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Pharmacology > Exam 4: NSAIDs/Non-Opioids yo-Part 2 NSAIDs & Tylenol > Flashcards

Exam 4: NSAIDs/Non-Opioids yo-Part 2 NSAIDs & Tylenol Flashcards

1
Q

Inhibiting cyclooxygenase reduces formation of _________ precursors and ____________ from arachidonic acid

A

prostaglandin…. thromboxanes

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2
Q

What are the 2 categories of NSAIDs?

A

Non-selecitve (COX-1 & COX-2 inhibitors) & Selective (COX-2 inhibitors)

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3
Q

Pharmacokinetics of NSAIDs…..Peak in ___-___ hours, metabolized by the ______, excreted by the _______.

A

1-2…liver..kidney

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4
Q

Pharmacokinetics of NSAIDs…..what is the half life?

A

IT VARIES by product

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5
Q

What are the 3 actions of NSAIDs?

A

1.Anti-Inflammatory 2.Analgesic 3.Antipyretic

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6
Q

Actions of NSAIDs…..________ effects on blood platelets

A

REVERSIBLE (opposite of aspirin!!!)

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7
Q

Actions of NSAIDs……their effect lasts only as long as _________.

A

the drug is in the bloodstream

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8
Q

If there is a need to DISCONTINUE NSAIDs before surgery, time is based on _______…..ibuprofen = ___ day(s) naproxen = __ day(s)….

A

HALF LIFE…..1 day….4 days

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9
Q

If you need to discontinue NSAIDs COUNT BACK ____ to ____ half lives!

A

4 to 5

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10
Q

_________ can interfere with the antiplatelet effect of low-dose aspirin (81 mg), potentially rendering aspirin less effective when used for cardioprotection and stroke prevention

A

ibuprofen

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11
Q

FDA recommends for patients who use immediate release aspirin (not enteric coated) and take a single dose or chronic doses of ibuprofen 400 mg, dose the ibuprofen at least 30 minutes or longer ______ aspirin ingestion or MORE than 8 hours ______ aspirin ingestion to avoid attenuation of aspirin’s effect….so like when?

A

AFTER…BEFORE…..before bed time (when MI/stroke most commonly occur)

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12
Q

Occasional use of ibuprofen or other NSAIDS pose _____ risk for attenuation of anti-platelet effects of low-dose aspirin

A

little

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13
Q

What are our 2 examples of NSAIDs?

A

1.ibuprofen 2.Naproxen

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14
Q

What are the 4 brand names for ibuprofen? Which one is the Rx name?

A

1.Advil 2.Midol 3.Motrin (Rx) 4.Ultraprin

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15
Q

What are the 3 brand names for naproxen? What are the 2 Rx?

A
  1. Aleve 2.Anaprox (Rx) 3.Naprosyn (Rx)
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16
Q

What is the NSAID with the MOST drug interactions?

A

IN-DO-METH-A-CIN

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17
Q

Which organ is most susceptible to NSAID use?

A

KIDNEYS (no not liver dawg)

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18
Q

Adverse Events with NSAIDs!!! Increased risk of ____, stroke

A

MI

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19
Q

Adverse Events with NSAIDs!!! New onset or worsening of ________.

A

hypertension

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20
Q

Adverse Events with NSAIDs!!! Compromised _____ function…Excessive or chronic use = ________…..Contraindicated in patients with advanced ______ disease… Age group more susceptible to this damage _______.

A

renal…nephrotoxicity…renal…elderly

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21
Q

Adverse Events with NSAIDs!!! _________ ulceration, irritation, bleeding and perforation…Consuming more then ___ alcoholic drinks per day increases risk for GI bleeding… and this age group is most susceptible to bleeding.

A

Gastrointestinal..3…Elderly

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22
Q

T/F NSAIDs have CNS effects.

A

TRUE! Dose-dependent effects…Sedation, dizziness, confusion, mental depression, headache, vertigo, convulsions…Blurred vision, TINNITUS…Caution operating heavy machinery, driving…No addiction, no tolerance, no withdrawal

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23
Q

Skin reactions are also associated with ______ adverse events.

A

NSAID

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24
Q

Avoid NSAIDs in pts with an _____ allergy and if they have decreased _____ function too.

A

aspirin…liver

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25
Q

What is STEVEN-JOHNSON syndrome and what is it a sign of?

A

sloughing off of skin on palms and soles….hypersensitivity to NSAIDs

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26
Q

Target organ for NSAIDS is ______!!! (not liver)

A

KIDNEY

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27
Q

NSAIDs: Inhibiting prostaglandins shuts down ______ blood flow…which can result in _______, especially beyond use for ___ days with high doses.

