Enhances excretion of Na+ and water.

- Increases GFR and blood flow.

Question 5

Prostacyclin’s actions on the uterus:

Answer 5

Relaxes uterine muscle.

Question 6

Prostacyclin’s actions on pain:

Answer 6

Induces pain by lowering threshold of nociceptors.

Question 7

Prostaglandin’s actions on circulation:

Answer 7

Vasodilation

Question 8

Prostaglandin’s actions on platelets (2):

Answer 8

• Low concentration: enhances aggregation.

- High concentration: inhibits aggregation.

Question 9

Prostaglandin’s actions on airway:

Answer 9

Bronchodilator.

Question 10

Prostaglandin’s actions on GI (2):

Answer 10

• Inhibits gastric acid secretion.

- Increases mucus secretion.

Question 11

Prostaglandin’s actions on renal function (2):

Answer 11

• Enhances excretion of Na+ and water.

- Increases GFR and blood flow.

Question 12

Prostaglandin’s actions on the uterus (2):

Answer 12

• High concentrations: Relaxes uterine smooth muscle.

- Low concentrations: Increase contraction.

Question 13

Prostaglandin’s actions on fever:

Answer 13

PGE2 is a direct pyrogen in the hypothalamus. IL-1 increases PGE2 levels.

Question 14

Thromboxane’s actions on circulation (2):

Answer 14

• Vasoconstriction.

- Stimulates platelet aggregation.

Question 15

Thromboxane’s actions on the lungs:

Answer 15

Bronchoconstriction.

Question 16

Thromboxane’s actions on the uterus:

Answer 16

Uterine muscle contraction.

Question 17

PGF2(alpha) (4):

Answer 17

• Vasoconstrictor.
• Contracts airway smooth muscle cells.
• Contracts uterine smooth muscle.
• Decreases intraocular pressure.

Question 18

Misoprostol:

Answer 18

PGE1 analogue.

Question 19

Misoprostol use:

Answer 19

Inhibits gastric acid secretion, reduces risk of peptic ulcer in patients taking NSAIDs.

Question 20

Misoprostol contraindication:

Answer 20

Pregnancy.

Question 21

Latanoprost:

Answer 21

• PGF2(alpha) analogue.
• Ophthalmic preparation for open angle glaucoma.
• Increases uveoscleral outflow.

Question 22

Alprostadil:

Answer 22

• PGE1.
• Temporarily maintain patency of the ductus arteriosus.
• Constant IV infusion.

Question 23

Zafirlukast/montelukast MOA (2):

Answer 23

• Competitive LTD4 receptor antagonist.

- Inhibit bronchoconstriction and vascular permeability.

Question 24

Zafirlukast/montelukast use (3):

Answer 24

• Prophylactic treatment of asthma.
  
  • Z > 5
  • M > 1
• Allergic rhinitis.
• M: aspirin sensitivity induced asthma.

Question 25

Zafirlukast/montelukast adverse effects (2):

Answer 25

• Headache.

- Z: pharyngitis.

Question 26

Zafirlukast drug interactions:

Answer 26

P450 inhibitor (Warfarin).

Question 27

Zileuton MOA:

Answer 27

Inhibitor of 5-lipoxygenase.

- Inhibits synthesis of all leukotrienes.

Question 28

Zileuton use:

Answer 28

Prophylaxis for asthma in adults ( > 12).

Question 29

Zileuton ADR:

Answer 29

Elevated liver enzymes.

Question 30

Non-selective NSAIDs (5):

Answer 30

• Aspirin
• Indomethacin
• Ibuprofen
• Ketorolac
• Diclofenac

Question 31

Selective cox-2 inhibitor:

Answer 31

Celecoxib

Question 32

Aspirin MOA (2):

Answer 32

• Irreversibly inhibits cyclo-oxygenase.

- Acetylates the enzyme.

Question 33

Aspirin ADRs (3):

Answer 33

• GI: pain, ulceration and hemorrhage.
• Urate excretion varies with dose.
• Risk of Reyes syndrome in children (after viral infection).

Question 34

Only NSAID approved for moderate to severe pain:

Answer 34

Ketorlolac.

Question 35

NSAID used in closure of ductus arteriosus:

Answer 35

Indomethacin.

Question 36

Gold salts MOA (3):

Answer 36

• Inhibit maturation and function of phagocytes and T cells.
• Decrease levels of rheumatoid factor.
• Inhibits migration and phagocytosis of macrophages.