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MSK pharmacology NSAIDS/WUHS Flashcards

week 9

1
Q

What are names of prescription NSAIDS?

A
  • salsylate (disalcid)
  • indomethacin (indocin)
  • meclofenamate(meclomen)
  • piroxicam (feldene)
  • sulindac (clinoril)
  • tolmetin (tolectin)
  • diclofenac (voltaren -cream)
  • diflusinal (dolobid)
  • etodolac (lodine)
  • fenoprofen (nalfon)
  • flurbiprofen (ansaid)
  • ketoralc (toradol)
  • mefenamic acid (ponstel)
  • nabumetone (relafen)
  • oxaprozin (daypro)
  • phenylbutazone (cotylbutazone)

  • voltaren down are also aspirin substitutes
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2
Q

what is diclofenac (voltaren)

A

NSAID cream - arthritis pain reliever

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3
Q

how is ketorolac (toradol) administered?

A

IV or intramuscular

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4
Q

what are the 3 over the counter NSAIDS?

A
  • aspirin (many trade names)
  • ibuprofen (advil, motrin, others)
  • naproxen (aleve, naprosyn)
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5
Q

OTC NSAIDs are sold ?

A

in smaller doses

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6
Q

why are OTC NSAIDS sold in smaller doses?

A

greater patient safety

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7
Q

what is a normal mg tablet amount for OTC ibuprofen?

A

200 mg

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8
Q

what is the mg tablet amount for prescription motrin?

A

800 mg
* take 4, 200mg ibuprofen tablets for same effect

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9
Q

what is the benefit of trying OTC medication first?

A

big cost difference

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10
Q

aspirin is the prototype for NSAIDS - what is aspirin made of?

A
  • acetylsalicylic acid = ASA
  • used clinically for century
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11
Q

what are some misconceptions of ASA (aspirin)? what is the truth of ASA?

A

some patients discrespect ASA
- see it as “old” drug
- inexpensive
readily available without prescription

truth: ASA is very powerful, very effective drug; probably drug of choise

  • as PT may need toweight placebo effect of gettinga prescription (patient expectation)
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12
Q

ASA vs. other NSAIDS

A
  • other NSAIDS are attempts by drug companies to make a better aspirin

goals of making other NSAIDs:
- more effective
- fewer side effects

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13
Q

waht is the usual dosage of other NSAIDS (not asa)? what is the result?

A

325mg-650mg every 4 hours for aches, pains, fevers
result:
- most have no significant advantage
- higher costs

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14
Q

MOTRIN
indications:
contraindications:
Dosage:

A

indications:
- arthritis
- musculoskeletal pain
- inflammatin

contraindications:
- sensitivity/allergic reaction to ibuprofen, aspirin other NSAIDS
- asthma caused by aspirin or other NSAIDS
- angioedema
- as well as general contraindictions for all NSAIDS

dosage:
- OA, RA: 1200 to 3200 mg/day divided into 3-4 doses. do not exceed 3200 mg per day.
- mild to moderate pain: 400mg every 4-6 hrs

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15
Q

NAPROXEN
Indications:
contraindications:
Dosage:

A

indications:
- pain management
- bursitis
- tendonitis

contraindications:
- prior allergies to naproxen
- NSAID induced asthma, rhinitis or nasal polyps
- carefully question about asthma, urticaria, nasal polyps, hypotension assoc. with NSAIDS
- all contraindications of general NSAIDS

Dosage:
- 375 mg or 500 mg 2x daily

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16
Q

relative contraindications for NSAIDS

10 of them …

A
  1. history of peptic ulcer disease
  2. history of renal disease
  3. history of liver disease
  4. history of congestive heart failure
  5. hypertension
  6. asthma/reactive airway disease
  7. pregnancy, nuring mothers
  8. concurrent use of corticosteroids
  9. concurrent use of anticoagulants
  10. age ≤ 15 or ≥ 65
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17
Q

what is the contraindication for NSAIDS and acute muscle injury?

A

evidence shows that NSAIDs given during acute stage of muscle injury may delay muscle fiber regeneration and recovery of force generating capacity

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18
Q

what are the main adverse side effects of all NSAIDS?

A
  • gastric irritation, ulcers
  • hepatic and renal toxicity, particularly in patients with previous damage
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19
Q

what are the adverse side effects of overdose: ASA intoxication?

A
  • hearing loss
  • tinnitis
  • confusion
  • headache
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20
Q

what is the half life (h), onset (min), comments for Aspirin?

A

half life (h): 0.25
onset (min): 10-30
comments: prototypical NSAID

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21
Q

what is the half life (h), onset (min), comments for ibuprofen (motrin, etc) (propionic acid derivative)

A

half life (h): 2.00
onset (min): 10-30
comments: inc. GI intolerance compared to ASA

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22
Q

what is the half life (h), onset (min), comments for naproxen, naprosyn (propionic acid derivative)?

