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PC 707 Pharmacology > Module 5: Unit A&B: ASA, NSAIDS > Flashcards

Module 5: Unit A&B: ASA, NSAIDS Flashcards

1
Q

Safety considerations with Aspirin?

A

It should not be used in children with a viral illness under the age of 19.
Increases the risk of bleeding.
Do not give in dose greater than 150mg to pregnant or lactating.

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2
Q

Should aspirin be used as primary prevention for heart attacks?

A

Aspirin should not be used in the routine primary prevention of ASCVD due to a lack of net benefit.

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3
Q

When should patients stop taking aspirin?

A

if tinnitus occurs, 7 days prior to surgery.

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4
Q

Who is ASA recommended for?

A

post-MI to decrease reoccurrence.

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5
Q

Who should avoid APAP (Acetaminophen)

A

Avoid in patients with:

chronic hepatitis, B/C/D, dehydration, liver disease, cirrhosis, or high alcohol intake

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6
Q

Is Tylenol safe in pregnancy?

A

yes, generally considered safe

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7
Q

What dosage do you want to limit Tylenol to?

A

Keep doses less than 4 grams/day for a healthy individual and 3 grams/day for frail or those at risk of liver toxicity.

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8
Q

Who should have caution with using NSAIDS?

A

Caution or avoid use in those with a hx of MI (dramatically increases the risk of repeat MI), CVA, emboli, ulcer, renal disease, elderly, and heart failure.

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9
Q

Drug to Drug cautions with NSAIDs?

A

Avoid using long-term if also taking ASA for prevention, as it interferes with ASA’s cardioprotective effects.
Caution with concurrent use of
corticosteroids, anticoagulants, ASA, and alcohol, as this can further increase the risk of upper gastro bleeding.

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10
Q

What else should you prescribe if a patient is on long term NSAID use?

A

PPI, H2RA, or Cytotec. Especially important for those over 70.

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11
Q

What pain medication worsens htn?

A

NSAIDS

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12
Q

Indication for aspirin?

A

Protection against clotting disorders as a secondary preventative measure, as an antipyretic, for effective relief of mild-moderate pain, and as an anti-inflammatory for rheumatoid arthritis, tendinitis, and bursitis.

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13
Q

MOA ASA?

A

Inhibits COX 1 and 2

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14
Q

BBW ASA?

A

Increased risk of GI bleed

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15
Q

Example of Cox 1 and 2 drugs?

A 
Ibuprofen (Motrin)
Diclofenac (Voltaren)
Ketorolac (Toradol)
Naproxen sodium (Aleve)
Magnesium salicylate (Doan’s)
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16
Q

Indication for cox 1 and cox 2? (Toradol, aleve, ibuprofen, etc.)

A

antipyretic, for effective relief of mild-moderate pain, and as an anti-inflammatory for rheumatoid arthritis, tendinitis, and bursitis

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17
Q

MOA of Torodol, Motrin, aleve, doan’s, voltaren:

A

inhibition of the enzymes COX-1 and COX-2

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18
Q

Safety with all cox1/cox 2?

A

Increase both bleeding and cardiovascular disease (CVD)

Prescribing NSAIDs with corticosteroids increases bleeding risk 12-fold, spironolactone 11-fold, and selective serotonin reuptake inhibitors (SSRIs) 7-fold.

contraindicated during pregnancy, especially during the 3rd trimester, when they can cause premature closure of the ductus arteriosus, prolonged labor, and increased bleeding

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19
Q

Safety with Aleve?

A

contains sodium. Avoid in pts who should not have sodium.

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20
Q

Who should not take Doan’s?

A

not for patients with renal insufficiency.

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21
Q

BBW cox1 and 2?

A

Increased risk of GI bleed, and cardiovascular events, hospitalization, death.

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22
Q

What does cox1/cox2 do to platelets?

A

Little or no suppression of platelet aggregation

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23
Q

Cox 2 example

A

celecoxib (Celebrex)

24
Q

MOA of celebrex?

A

selectively inhibits COX-2

25
Q

Contradicated with celebrex?