A

renal…renal necrosis…5 days

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28
Q

Short-term use of NSAIDs: _____ to _____ risk if normal kidney function…Slight increased risk for ____, cystitis

A

little to no..UTI (i wonder why!?)

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29
Q

ibuprofen (MOTRIN): Available both OTC and prescription strength…OTC dose = _____ mg tablets….Prescription dose = ____ – _____ mg

A

200 mg….Rx-400 - 800 mg

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30
Q

ibuprofen (MOTRIN): _______ onset of analgesia (30-60 minutes)

A

RAPID

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31
Q

ibuprofen (MOTRIN): ______ duration of action (4-6 hours)

A

Short

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32
Q

ibuprofen (MOTRIN): ______ half-life (2-4 hours) = must take frequently

A

Short

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33
Q

ibuprofen (MOTRIN): Dental dosing (analgesic/fever reduction) Children: __-__ mg/kg/dose every __-__ hours…Use of ______ to select dose is preferred!!

A

4-10 mg/kg/dose every 6-8 hours..WEIGHT

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34
Q

ibuprofen (MOTRIN): Adults: 200-400 mg/dose every 4-6 hours for a maximum daily dose of _____ mg…WHAT is the upper dose of ibuprofen for arthritic pain?

A

1200 mg…3200 mg for arthritis

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35
Q

Please compare the limit for daily ibuprofen vs aspirin…

A

1.2 g for ibuprofen vs 4 g for aspirin

36
Q

PRACTICAL APPLICATION—–ibuprofen (MOTRIN): Preoperative use of ibuprofen at a dose of ____-____ mg every __ hours for ____ hours before the appointment decreases postoperative edema and hastens healing time!!!!! ANTICIPATORY

A

400-600 mg….4 hours… 24 hours

37
Q

Ibuprofen is unique, it has a “______” effect for dental pain where the optimal analgesia occurs at ____ mg dose

A

“ceiling”…400 mg

38
Q

NSAIDs and Arthritis-Takes ____ to _____ to reach anti-inflammatory effects, from gradual reduction in prostaglandin synthesis

A

days to weeks

39
Q

In our Rx example of ibuprofen, what was the daily limit?

A

3200 mg (directed by a physician)

40
Q

naproxen: ______ onset of analgesia (1 hour)

A

quick

41
Q

naproxen: _____ half life (12-17 hours)

A

long

42
Q

naproxen: Duration of action (analgesia: < 7 hours; anti- inflammatory: < ____ hours; peaks after ___ weeks)

A

12…2 weeks

43
Q

naproxen: Dental dosing = adults: ____ mg initially, then 250 mg every 6-8 hours; maximum: _____ mg /day…this is called a “_____” dose

A

500 mg…1250 mg…“loading” dose

44
Q

________ (Feldene) = **longest acting of all NSAIDS *…10 mg 2 times per day…Long half life = ___-___ hours

A

PRI-OXI-CAM…45-50 hours

45
Q

What are the 3 “other important NSAIDs in Dentistry?

A

1.Pir-oxi-cam 2.flur-bi-profen 3.keto-ro-Lac

46
Q

_______ (Toradol)* = used for up to 5 days for severe acute pain requiring analgesia at opioid level; taken primarily by injection; causes renal damage

A

Keto-RO-Lac

47
Q

______=“super aspirin” = No greater efficacy than

aspirin…____ half life- ___ to ___ hours.

A

di-flu-nis-al…8-12 hours

48
Q

What are the two ways to Rx for pain? Why do we do this?

A
  1. As needed for pain 2.every 6 hours….keep the [ ] in blood at therapeutic level
49
Q

Sometimes its useful to think about ________ considerations:…A prescription drug gives more relief to a
patient than an OTC drug….More relief with expensive drug vs. cheap drug…More relief from colored pills vs. white pills

A

psychological considerations

50
Q

WHAT IS THE ONLY COX-2 INHIBITOR AVAILABLE? What is it indicated for?

A

cel-e-cox-ib (Celebrex)…arthritis

51
Q

_____ inhibitors have better adverse events profile

A

COX-2 (then why aren’t there more of them???)

52
Q

Interesting…Celebrex has been shown to reduce risk for _______ of the colon…also improvements in ____ cancer, and possibly ____ cancer

A

adenocarcinoma…lung…oral

53
Q

Freaking wonder drug- Celebrex shown to delay onset and degree of severity of _________ too!!

A

Alzheimer’s disease

54
Q

Celebrex can be used for acute DENTAL pain!! Initial ____ mg “losing” dose, followed by an additional ____ mg dose if needed on day 1.

A

400 mg…200 mg

55
Q

COX-2 inhibitors OK to use with ________.

