Exam 5: NSAID Toxicosis

Question 1

What is toxicology?

Answer 1

The study of adverse effects of chemical or physical agents on living organisms

Question 2

What is a toxin?

Answer 2

Toxic substance produced by biological systems (plants, animals, fungi, bacteria)

Question 3

What is a toxicant?

Answer 3

Toxic substance made by man

Question 4

What is toxicity?

Answer 4

The degree to which a substance can damage an organism

Question 5

What is toxicosis?

Answer 5

The disease state that results from exposure to a toxin or toxicant

Question 6

What is toxicokinetics?

Answer 6

The rate a toxin or toxicant will enter the body and what happens to it when it is in the body

Question 7

What is venom?

Answer 7

A toxin that is injected from a living organism into another

Question 8

What does NSAID stand for?

Answer 8

Non-steroidal anti-inflammatory drug

Question 9

Describe NSAIDs

Answer 9

Anti-inflammatory
Analgesic
Antipyretic

Question 10

What are examples of NSAIDs?

Answer 10

Carprofen
Meloxicam
Deracoxib
Firocoxib
Robenacoxib
Aspirin
Ibuprofen
Naproxen sodium

Question 11

What would indicate that NSAIDs should be used?

Answer 11

Acute pain (surgery, injury)
Chronic pain (arthirits, neoplasia)
Inflammation
Fever

Question 12

What can cause toxicosis in animals?

Answer 12

Human NSAIDs
Flavored medication
Accidental over dosage
Potentiating factors

Question 13

What are potentiating factors that can cause toxicosis?

Answer 13

Concurrent corticosteroids (number 1 problem)
Multiple NSAIDs
Dehydration
Hypovolemia
Concurrent medications that may affect renal physiology
Pre-existing renal/GI disease

Question 14

How do NSAIDs help with inflammation?

Answer 14

They inhibit prostaglandins via COX enzyme inhibition

Question 15

What does COX1 do?

Answer 15

Renal perfusion
Gastric mucus secretion
Platelet function

Question 16

What does COX2 do?

Answer 16

Mediation of pain, fever, and inflammation

Neoplasia

Question 17

What are the highly selective drugs?

Answer 17

Firocoxib
Robenacoxib
Deracoxib

Question 18

What are the moderately selective drugs?

Answer 18

Meloxicam
Carprofen
Etodolac

Question 19

What are the drugs with little to no selectivity?

Answer 19

Aspirin
Piroxicam
Ketoprofen

Question 20

Which drugs are more selective, newer or older drugs?

Answer 20

Newer

Question 21

What can NSAID toxicosis cause?

Answer 21

Gastric ulceration (dose dpendent)
Acute renal failure (dose dpendent)
Neurotoxicosis (dose dpendent)
Hepatic injury

Question 22

What occurs with gastric ulceration?

Answer 22

Topical irritation
Disruption of gastric mucosa barrier
Delayed healing
Increased bleeding

Question 23

What happens with acute renal faiulre?

Answer 23

NSAID induced decreased GFR

Prostaglandins cause dilation of renal afferent arteriole

Question 24

How do you treat NSAID toxicosis that is acute?

Answer 24

Emesis
Activate charcoal
Supportive therapy to protect the kidneys, GI tract
Treat secondary problems

Question 25

What is the supportive management used for GI?

Answer 25

Misoprostol Sucralfate H2 antagonists Proton pump inhibitors

Question 26

What is the supportive management used for renal?

Answer 26

Fluid diuresis with isotonic fluids at 1.5-2.5x maintenance Monitor electrolytes, renal values, "in and outs", and weight Manage acid/base imbalances Maintain fluid therapy until values decline

Question 27

What is the long term management for NSAID toxicosis?

Answer 27

Dietary management (reduced protein and phosphorus) SQ fluids Famotidine/omeprazole, monitor bloodwork