module 4 NSAIDS Flashcards
1
Q
Traditional NSAID analgesic efficacy
A
- more effective than full doses of ASA or APAP
- equal or greater than usual doses of opioid + APAP combo
2
Q
NSAID MOA
A
COX inhibition
blocks conversion of arachidonic acid to prostaglandins
-> dec. production and release of PGs
3
Q
NSAID uses
A
analgesic
anti-inflammatory
antipyretic
4
Q
NSAID metabolism
A
highly protein bound
weak acids- well absorbed
extensively metabolized and excreted in urine
half-life: <6 to > 12hrs
5
Q
COX-1
A
protection and maintenance functions
6
Q
COX2
A
pro-inflammatory and mitogenic functions
7
Q
COX 1 AE
A
Non-selective COX inhibitors
- gastric ulcers
- inhibit plt function (reversible)
- inhibit labor induction
- inhibit renal function
- hypersensitivity reaction
- bronchoconstriction in asthmatics
8
Q
COX 2 AE
A
gastric ulceration (less than COX1) inhibit labor induction inhibitor renal function bronchoconstriction in asthmatics
9
Q
NSAID renal risk
A
all NSAIDs inc. risk - longer half-life - highly potent: ketorolac, indomethacin - high dose Renal sparing (low risk): - sulindac, nabumetone - celecoxib
10
Q
NSAID GI AE risk
A
Low: - ibuprofen and naproxen low dose - etodlac, sulindac - celecoxib Moderate: - ibuprofen and naproxen med-high dose - declofenac, oxaprozin, meloxicam, nabumetone
11
Q
Preventing AE with NSAIDS
A
prostaglandin analog: misoprostil PPI H2 Rc antagonist sucralfate (dyspepsia) take with food
12
Q
NSAID precautions
A
Preg: 3rd tri: Category D: - closure of ductus arteriosus previous GI bleed excessive ETOH elderly Renal: - CHF - HTN - ascites - diuretic use
13
Q
NSAID AE
A
Gastric ulcer/bleed inhibit plt inhibit labor inhibit renal function - dec. renal BF - Na and H2O retention - interstitial nephritis bronchoconstriction with asthmatics salicylate buildup: tinnitus/hearing loss dyspepsia inc. GI acid production dec. gastric flow
14
Q
ketorolac
A
only IV NSAID
do not exceed 5 days of use
comparable to mild opioids
15
Q
Ketorolac AE
A
serious GI bleeding
ulceration
perforation
renal toxicity
