Chapter 44-Antiinflammatory and Antigout Drugs

Question 1

NSAIDS

Answer 1

Large and chemically diverse group of drugs with the following properties

Question 2

NSAIDS are:

Answer 2

• Analgesic
• Antiinflammatory
• Antipyretic
• Antirheumatic

Question 3

NSAIDS: Mechanism of Action

Answer 3

Activation of the arachidonic acid pathway causes: Pain, headache, fever, inflammation

Question 4

Analgesia

Answer 4

Treatment of headaches, mild to moderate pain and inflammation:

• block the chemical activity of either or both COX enzymes (prostaglandin PG pathway)
• result: limits the undesirable inflammatory effect of PGs

Question 5

Antipyretic

Answer 5

Reduce fever

-inhibit prostaglandin E2 within the area of the brain that controls temperature

Question 6

Chemical Categories of NSAIDS

Answer 6

• Salicylates
• Acetic acid derivatives
• Cyclooxygenase-2 (COX-2) inhibitors
• Enolic acid derivatives
• Propionic acid derivatives

Question 7

NSAIDS: Salicylates

Answer 7

• Salicylates also have antiplatelet activity
• inhibit platelet aggregation
• Examples: aspirin, diflunisal (Dolobid)

Question 8

NSAIDS: Acetic Acids

Answer 8

• indomethacin (Indocin)
• ketorolac (Toradol)
• diclofenac sodium (Voltaren)
• sulindac (Clinoril)
• tolmetin (Tolectin)
• etodolac (Lodine)

Question 9

NSAIDS: celecoxib (Celebrex)

Answer 9

• First and only remaining COX-2 inhibitor
• Indicated for osteoarthritis, rheumatoid arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea

Question 10

NSAIDS: Enolic Acid Derivatives

Answer 10

• piroxicam (Feldene)
• meloxicam (Mobic)
• nabumetone (Relafen)

Question 11

NSAIDS: Propionic Acids

Answer 11

• fenoprofen (Nalfon)
• flurbiprofen (Ansaid)
• ibuprofen (Motrin, Advil)
• ketoprofen (Orudis KT)
• naproxen (Naprosyn, Aleve)
• oxaprozin (Daypro)

Question 12

NSAIDS: Indications

Answer 12

• Analgesia (mild to moderate)
• Antigout effects
• Antiinflammatory effects
• Antipyretic effects
• Relief of vascular headache
• Platelet inhibition (ASA)
• Relief of mild to moderate pain
• Acute gout
• Various bone, joint, and muscle pain
• Osteoarthritis
• Rheumatoid arthritis
• Juvenile rheumatoid arthritis
• Dysmenorrhea
• Fever

Question 13

NSAIDS: Salicylates (aspirin)

Answer 13

• More potent effect on platelet aggregation
• analgesic
• antipyretic
• anti-inflammatory
• Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders

Question 14

NSAIDS: Adverse Effects Gastrointestinal

Answer 14

• Dyspepsia, heartburn, epigastric distress, nausea
• GI bleeding
• Mucosal lesions (erosions or ulcerations)

Question 15

NSAIDS: Adverse Effects Renal

Answer 15

• Reductions in creatinine clearance

* Acute tubular necrosis with renal failure

Question 16

NSAIDS: Salicylate Toxicity

Answer 16

Adults: tinnitus and hearing loss
Children: hyperventilation and CNS effects
Metabolic acidosis and respiratory alkalosis may be present

Question 17

NSAIDS: Interactions

Answer 17

Serious interactions can occur when given with:

• Anticoagulants
• Aspirin
• Corticosteroids and other ulcerogenic drugs
• Protein bound drugs

Question 18

Gout:

Answer 18

Condition that results from inappropriate uric acid metabolism

• decreased excretion of uric acid
• excessive production of uric acid

Question 19

Gout: Uric acid crystals are:

Answer 19

deposited in tissues and joints, resulting in pain

Question 20

Antigout Drugs: Indications- allopurinol (Zyloprim)

Answer 20

Used to reduce production of uric acid

Question 21

colchicine:

Answer 21

Reduces inflammatory response to the deposits of urate crystals in joint tissue

Question 22

probenecid (Benemid), sulfinpyrazone (Anturane)

Answer 22

Increases excretion of uric acid in the urine