Cycloxygenase Inhibitors

Question 1

Cyclooxygenase Inhibitors:

Answer 1

Nonsteroidal Anti-inflammatory Drugs and Acetaminophen

Question 2

Cyclooxygenase Inhibitors Uses

Answer 2

➢ Suppress inflammation
➢ Relieve pain
➢ Reduce fever

Question 3

Cyclooxygenase Inhibitors adverse effects

Answer 3

➢ Gastric ulceration
➢ Bleeding
➢ Renal impairment

Question 4

Classification of Cyclooxygenase Inhibitors

Answer 4

Drugs with anti-inflammatory properties or Drugs without anti-inflammatory properties

Question 5

Drugs with anti-inflammatory properties -

Answer 5

NSAIDs: nonsteroidal anti-inflammatory drugs (Aspirin, celecoxib, ibuprofen, and naproxen)

Question 6

Drugs without anti-inflammatory properties -

Answer 6

Acetaminophen

Question 7

First-Generation NSAIDs:

Answer 7

(aspirin, ibuprofen (Motrin)
 Inhibit COX-1 and COX-2
 Used to treat inflammatory disorders (rheumatoid arthritis, osteoarthritis, bursitis)
➢ Alleviate mild to moderate pain
➢ Suppress fever
➢ Relieve dysmenorrhea
 Suppress inflammation but have risk of serious harm

Question 8

Aspirin

Answer 8

 Nonselective inhibitor of cyclooxygenase

Question 9

Aspirin Therapeutic uses

Answer 9

➢ Analgesic, antipyretic, anti-inflammatory
➢ Suppression of platelet aggregation - Protects in thrombotic disorders
➢ Dysmenorrhea
➢ Cancer prevention
➢ Prevention of Alzheimer’s disease

Question 10

Aspirin Adverse effects

Answer 10

➢ Gastrointestinal effects (now is given enteric coated)
➢ Bleeding
➢ Renal impairment
➢ Salicylism
➢ Reye’s syndrome
➢ Pregnancy - Anemia, postpartum hemorrhage, may prolong labor
➢ Hypersensitivity reaction

Question 11

Aspirin Drug interactions

Answer 11

➢ Anticoagulants: warfarin and heparin
➢ Glucocorticoids (increase risk of gastric ulcer)
➢ Alcohol (can cause more problems with gastric ulcers)
➢ Ibuprofen (same thing)
➢ ACE inhibitors and ARBS (lead to renal impairment)

Question 12

Nonaspirin First-Generation NSAIDs

Answer 12

 Aspirin-like drug with fewer GI, renal, and hemorrhagic effects than aspirin
 20+ nonaspirin NSAIDs available (all similar, but for unknown reasons, patients tend to do better on one drug or another
 Inhibit COX-1 and COX-2 – inhibition is reversible (unlike with aspirin)
 Principal indications – rheumatoid arthritis and osteoarthritis
 Do not protect against MI and stroke

Question 13

First-Generation NSAIDs

Answer 13

	ibuprofen (Advil, Motrin)
	naproxen (Naprosyn)
	naproxen plus lansoprazole (Prevacid)
	ketorolac (Toradol)
	Indomethacin (Indocin)

Question 14

Second-Generation NSAIDs

Answer 14

 Just as effective as traditional NSAIDs at suppressing inflammation and pain
 Somewhat lower risk for GI side effects
 Can impair renal function and cause hypertension and edema
 Increase the risk for MI and stroke

Question 15

Celecoxib (Celebrex)

Answer 15

 Second-generation COX-2 inhibitor—fewer adverse effects than first-generation drugs
 Because of cardiovascular risks, last-choice drug for long-term management of pain

Question 16

Celecoxib (Celebrex) Uses

Answer 16

➢	Osteoarthritis
➢	Rheumatoid arthritis
➢	Acute pain
➢	Dysmenorrhea
➢	Familial adenomatous polyposis

Question 17

Celecoxib (Celebrex) adverse effects

Answer 17

➢ Dyspepsia
➢ Abdominal pain
➢ Renal toxicity
➢ Sulfonamide allergy
➢ Cardiovascular impact (stroke, MI, and other serious events)
➢ Contraindicated in pregnancy, allergy to sulfonamides, aspirin or any NSAID
➢ Use with caution if any liver impairment

Question 18

Celecoxib (Celebrex) drug interactions

Answer 18

➢ Warfarin
➢ May decrease diuretic effect of furosemide
➢ May decrease antihypertensive effect of ACE inhibitors
➢ May increase levels of lithium
➢ Levels of celecoxib may be increased by fluconazole

Question 19

Acetaminophen (Tylenol) therapeutic use **

Answer 19

➢ Analgesic, antipyretic***
➢ Does not have any anti-inflammatory or antirheumatic actions
➢ Not associated with Reye’s syndrome

Question 20

Acetaminophen (Tylenol) action

Answer 20

➢ Inhibits prostaglandin synthesis in central nervous system

Question 21

Acetaminophen (Tylenol) adverse effects

Answer 21

➢ Very few at normal doses
➢ Hepatotoxicity- With overdose or in patients with liver failure (when combined with alcohol)
➢ Overdose – hepatic necrosis
• S/S of hepatic failure, coma, death
• Early symptoms: N/V, diarrhea, sweating, abdominal pain

Question 22

Acetaminophen (Tylenol) drug interactions

Answer 22

➢ Alcohol
➢ Warfarin
(both cause more liver damage)

Question 23

Treatment for overdose: **

Answer 23

acetylcysteine (Mucomyst) - loosens up secretions, can give inhalation, given orally for tylenol toxicity
Acetaminophen (Tylenol)

Question 24

Most COX inhibitors – especially COX-2 inhibitors – increase

Answer 24

the risk for MI and stroke

Question 25

AHA recommends a

Answer 25

stepped-care approach

Question 26

Rye’s Syndrome**

Answer 26

occurs in childhood, 30% mortality rate; can lead to hepatic ajury and damage to the brain - encephelopathy; so don’t ever treat childhood fever w/ aspirin*

Question 27

saclicylism

Answer 27

ringing in the ear, when aspirin levels climb above therapetuic levels, number 1 symptom is tennitus

Question 28

acute poisonings of aspirin are

Answer 28

salicylism

Question 29

what is the only injectable NSAID

Answer 29

ketorolac (Toradol); great for post op pts with patin and if pt is addicted to morphine