Chapter 44 Anitinflammatory and Antigout

Question 1

inflammation

Answer 1

localized protective response stimulation by injury to tissues, which serves to destroy, dilute, or sequester both the injurious agent and injured tissue

Question 2

5 signs of inflammation

Answer 2

fever, pain, loss of function, redness, swelling

Question 3

Endogenous compounds released during inflammation

Answer 3

histamine, serotonin, bradykinin, leukotrienes, prostaglandins

Question 4

NSAID characterisitics

Answer 4

analgesic, anti inflammatory, antipyretic, aspirin- platelet inhibition

Question 5

NSAIDs are used for the relief of:

Answer 5

-mild to moderate pain
-arthritic disorders such as rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, osteoarthritis
-treatment of gout and hyperuricemia

Question 6

Aspirin in reducing cardiac death:

Answer 6

-reduce cardiac death after an MI
-should be administered at first sign of MI
-if not given before arriving to ER, aspirin is one of the first drugs given if there are no contradictions

Question 7

NSAID types:

Answer 7

-salicylates- aspirin
-acetic acid derivatives- ketorolac
-cyclooxygenase 2 (COX 2) inhibitors- celecoxib (celebrex)
-enolic acid derivatives- meloxicam
-propionic acid derivatives- ibuprofen and naproxen

Question 8

NSAID mechanism of action

Answer 8

-inhibition of the leukotriene pathway, the prostaglandin pathway, or both
-blocking the chemical activity of the enzyme COX

Question 9

NSAID contradictions

Answer 9

-allergies!! patients with a aspirin allergy must not receive NSAIDs
-conditions that place the patient at risk for bleeding (Vit K deficiency, peptic ulcer disease)
-sometimes held for surgery and in 3rd trimester pregnancies
-GI BLEED IS GREATEST RISK

Question 10

NSAID interactions

Answer 10

serious interactions when given with:
- anticoagulants, aspirin, corticosteriods and other ulcerogenic drugs, protein bound drugs, diuretics, ACE inhibitors, etc

Question 11

NSAID Black Box Warning

Answer 11

-all NSAIDs (except aspirin) share a BB Warning regarding an increased risk of adverse cardio thrombotic events like fatal MI and stroke
-NSAIDs may counteract the cardioprotective effects of aspirin

Question 12

children should never take _____ because of the risk of ______

Answer 12

aspirin, Reye’s syndrome

Question 13

aspirin inhibits platelet aggregation ( antithrombotic effect)

Answer 13

used in treatment of MI and other thromboembolic disorders

Question 14

Types of aspirin

Answer 14

-topical cream (aspercreme), rectal suppositories, oral liquids
-combination products: aspirin-acetaminophen-caffeine such as excedrin, aspirin-antacid combo like bufferin
-enteric coated aspirin (ecotrin)
-big warning of toxicity

Question 15

81 mg or 325 mg aspirin tablets

Answer 15

-prophylactic therapy for adults who have strong risk factors for developing CAD or cardio accident
-these strength tablets appear to be equally beneficial for prevention of thrombotic events
-these strength aspirins given once daily for thromboprevention
-dosages for pain, fever, or arthritis is much higher

Question 16

Salicylate toxicity

Answer 16

-cardio: increased heart rate
-CNS: tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness
-GI: nausea, vomiting, diarrhea
-metabolic: sweat, thirst, hyperventilation, hypoglycemia or hyperglycemia

Question 17

acedic acid NSAID derivative

Answer 17

ketorolac

Question 18

ketorolac characteristics:

Answer 18

-some inflammatory activity
-used primarily for its powerful analgesic effects which are comparable to those of narcotic drugs like morphine
-short term use (5 DAYS) to manage moderate to severe acute pain

Question 19

ketorolac adverse effects

Answer 19

renal impairment, edema, GI pain, dyspepsia, nausea- if used over 5 days

Question 20

propionic acid derivatives

Answer 20

ibuprofen and naproxen

Question 21

ibuprofen (motrin, advil)

Answer 21

• most commonly used NSAID
• used for analgesic effects in management of RA, OA, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, antipyretic actions

Question 22

naproxen

Answer 22

-2nd most commonly used NSAID
-better adverse effect profile than ibuprofen
-fewer drug interactions with ACE inhibitors given for HTN

Question 23

COX 2 inhibitor

Answer 23

celecoxib (celebrex)

Question 24

celecoxib

Answer 24

• 1st and only remaining COX 2 inhibitor
  -indicated for OA, RA, acute pain symptoms, ankylosing spondylitis, primary dysmenorrhea- long standing pain

Question 25

adverse effects of celecoxib

Answer 25

headache, sinus irritation, diarrhea, fatigue, dizziness, lower extremity edema, HTN
-no GI effects
-do not use on patients with sulfa allergy

Question 26

enolic acid derivative

Answer 26

meloxicam (mobic)

Question 27

meloxicam characteristics

Answer 27

-used to treat mild to moderate OA, RA, and gouty arthritis
- Nabumetone is better tolerated gastrointestinally then other NSAIDs

Question 28

gout

Answer 28

-condition that results from inappropriate uric acid metabolism
- either under excretion or overproduction of uric acid
-uric acid crystals are deposited in tissues and joints, resulting in pain

Question 29

antigout drug examples

Answer 29

-allopurinol
-feuxostat
-colchicine
-probenecid
-lesinurad
-sulfinpyrazone

Question 30

allopurinol

Answer 30

-used to prevent uric acid production and to prevent acute tumor lysis syndrome
-could cause exfoliative dermatitis, stevens-johnson syndrome (skin looks burned), toxic epidermal necrolysis

Question 31

probenecid

Answer 31

-inhibits reabsorption of uric acid in kidneys and thus increases the excretion of uric acid
-must have good renal function!

Question 32

colchicine

Answer 32

-reduces inflammatory response to the deposits of urate crystals in joint tissue (brings down uric acid)
-used for short term management or prevention of gout
-may cause short term leukopenia and bleeding in GI tract or urinary tracts
-dose may be adjusted if they have a decreased renal function

Question 33

herbal products- glucosamine and chondroitin

Answer 33

-used to treat pain of OA

Question 34

adverse effects of glucosamine and chondroitin

Answer 34

GI discomfort, drowsiness, headache, skin reactions

Question 35

drug interactions with glucosamine and chondroitin

Answer 35

enhances effects of warfarin, may increase insulin resistance