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Thompson class fall 2015 > Exam 2: Week 8 Monday NSAIDs > Flashcards

Exam 2: Week 8 Monday NSAIDs Flashcards

1
Q

What do NSAIDs do that affects blood clotting?

A

They inhibit platelet aggregation

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2
Q

What 4 things do NSAIDs do?

A
  1. decrease inflammation
  2. relieve mild to moderate pain (analgesia)
  3. decreased elevated body temp (antipyresis)
  4. decrease blood clotting (anticoagulation)
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3
Q

What is acetylsalicylic acid (ASA)?

A

aspirin

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4
Q

What do apsirin and other NSAIDs inhibit in inflammatory process?

A

protaglandins

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5
Q

What cells can make prostaglandins?

A

every cell except red blood cells

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6
Q

What do prostagladins do?

A
  • act as signals to control several different processes such as pain
  • prostaglandin called thromboxane stimulates the formation of a blood clot
  • cause inflammation, pain and fever as part of the healing process
  • involved in regulating the contraction and relaxation of the muscles in the gut and the airways.
  • involved in the control of ovulation, the menstrual cycle and the induction of labour
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7
Q

What are thromboxanes, lekotrienes, and prostaglandins collectively known as?

A

Eicosanoid

(due to all being derived from same carbon fatty acids with double bonds)

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8
Q

What is so great about the ecosanoids?

A

They help regulate a BUNCH of cell functions under both normal and pathological conditions

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9
Q

What is arachidonic acid?

A
  • fatty acid ingested and stored as phospholipids in cell membrane
  • it is the grandparent of ecosanoids
  • metabolized by enzyme pathways- COX (cyclooxygenase) and LOX (lipoxygenase)
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10
Q

Which enzymatic pathway synthesizes prostaglandins and thromboxanes?

A

Cyclooxygenase (COX)

  • important when deciding which meds to prescribe
  • NSAIDs or corticosteroids
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11
Q

Which enzymatic pathway synthesizes lekotrienes?

A

Lipoxygenase (LOX)

  • important when deciding which meds to prescribe
  • corticosteriods
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12
Q

Why might you get GI upset when taking NSIADs?

A

They inhibit prostaglandins which are important to the protection of the lining of the stomach

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13
Q

What test may need to be done regularly when a pt. is taking NSAIDs?

A
  • INR
  • NSAIDs inhibit prostaglandins which are important to clotting
  • Tested typically with people who are elderly or have comorbidities
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14
Q

Difference between COX-1 and COX-2

A

COX-1- seen more in normal cell functioning, lining of various organs, helping with homeostaisis

COX-2- shows up when there is a cell emergency or inflammation or cell damage

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15
Q

Why were COX-2 medications initially developed?

A
  • Meds intended to address areas with cell damage and leave normal functioning prostaglandins alone
  • ideally would prevent GI upset
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16
Q

What happened with the COX-2 meds?

(some side effect info in here)

A
  • caused problems with blood pressure and clotting and other cardiovascular problems
  • Clotting occurs because of selective inhibition of vasodilators and the thromboxane is not inhibited and also happens to facilitate platlet aggregation
  • at risk for prolonged bleeding and bruising
  • Celebrex still on market. Most others taken off
  • some questions raised about effect on bone density
  • increased risk of of upper respiratory infection- not understood why
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17
Q

Aspirin- positive effects

A
  • anti-inflammatory properties
  • preventing thromboembolitic events- blood thining
  • can act on arthrosclerosis in blood vessels (which is an inflammatory process)
  • correlated to have positive effects with colorectal cancer
  • very difficult to overdose (30g roughly to overdose)
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18
Q

Aspirin- negative

A
  • inhibiting prostaglandins in the mucosal lining of the stomach- not good for people with ulcers
  • lose a fair amount of medication with first pass effect, thus not great for immediate pain relief
  • blood pressure can increase- even though it is typically a blood thinner, it can act on other prostaglandins that would cause BP to increase. So CHECK VITAL SIGNS
  • bad for tinnitus- can cause ringing in ears if too much
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19
Q

Should you advise a patient to take prilosec with aspirin?

A

No

  • Even though the prilosec is designed to help with stomach upset, we do not know how teh meds will interact.
  • pt. should consult pharmacist
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20
Q

Low dose NSAIDs

A
  • work for 4-6 hours typically
  • work on COX-1 mechanism
  • typically broken down in system quickly
  • not very toxic to liver
  • may be safest option

Disadvantage- maintaining sustained therapeutic dose

21
Q

If a patient complains about symptoms of dizziness, nauseau, ect. , then…..

A

always ask if there has been a change in their medication- actual med or dosage

22
Q

Why should kids not take aspirin?

A

puts them at risk for Reye Syndrome

23
Q

List of common NSAIDs that Thompson reviewed in class from table 15-2

This is just a refernce flash card

Don’t need for test

A
  • aspirin
  • Voltaren (generic: diclofenac)
  • Dolobid- not antipyretic
  • Lodine
  • Ibuprofin
  • Toradol- can be intramuscular injection, good post-op choice, good choice when dug seeking behavior is in question
  • Ketaprofen- can be used in iontophoresis
  • Feldene- long half life
  • Clinoril
  • Tolectin

*do not need to memorize drug names

* made comment that sometimes prescription was related to the last drug rep to pass throughthe office

24
Q

Acetominophen (aka Tylenol) - possitive points

A
  • effective analgesic
  • antipyretic effect
  • not associated with GI upset
  • not connected to Reye syndrome so option for kids
  • may be good for osteoarthritis
  • asborbed rapidly in upper GI tract and is more readily availible systemically in comparison to aspirin
25
Q

Acetominophen (aka Tylenol)- negative points

A
  • not an antiinflammatory
  • not an anticoagulant
  • not understood how it works
  • very hepatatoxic
  • not intended to be taken continually
26
Q

A place I would like to visit in Sharlene’s homeland

A

Kaieteur Falls

27
Q

Good follow up question to ask someone if they state they are taking OTC meds for analgesia only when they need it.

