Management of pain and inflammation Part 2

Question 1

Nonopioid analgesions incluse

Answer 1

NSAIDs (nonsteroidal anti-inflammator drugs) and Acetaminophen

Question 2

NSAIDs: primary effects

Answer 2

-analgesic
-anti inflammatory
-antipyretic (reduce fever)
-anticoagulant
-anticancer?
(NSAAAAAIDs)

Question 3

OTC (over the counter) NSAIDs

Answer 3

aspirin, ibuprofen, naproxen, ketoprofen

Question 4

prescription NSAIDs

Answer 4

• Etodolac
• Fenoprofen
• Ketorolac
• Meclofenamate
• Piroxicam
• etc.

Question 5

OTC vs Rx: therapeutic differences?

Answer 5

not really if give same relative dose

Question 6

OTC vs Rx: safety differences?

Answer 6

not really– related to dosage

Question 7

OTC vs Rx: cost differences

Answer 7

OTC much cheaper

Question 8

NSAIDs inhibit synthesis of

Answer 8

prostaglandins

Question 9

lipid compounds produced in cells (usually when cell is injured)

Answer 9

prostaglandins

Question 10

NSAIDs decrease prostaglandins by inhibiting

Answer 10

cyclooxygenase

Question 11

NASIDs inhibit

Answer 11

cyclooxygenase enzyme (COX) (decreaes prostaglandin synthesis)

Question 12

COX enxyme: 2 primary subtypes

Answer 12

1) COX-1

2) COX-2

Question 13

COX-1 vs COX-2: normal constituent certain cells

Answer 13

COX-1

Question 14

COX-1 vs COX-2:synthesizes PGs to protect cells, maintain function

Answer 14

COX-1

Question 15

COX-1 vs COX-2: induced when cell is injured

Answer 15

COX-2

Question 16

COX-1 vs COX-2:synthesizes PGs that mediate pain, inflammation

Answer 16

COX-2

Question 17

COX-1 vs COX-2: ex= stomach, kidneys, platelets

Answer 17

COX-1

Question 18

COX-1 vs COX-2: ex= RA, other pathologies

Answer 18

COX-2

Question 19

COX-2 selective drugs inhibit …

Answer 19

synthesis of PGs in pain, inflammation

Question 20

COX-2 selective drugs spare production of beneficial PGs in…

Answer 20

stomach, kidney, platelets

Question 21

COX-2 selective drugs may decrease pain and inflammation with…

Answer 21

less toxicity

Question 22

COX-2 selective drugs include

Answer 22

celecoxib (Celebrex)

Question 23

Evidence that COX-2 inhibitors promote ( )

Answer 23

infarction (heart attack, stroke)

Question 24

some ( ) more selective for COX-2

Answer 24

NSAIDs

Question 25

which NSAIDs are 5-50 times more selective for COX-2?

Answer 25

- Diclofenac (voltaren) - Etodolac (lodine) - Meloxicam (mobic)

Question 26

why does COX-2 inhibition promote infarction:

Answer 26

normally there is balance b/w PGs that cause vasodilation/constriction...the drugs allow PGs that increase platelet activity and promote constriction to dominate

Question 27

acetaminophen effects

Answer 27

analgesic and antipyretic

Question 28

what effects does acetaminophen not have?

Answer 28

gastric irritation, anti-imflammatory, anticoagulant (peripheral effects)

Question 29

high doses of actaminophen lead to

Answer 29

liver toxicity

Question 30

actaminophen and opioid combos: tramadol + acetam

Answer 30

altraCET

Question 31

actaminophen and opioid combos: hyrocodone + acetam

Answer 31

lorTAB, lorCET, vidoden, detc.

Question 32

actaminophen and opioid combos: oxycodone + acetam

Answer 32

endoCET, roxiCET, primalev

Question 33

are NSAIDs the same as acetaminophen?

Answer 33

NO

Question 34

anti inflammatory: nonsteroidal

Answer 34

NSAIDs

Question 35

anti inflammatory: steroids

Answer 35

glucocorticoids

Question 36

NSAIDs inflammation: inhibit ( )

Answer 36

PG biosynthesis

Question 37

NSAIDs inflammation: anti-inflammatory higher or lower dosage than analgesisc?

Answer 37

higher

Question 38

NSAIDs inflammation: T/F: should be used continuously until inflammation is resolved

Answer 38

T (ex. dumping water on fire)

Question 39

glucocorticoids inflammation: powerful anti-inflammatory AND ( )

Answer 39

immunosuppressive effects

Question 40

common glucocorticoids

Answer 40

betamethasone, cortisone, dexamethasone, hydrocortisONE, praramethasONE, predinisolONE

Question 41

anti inflammatory effects: act on ( )

Answer 41

inflammatory cells (macrophages, leukocytes)

Question 42

anti inflammatory effects: drug binds to ( ) in cytoplasm

Answer 42

glucocorticoid receptor

Question 43

anti inflammatory effects: when drug-receptor travels to nucleus, it decreases...

Answer 43

expression of inflammatory proteins (cytokines, enzymes, etc)

Question 44

anti inflammatory effects: when drug-receptor travels to nucleus, increases...

Answer 44

expression of antiinflammaotry proteins

Question 45

administration methods: regular maintenance dose, dose packs

Answer 45

oral, systemic

Question 46

administration methods: intra-articular, 3-4 per year

Answer 46

injections

Question 47

administration methods: other

Answer 47

inhalation, topical, nasal, opthalmic, otic

Question 48

why would you use injection?

Answer 48

put drug right where you need it

Question 49

primary concern for anti-inflammatory steriods

Answer 49

catabolic effect on bone, muscle, ligament, tendon, skin (break down collagen in these tissues)

Question 50

other anti-inflammatory steroid side effects:

Answer 50

salt/water retention, increased infection, gastric ulcers, glucose intolerence, glaucoma...adrenal suppression (METABOLIC DYSFUNCTIONS)

Question 51

can we intervene with the primary problem?

Answer 51

yes, with resistance exercises and stuff

Question 52

how long is gap where body does not have adrenal hormones?

Answer 52

4-5 days

Question 53

glucocorticoids: adrenocortical shock

Answer 53

vascular collapse, severe hypotension, organ damage

Question 54

when can adrenocortical shock occur?

Answer 54

when GCs are suddenly discontinued