A

low dose aspirin

56
Q

COX-2 inhibitors; Monitor _______ when used with antihypertensives (reduces effectiveness)

A

blood pressure

57
Q

COX-2 inhibitors- Assess ________ when used with warfarin

A

bleeding times

58
Q

Celebrex contains _____ atom = some may be allergic

A

SULFA (or sulfer, wtf?)

59
Q

Celebrex is _______ in pregnancy.

A

CONTRAINDICATED

60
Q

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! _______ and ibuprofen/aspirin-Used for autoimmune diseases and cancer….Ibuprofen _______ the breakdown of this drug…, causing toxicity…Cannot give aspirin = displaces this drug and interferes with its ______, increasing serum concentrations and causing toxicity (bone marrow depression).

A

Meth-o-trex-ane…INHIBITS…clearance

61
Q

DRUG INTERACTIONS-NSAIDs & aspirin!!!!!….________ = used for bipolar disorder (manic depression) = NSAIDS block excretion, resulting in toxicity.

A

Lithium

62
Q

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! aspirin = separate dosing intervals with NSAIDS to avoid attenuation of ______ effects of aspirin.

A

anti- platelet

63
Q

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! NSAIDS = taking multiple NSAIDS together can give an ______ toxic effect

A

ADDITIVE!!

64
Q

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! Alcohol increases the risk for _____ bleeding associated with aspirin and NSAIDS

A

GI

65
Q

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! Aspirin and NSAIDS may decrease the effectiveness of many common ________ medications = monitor BP if giving NSAIDS to patients taking BP meds

A

antihypertensive

66
Q

What is the abbreviated name for acetaminophen?

A

APAP (n-Acetyl-P-AminoPhenol)

67
Q

Acetaminophen is categorized as a “_______” analgesic..It blocks _____.

A

“miscellaneous”…COX-3

68
Q

Where does acetaminophen work most, peripherally or centrally?

A

centrally…CNS COX-3

69
Q

Acetaminophen DOES NOT-inhibit _______ aggregation….irritate the ______….cause broncho_______.

A

platelet….GI tract…bronchoconstriction

70
Q

Pharmacokinetics of acetaminophen- _______ and completely absorbed from GI tract

A

rapidly

71
Q

Pharmacokinetics of acetaminophen- Peak plasma level occurs in __ to __ hours..Metabolized by ____

A

1 to 3 hours..liver

72
Q

Pharmacokinetics of acetaminophen- Metabolite is BOTH ________ and ________.

A

hepatotoxic and nephrotoxic

73
Q

Pharmacokinetics of acetaminophen- Half-life of ___ to ____ hours… Excreted by ______

A

1-4…kidneys

74
Q

AWESOME SYNOPSIS- Pt has GI problems? Rx this…

A

Acetaminophen

75
Q

AWESOME SYNOPSIS- Pt has decreased kidney function/ diabetes? Rx this…

A

Acetaminophen

76
Q

AWESOME SYNOPSIS- Pt has compromised liver function? Rx this…

A

NSAID

77
Q

Effects of Acetaminophen…it is an ________, ________, but it is NOT an __________!!!!!!

A

Analegesic…antipyretic…anti-inflammatory!!!!!

78
Q

How do acetaminophen and aspirin compare in POTENCY?

A

EQUAL!

79
Q

While acetaminophen is not irritating to the ______, it is toxic to the ______.

A

GI…liver

80
Q

What is the maximum dose of acetaminophen? But what about Tylenol?

A

4 g….3 g they are toning it down a bit

81
Q 
Remember this (YOU EXCEDRIN USERS)....Acetaminophen and aspirin are: Equally \_\_\_\_\_\_\_\_ (reduces same degree
of pain)....Equally \_\_\_\_\_ (same dose in milligrams needed for effect)....BUT \_\_\_\_\_\_\_\_\_\_ is less useful clinically, because it is NOT anti-inflammatory
A

efficacious..potent… Acetaminophen

82
Q

Unlike aspirin, acetaminophen has no effect on ______ acid.

A

uric

83
Q

acetaminophen dosing——-Usual dental dosing….Children (

A

10-15…..325 mg…4000 mg…2 grams

84
Q

Alcohol stimulates the _______ enzymes that metabolize acetaminophen to its toxic metabolite. yikes.

A

oxidizing

85
Q

WARNING: An important dental drug interaction….Taking ________ with warfarin (Coumadin) causes enhanced anticoagulation….. One study showed that taking 4 325 mg tablets for one week raised the INR (bleeding time test) ______ above those NOT taking this drug; risk also occurred in patients taking 6 tablets or fewer of 325 mg this drug in one week

A

acetaminophen…10x

Pharmacology (23 decks)

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