A

How often do you need it?

(may need to follow up with doctor)

28
Q

True or False: acetaminophen is never mixed with other medication

A

False

It is often mixed with other meds such as antibiotics

Ex: Z-pack

29
Q

Considerations for rehab patients

A
  • try to schedule therapy when NSAIDs are most effective- peaking at about 30 min after they take it
  • need to know when they are taking their meds (with food?)
  • want max pain relief and anti-inflammatory effects
  • if meds are taken at night, may need to ask follow up questions: help with sleep, helpful during day, appropriate med with symptoms?
  • want to know about any side effects they experience with the medication- GI upset, blurred vision, tinnitus, ect..
  • mixing with alcohol or other meds? follow up question b/c of liver
  • NSAIDs do not have psychological effect unlike opioids which can make pt. fuzzy.
30
Q

If pt. asks you aspirin or tyleonol, how do you respond?

A
  • find out what their symptoms are- inflammation?, general pain?, fever?
  • Know general side effects and how it could impact your pt. EX: Pt. with Hx of stomach ulcers, probably should take tylenol.
31
Q

What is the “master anti-inflammatory”

(Thompson’s words) and why?

A

Adrenocorticosteroids

  • Works on everything below archidonic acid
  • suppresses entire immune system thus makes person immunosupressed
32
Q

2 types of steroids

A
  1. glucocorticoids
  2. mineralocorticoids
33
Q

What are glucocorticoids?

A

steroids primarily involved in control of glucose metabolism and body’s ability to deal with stress

Ex: cortisol, predinsone

34
Q

What are mineralocorticoids?

A

steriods that maintain fluid and electrolyte balance

Ex: Aldosterone

35
Q

How does use of adrenocorticosteroids affect theadrenal glands?

A
  • Adrenal glands already manufacture the steroids that are being intoduced synthetically into the system.
  • Adrenal glands slow production as a result

**Important for patient to taper off med so that adrenals will start back up production gradually.

36
Q

Difference between physiologic dose and pharmacologic dose

A

Physiologic- what is made within our body

Pharmacologic- the higher dose introduced into the body as prescription

37
Q

Do mineralcorticoids influence glucocorticoids?

A

Yes. and vice versa

structurally similar and can be precursers of the other

38
Q

What provides a systemic regulation of glucocorticoid levels and cortisol synthesis?

A

Negative feedback loop with hypothalmus

39
Q

What influences cortisol production?

A

Circadian Rhythms

  • in healthy normal, peak cortisol occurs just before waking
  • in healthy normal, cortisol levels drop when preparing to sleep
40
Q

What can cortisol affect?

A
  • protein synthesis
  • cell function
  • this effect will occur immediately which is why people often start feeling better right after receiving steroid injection
41
Q

What are some of the physiologic effects of glucocorticoids?

A
  • increases blood glucose- means pancreas has to work harder
  • increases liver glycogen- results in fat and weight gain
42
Q

What is the metabolic paradox of glucocorticoid use?

A
  • Affecting metabolism of glucose, fat, and protein AND break muscle into amino acids while glucose storage is enhanced
  • storing glucose, but using glucose
  • receive inappropriate amount of energy but at the expense of muscle breakdown
  • Thompson “like taking money out of the bank and saving at the same time
43
Q

Rehab implications and patient presentation of short term steroid use

A
  • will present with increased energy
  • may have mood changes (steroid induced pychosis is a thing)
  • may have increased strength, but at risk for exacerbating muscle breakdown- need to curb some of their enthusiasm
  • reistive exercises should be moderate with gentle increases and monitor effects
  • immune system will be diminished- wounds will not heal as quickly and susceptibale to infections and viruses
  • impacts renal system- impairs kidneys ability to excrete water- fluid retention
  • can impact CNS system
  • blood counts- increased erythrocytes, platlets, and neutrophils. decrease with other WBCs.
44
Q

Various preparations of steroids (6)

A
  1. systemic
  2. topical
  3. inhalation
  4. opthalmic
  5. otic
  6. nasal
45
Q

hint in drug name that will make you think steroid

A

ends with -one or -ide

46
Q

Long term use of steroid use complications/adverse effects

A
  • Type 1 and 2 adrenal insufficiencies
  • Cushing Syndrome
  • fluid retention can lead to hypertension and CHF
  • breakdown of supporting tissues such as collagen
  • can cause stomach irritation
  • hyperglycemia

* long term and short term use are the same in terms of our rehab considerations. Will monitor vitals

** These patients will probably not be our orthopedic/musculoskeletal patients.

47
Q

Other reasons to use adrenocorticosteroids aside from treating inflammation

A
  • autoimmune disorders
  • organ transplants
48
Q

How many steroid injections may a person have in a year?

A

Up to 4

That is a lot of injections if this occurs over multiple years

49
Q

Who may be particularly sensitive to the steroids

A
  • elderly patients, especially those with poor nutrition and inactive
  • negative effects can be magnified

Thompson class fall 2015 (12 decks)

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