A

Contraindicated during pregnancy

Contraindicated for those with a history of MI or current unstable angina.

26
Q

Risks and D2D with celebrex?

A

Decreased GI issues but increased cardiac issues
Potential for decreasing digitalis (digoxin) clearance.
Use with extreme caution in diabetics and others who use ACEIs because of potential damage to the kidneys

27
Q

Indication for Acetaminophen

A

antipyretic and analgesic

28
Q

MOA tylenol?

A

Inhibition of Cox in the CNS

29
Q

D2D Tylenol?

A

Increase warfarin (Coumadin)=bleed risk

30
Q

Who should avoid Tylenol?

A

Avoid in patients with hepatitis, dehydration, liver disease, cirrhosis, or those who are heavy drinkers.

31
Q

Who is most at risk for liver toxicity with tylenol?

A

patient drinks >3 drinks/day or take other liver-toxic drugs.

32
Q

Example of Topical NSAIDs

A

Diclofenac sodium

Voltaren

33
Q

MOA of Voltaren?

A

Inhibition of COX 1 and 2

34
Q

Safety with VOltaren?

A

While low serum concentrations, they can still cause GI bleeding.

35
Q

MOA Lidocaine

A

Block action potential and sensation

36
Q

Side effects with Lidocaine?

A

Vasovagal related to pain

Rare seizure

Rare cardiac toxicity

37
Q

Local Capsaicin (Qutenza) Indication

A

arthritis, diabetic neuropathy, postherpetic neuralgia, headaches, and Fibromyalgia

38
Q

MOA Capsaicin (Qutenza)

A

releases substance P, a sensory neurotransmitter that mediates pain.

39
Q

Safety Capsaicin. (Qutenza)?

A

Avoid mucus membranes and eyes

Careful disposal

40
Q

Example Anticonvulsant

A

Pregabalin (Lyrica), Topomax, Gabapentin, depakote.

41
Q

INdication Lyrica?

A

Epilepsy, neuropathic pain, Fibromyalgia, general anxiety disorder

42
Q

MOA Lyrica

A

Inhibits release of neurotransmitters

43
Q

Safety and D2D with Lyrica

A

Scheduled V
Potential physical dependence
drug-to-drug interactions: alcohol, benzos, CNS depressants

44
Q

Anticonvulsant example

A

Gabapentin, (Neurontin)

45
Q

Indication Gabapentin

A

Antiseizure, postherpetic neuralgia (off-label diabetic neuropathy, migraine prophylaxis, Fibromyalgia, RLS)

46
Q

MOA Gaba

A

May enhance GABA release)

47
Q

Safety with gaba

A

Avoid driving may cause drowsiness

48
Q

TCAs Examples

A

Nortriptyline (Elavil)

49
Q

Indication TCAs (Elavil)

A

Migraine prevention, Depression, Fibromyalgia, neuropathic pain

50
Q

MOA TCA

A

Block reuptake of NE and 5-HT

51
Q

Safety TCA

A 
Orthostatic hypotension
Anticholinergic effects 
Diaphoresis
Sedation
Cardiac toxicity
seizures
52
Q

BBW TCA

A

May increase the risk of suicide

53
Q

Muscle Relaxants Example

A

Cyclobenzaprine (Flexaril/Amrix)

Metaxalone (Skelaxin)

54
Q

Indication Cyclobenzaprine and Metaxalone (Skelaxin)

A

Muscle spasm

55
Q

Safety with Muscle relaxants

A 
Physical dependence
CNS depression
Anticholinergic effects
Cardiac rhythm disturbances 
Do not combine with MAOIs

Metaxalone (Skelaxin)- Liver damage; check LFTs before beginning and periodically.

56
Q

Indication for Medical Marijuana

A

Suppression of emesis
Appetite stimulation
Treatment of Lennox-gastaut and Dravat syndrome
Relief of neuropathic pain

57
Q

Safety with MJ

A

Schedule I

Inhibits CYP450

PC 707 Pharmacology (39 decks)

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