Cyclooxygenase Inhibitors Or Non-steroidal Anti-inflammatory Medications (NSAIDS) Flashcards
Cyclooxygenase inhibitors is a class that consist of
Non-steroidal anti-inflammatory meds (NSAIDs):
Ibuprofen, naprosyn, ASA (aspirin)
What is not consistered an NSAID
Acetaminophen (Tylenol)
What do NSAIDs do
Suppression of inflammation
Relief pain (analgesic)
Reduction of fever(anti-pyretic)
Where is cox found?
In all tissues
Cox 1
“Good cox” in all tissues and brain
“Protective” cox
What does cox1 do
- Protect gastric area (reduce secretion of gastric acid)
2.increase secretion of bricarbonate and cytoprotective mucus
- Maintenance of sub-mucosal blood flow
- Catalyzes synthesis of PGE2 and PGI2 (promotes vasodilation and increases renal blood flow)
- Promotes synthesis of TXA2 (stimulates platelet aggregation)
Cox2
“Bad cox”
Present only at site of tissue injury
When cox2 is activated it causes:
Inflammation
Pain
Fever (increased heat at injury site)
What does giving a pt a non-specific cox inhibitor block:
Cox1 and cox2
What does giving a pt a specific cox inhibitor block mostly?
Cox2
What are the two categories of cox meds
-With anti-inflammatory properties
-Without
NSAIDs non-steroidal anti-inflammatory meds
Can be subdivided into two groups
First generation :
Blocks both cox 1&2
Nonselective
Second-generation:
Specifically blocks cox 2
Selective
Difference between first gen and second gen nsaids
1st gen can provide:
Pain, fever, and inflammation relief
With serious SEs
2nd gen can provide:
Pain, fever and inflammation relief
With minimal SEs
Giving a pt cox 1 & 2 inhibitor (nonspecific) will cause:
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)
1st gen nsaids (non-selective)
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
Aspirin (acetylsalicylic acid) usage:
Pain relief
Inflammation relief
Reduces fever
Dysmenorrhea (helps inhibit contractions of uterus smooth muscles)
Suppression of platelet aggregation
Prevention of colorectal cancer
Aspirin (Acetylsalicylic acid)
AR/SEs
GI problems (bleeding, cramps, ulceration in gastric lining)
Bleeding
Renal impairment
Salicylism
Reye’s syndrome
Salicylism
When levels reach supra-therapeutic this syndrome may begin which features
tinnitus(mainly)
sweating
headache
dizziness
Withhold me until s/s subside, contact pcp
Reyes syndrome
Peds patients
Encephalopathy and fatty liver degeneration
Triad:
Ped pt
Aca use
Fever of unknown origin
Different types of ASA
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
Other first gen non-selective cox inhibitors nsaids
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)
Medication interactions with 1st gen nsaids
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
First gen nsaids
SE/AR
Same SE/AR as ASA
Same precautions except reyes syndrome
A child with a fever is safe to take first gen cox
what should you take with 1st gen cox inhibitors
Food/buffer system
Water/liquids