A

half life (h): 13.00
Onset (min): 60-120
comments: inc. GI tolerance compared to ASA

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23
Q

potential NSAID adverse effects by system

system: gastrointestinal
adverse effects:

A

nausea, heartbur, dyspepsia, gastric ulcers, duodenal ulcers, perforations, bleeding complications

24
Q

system: Renal
Adverse Effects:

A

sodium retention
edema
hyperkalemia
acute failure
nephritic syndrome
papillary necrosis

25
system: CNS Adverse effects:
tinnitus sedation dizziness
26
system: hematological Adverse Effects:
hemorrage anemia COX-2 cardiovascular events
27
system: allergic reactions adverse effects:
other NSAID - or salicylin containg foods: apples, oranges, bananas
28
# identification of patients at high risk and potential adverse effects high risk population: increasing age, female sex, age > 85 y adverse affect:
slowed metabolism and elevated tissue levels of more lipid soluable drugs
29
high risk population: history of peptic ulcer adverse effect:
repeat ulceration and GI hemorrhage
30
high risk population: low serum albumen adverse effect:
elevated serum NSAID levels and possible overdosage
31
high risk population: concomitant use of multiple antithrombotic agents adverse effect:
hemorrhage
32
high risk pop: concomitant use of other NSAIDs or steroid agents, increase nsaid dose, new nsaid user
GI injury gastric hemorrhage initiation of Gi hemorrhage
33
high risk pop: hypovolemic states, renal impairment due to age, atherosclerosis, hypertensive renal disease, otherintrinsicrenal disease adverse effect:
renal failure, impairemnt of glomerular filtration, acute renal failure, edema, iinterstitial nephritis, papillary necrosis, chronicrenal fialure, hyperkalemia (high potassium)
34
what is the primary reason for NSAID use in elderly?
osteoarthritis
35
NSAID users are how many times more likely to be hospitalized? new nsaid users?
4x more likely 5x-6x more likely
36
what % of elderly (≥65yrs) are on prescription NSAIDS?
15%
37
how many death yearly occur from NSAID prescriptions?
7,600
38
how many hospitalizations per year occur due to NSAIDS?
76,000
39
elderly _____ are ___ as likely to have GI problems from NSAIDS than _____
women are 2x, than men
40
what % of NSAID prescriptions were unnecessarily written?
42%
41
what are the alternatives to NSAIDS used for osteoarthritis?
- physical therapy (evidence based, active treatment programs) - behavior modification - joint protection - exercise - weight loss - acetaminophen (not NSAID - affects brain differently)
42
should people be choosing the drug with a longer or shorter 1/2 life first?
avoid first choice use of longer half-life agents (naproxen at 13 hrs vs ibuprofen at 2 hrs)
43
where NSAIDS found to be more helpful than other drugs when it comes to LBP?
no - NSAIDS are not more effective than other drugs (including tylenol, mms relaxants, opiates) for acute LBP, lacking evidence for chornic LBP
44
acetaminophen (tylenol) indications: difference from NSAID: adult dosage:
indications: analgesic, antipyretics difference: equivalent analgestic benefit to low dose NSAID, no anticoagulant or anit inflammatory effect adult dosage: 325 mg tabelts take 2 every 4-6 hrs, do not exceed 12 tablets in 24 hrs 500 mg tablets take 2 gelcaps, 4-6 hrs no more than 8 gelcaps in 24 hrs generally up to 1000 mg TID is sufficient
45
acetaminophen (tylenol) adverse effects
- less gastric irritaion with tylenol - tylenol drug of choice for pregnant women and children w fever metabolzied and excreted by liver (liver toxicity) - do not take if liver or kidney problems - tylenol overdose - liver toxicity (potentially fatal!!)
46
what is the toxic dose for acetaminophen?
varies, depends on many factors including hydration level (hydrated cells more robust) the mechanism is unknown
47
48
selection of NSAID or acetaminophen - how to pick?
**inflammation or pain & inflammation** --> assess risk factors for GI or renal toxicity ---> if no risk factors nonselective NSAID (ibuprofen, naproxen aspirin) if risk factor is present --> refer NSAID prescription choise to PC. will require non selective NSAID + GI protective agent **pain only:** acetaminophen
49
drugs for muscle spasms
polysynapticinhibitors - methocarbal (robaxin) - cyclobenzaprine (flexeril) diazepam (calium)
50
# polysynaptic inhibitors (muscle spasms) Flexeril (cyclobenzaprine) indications: action: dosage: duration of therapy: considerations for use:
indications: relief muscle spasms assoc. with acute, painful MSK considitons action: relieves msucles spasm oflocal origin dosage: 10 mg TID, not to exceed 60 mg/day duration: 2-3 weeks considerations of use: - take 1-2 hrs before bed if using at night only - may cut in half, if siginificant drowsiness in morning - no driving/heavy equipemnet operation
51
# muscle spasms contraindications for flexeril (cyclobenzaprine)
- hypersensitivity to drug cardiac disease, CHF, arrhythmias, heart block or conduction disturbances -hyperthyroidism -concamitant use of MAO inhibitors, or within 12 days of discontinuation - concomitant use of tricyclinc antidepressants
52
what are some drug intractions/precautions for flexeril (cyclobenzaprine)?
- may enhance effects of alcohol, barbiturates, CNS depressants - may impair mental/physical abilities requires for performance of hazardous tasks (ddriving, operating machinery)
53
# muscle spasms Robaxin (methocarbamol) 1 indications dosage
indications: relief of discomfort associated with acute painful MSK conditions dosage: initial 1500 mg QID maintenance: 1000 mg QID or 1500 TID
54
robaxin (methocarbamol) 2 contraindications: adverse reactions:
contraindications: - hypersensitivity to any of the ingredients - kidney or liver disease - porphyria - epilepsy adverse reactions: light headedness, dizziness, drowsiness, nausea, blurred vision, headache, fever, rash
55
what are the main take aways fro muscle relaxants? ## Footnote 3 of them
- indicated for acute msucle spasm associated with pain - treatment efficacy greatest in 1st 4 days - outcomes better when NSAIDS and MS relaxants combined then NSAIDS alone

pharmacology (7 decks)

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