MAGA (Brooke's Deck, Exam II) Flashcards
What enzyme catalyzes the synthesis of prostaglandins?
COX (Cyclooxygenase)
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 affect 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
List some alternatives to treat pain.
PT & OT, Chiropractic care, acupuncture, massage, yoga, weight loss, cold/heat, OTC medications, TENS unit…etc.
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
What are the side effects of Ondansetron?
HA, diarrhea, and some QT prolongation!
What is the duration & dose of Ondansetron? (pediatric?)
Duration/plasma half life: 4 hours
Dose: Adults: 4 - 8 mg IV
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?
- 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.