Cyclooxygenase Inhibitors Or Non-steroidal Anti-inflammatory Medications (NSAIDS)

Question 1

Cyclooxygenase inhibitors is a class that consist of

Answer 1

Non-steroidal anti-inflammatory meds (NSAIDs):
Ibuprofen, naprosyn, ASA (aspirin)

Question 2

What is not consistered an NSAID

Answer 2

Acetaminophen (Tylenol)

Question 3

What do NSAIDs do

Answer 3

Suppression of inflammation

Relief pain (analgesic)

Reduction of fever(anti-pyretic)

Question 4

Where is cox found?

Answer 4

In all tissues

Question 5

Cox 1

Answer 5

“Good cox” in all tissues and brain

“Protective” cox

Question 6

What does cox1 do

Answer 6

1. Protect gastric area (reduce secretion of gastric acid)

2.increase secretion of bricarbonate and cytoprotective mucus

3. Maintenance of sub-mucosal blood flow
4. Catalyzes synthesis of PGE2 and PGI2 (promotes vasodilation and increases renal blood flow)
5. Promotes synthesis of TXA2 (stimulates platelet aggregation)

Question 7

Cox2

Answer 7

“Bad cox”

Present only at site of tissue injury

Question 8

When cox2 is activated it causes:

Answer 8

Inflammation

Pain

Fever (increased heat at injury site)

Question 9

What does giving a pt a non-specific cox inhibitor block:

Answer 9

Cox1 and cox2

Question 10

What does giving a pt a specific cox inhibitor block mostly?

Answer 10

Cox2

Question 11

What are the two categories of cox meds

Answer 11

-With anti-inflammatory properties

-Without

Question 12

NSAIDs non-steroidal anti-inflammatory meds
Can be subdivided into two groups

Answer 12

First generation :
Blocks both cox 1&2
Nonselective

Second-generation:
Specifically blocks cox 2
Selective

Question 13

Difference between first gen and second gen nsaids

Answer 13

1st gen can provide:
Pain, fever, and inflammation relief
With serious SEs

2nd gen can provide:
Pain, fever and inflammation relief
With minimal SEs

Question 14

Giving a pt cox 1 & 2 inhibitor (nonspecific) will cause:

Answer 14

Blockage of cox2 (what we want):
Suppression of inflammation, pain, fever

Blockage of cox1:
Gastric erosion and ulceration
Bleeding tendencies
Acute renal failure

(One positive of blocking cox1):
AMI/CVA protection
Inhibiting unwarranted platelet aggregation by blocking/stopping the synthesis of TXA2 (prevents clots/ prevents AMI/CVA)

Question 15

1st gen nsaids (non-selective)

Answer 15

Aspirin (acetylsalicylic acid)

Most widely utilized NSAID

Been the DOC for rheumatoid arthritis

Good for prophylaxis to platelet aggregation with AMI/CVA high-risk pts

Belongs to the salicylate family

A nonselective cox inhibitor

Question 16

Aspirin (acetylsalicylic acid) usage:

Answer 16

Pain relief

Inflammation relief

Reduces fever

Dysmenorrhea (helps inhibit contractions of uterus smooth muscles)

Suppression of platelet aggregation

Prevention of colorectal cancer

Question 17

Aspirin (Acetylsalicylic acid)
AR/SEs

Answer 17

GI problems (bleeding, cramps, ulceration in gastric lining)

Bleeding

Renal impairment

Salicylism

Reye’s syndrome

Question 18

Salicylism

Answer 18

When levels reach supra-therapeutic this syndrome may begin which features
tinnitus(mainly)
sweating
headache
dizziness

Withhold me until s/s subside, contact pcp

Question 19

Reyes syndrome

Answer 19

Peds patients
Encephalopathy and fatty liver degeneration

Triad:
Ped pt
Aca use
Fever of unknown origin

Question 20

Different types of ASA

Answer 20

Plain ASA tablet (white, hard on stomach)

Buffered ASA (add bicarb)

Buffered solution (tab in water)

Enteric-coated ASA (polymer coated to pass thru stomach to SI)

Timed-release tablets

Question 21

Other first gen non-selective cox inhibitors nsaids

Answer 21

Ibuprofen (advil, motrin)
Fenoprofen (Nalfon)
Flurbiprofen (Ansaid)
Piroxicam (feldene)
Naproxen and naproxen sodium (Naprosyn, Aleve)
Nabumetone (Relafen)
Indomethacin (indocin)
Ketorolac (toradol)-injection only bc of ARs
Sulindac (clinoril)
Oxaprozin (daypro)

Question 22

Medication interactions with 1st gen nsaids

Answer 22

Anti coagulation meds = higher pt reading

Dont utilized with pregnancy in first trimester

Mixed with glucocorticoids the gastric upset if increased

Not mix with alcohol=risk of gastric bleeding increased

Question 23

First gen nsaids
SE/AR

Answer 23

Same SE/AR as ASA

Same precautions except reyes syndrome

A child with a fever is safe to take first gen cox

Question 24

what should you take with 1st gen cox inhibitors

Answer 24

Food/buffer system

Water/liquids

Question 25

2nd gen nsaids

Answer 25

All benefits of blocking cox2 without harmful effects of 1st gen nsaids bc it does block cox 1

Down fall: cost, can still cause bleeding in pt on warfarin (coumadin)

Question 26

2nd gen nsaids meds

Answer 26

Celecoxib (celebrex)

Question 27

Acetaminophen will achieve what

Answer 27

Anti-pyretic (anti-fever_

Analgesia (pain)

Question 28

What does acetaminophen not do?

Answer 28

No anti inflammatory properties

Does not suppress platelet aggregation

Does not cause gastric ulceration

Does not decrease renal blood flow or cause ARF

Question 29

What is the antidote for acetaminophen?

Answer 29

Acetylcusteine (mucomyst)

Overdose is more complicated

Caused liver issues

Question 30

ASA/ibuprofen selects both types of prostaglandins

Answer 30

Peripheral and CNS

Question 31

Acetaminophen AR/SEs

Answer 31

Rare at therapeutic dose

Possibly fatal at supra-therapeutic doses or when mixed with alcohol

Liver damage (can be decreased by giving acetylcysteine (mucomyst)