MAGA (Brooke's Deck, Exam II) Flashcards
What enzyme catalyzes the synthesis of prostaglandins?
COX (Cyclooxygenase)
Slide 33
This form of COX is responsible for gastric protection, hemostasis, and renal function…
COX-1
COX-1 or COX-2?
Ubiquitous, “physiologic”, inhibition of this enzyme is responsible for many adverse effects.
COX-1
COX-1 or COX-2?
Pathophysiologic, expressed at sites of injury, not protective.
COX-2
COX-2 propagation is responsible for which symptoms?
Pain, inflammation, and fever
What are the three main properties of NSAID drugs?
Analgesic
Anti-inflammatory
Antipyretic
Are the following drugs non-specific or COX-2 selective?
–Ibuprofen, naproxen, aspirin, and ketorolac–
What gastric symptomology would be seen with administration of these drugs?
Non-Specific
Increased gastric irritation with these drugs
Multimodal includes _____ acting anesthetics agents and _______ sparing components.
short acting; Opioid sparing.
Celecoxib (Celebrex), Rofecoxib (Vioxx), Valdecoxib (Extra), Parecoxib (Dynastat) are all examples of what?
COX-2 Selective NSAIDs
Do COX-2 selective NSAIDs effect platelets?
No
Because COX-2 selective NSAIDs have no effect on platelets, this would increase the chance of what pathology?
Clotting (think MI and CVA)
COX-2 selective and nonspecific inhibitors have _____________ analgesia
Comparable
What was the first COX-2 inhibitor that decreases PG synthesis?
Celecoxib (Celebrex)
What is the dosage for Celebrex?
200 to 400 mg PO QD
Celebrex reaches its peak in…
3 hours
Define non-opioid anesthesia. List some alternatives to treat pain.
PT & OT, Chiropractic care, acupuncture, massage, yoga, weight loss, cold/heat, OTC medications, TENS unit…etc.
What is the pain response pathway? (5)
(this was in the pain pathway slide set too)
What are the 2 classes of opioids?
1) Phenanthrenes (L-isomers have opioid activity; morphine, codeine)
2) Benzylisoquinolones (Lack opioid activity; Papaverine, noscapine)
What drug class does Ondansetron fall into?
What was it first developed for?
What CYP450 is relevant to ondansetron?
It is the first 5-HT3 antagonist
-It was approved for CINV
-Responsiveness decreased by variations in the CYP2D6 activity!
Ondansetron is equivocal to what two drugs in its treatment of N/V?
Droperidol & Metoclopramide
(Slide 51)
What are the side effects of Ondansetron?
HA, Constipation, and some QT prolongation!
What is the duration & dose of Ondansetron?
Duration/plasma half life is 4 hours!
Dose: Adults: 4 mg IV (up to 8 mgs)
Dose: Pediatrics: 0.1 mg/kg IV
What is the MOA of Corticosteroids in the treatment of N/V?
Why are Corticosteroids used with 5-HT3 (Ondansetron) & droperidol?
Hint: It was studied in CINV!
- MOA is unknown: It works on glucocorticoid receptors in Nucleus Tractus Solitarius (NTS).
- Corticosteroids potentiate 5 HT3 antagonists and droperidol!
What is the dose for Dexamethasone (Decadron)?
What is the MOA of Dexamethasone (Decadron)?
4 - 8 mg IV
MOA: Anti-inflammatory; inhibition of phospholipase and cytokines and stabilization of cellular membrane.