CNS Meds: NSAIDS

Question 1

What is cyclooxygenase (COX) and recognize the effects of COX-1 inhibitors and COX-2 inhibitors

Answer 1

COX is an enzyme that helps create the chemicals prostaglandin and thromboxane (TxA2). Prostaglandins help create inflammation, and TxA2 helps make blood clot.

COX-1 inhibitor: decreases thromboxane-2 (anti-thrombic)

COX-2 inhibitor: increase aspirin-triggered lipoxin (ATL) –> anti-inflammation

Question 2

List 3 non-steroidal anti-inflammatory drugs (NSAIDs) that are available over the counter

Answer 2

NSAIDs are COX inhibitor and include aspirin and related drugs.

1. Aspirin (Bayer, Bufferin, Excedrin)
2. Ibuprofen (Advil, Motrin)
3. Naproxen (Aleve)

Question 3

Specify the 3 therapeutic uses of NSAIDs

Answer 3

1. Relieve pain
2. Suppress inflammation
3. Reduce fever

acronym: PIF

Question 4

List 2 compounds that require the cyclooxygenase (COX) enzyme for their synthesis

Answer 4

Prostaglandin
Thromboxane

Question 5

Specify the site of production of prostaglandins

Answer 5

Prostaglandins (originally found in semen lol) is produced by ALL nucleated cells except lymphocytes. Thus, prostaglandins are found in most tissues and organs.

**Synthesis: made from essential fatty acids

Question 6

Identify 3 effects of prostaglandins in the body

Answer 6

…support platelets (blood-clotting function)
…protect stomach lining from the acids
…promote inflammation that is necessary for healing

Question 7

Compare the roles of COX-1 and COX-2 in the body

Answer 7

COX-1
produces prostaglandins that support platelets and protect stomach (2 of 3)

COX-2
prostaglandins that promote inflammation

Question 8

List 3 side effects of cyclooxygenase-1 (COX-1) inhibitors in the gastrointestinal tract

Answer 8

COX-1 inhibitors are hard on your stomach!
- stomach upset,
- intestinal bleeding
- peptic ulcers

COX-1 inhibitors can reduce inflammation, but they may also decrease the natural protective mucus lining of the stomach.

Question 9

Recognize the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure

Answer 9

NSAIDs can raise blood pressure!

NSAIDs cause dose-related increases in Na and water retention in kidney.

Drug-induced hypertension is also seen with celecoxib (COX-2 selective agents, good therapeutic agents for arthritis)

Question 10

The effects of low-dose aspirin

Answer 10

No COX-2 inhibition

No hypertensive effects

Question 11

List 3 contraindications of non-steroidal anti-inflammatory drugs (NSAIDs)

Answer 11

1. Renal compromise
2. Risk of excessive bleeding –patients are recommended to stop all NSAIDs 1 week before elective surgery (surgery that can be scheduled in advance, not life-threatening)
3. Gastric impact

Question 12

What should you do before administering NSAIDs to a patient who is at risk for renal compromise

Answer 12

Watch lab work: check BUN and creatinine

For the elderly, check creatinine clearance/

Question 13

Specify the measures that minimize gastric upset while taking non-steroidal anti-inflammatory drugs (NSAIDs)

Answer 13

• take at the end of a full meal or with an antacid
• take NSAIDs along with misoprostol (Cytotec) **endogenous prostaglandins
• take along with proton pump inhibitor (inhibit acid secretion)