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PHARM II TEST 1 > Non-Opioid Analgesics > Flashcards

Non-Opioid Analgesics Flashcards

1
Q

Selectivity for COX-1 and COX-2 are associated with which AEs?

A

COX-1 = undesirable GI effects

COX-2 = increased CV risk

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2
Q

Non-opioid used for self-limiting painful conditions like tension headaches, mild/mod MSK pain, OA, low back pain, mild/mod non-inflammatory nociceptive pain, pts w/gastric problems, analgesic/antipyretic of choice in children

A

Acetaminophen

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3
Q

APAP usually turns into glutathione and is excreted, but if too much is taken, produces what toxic metabolite that kills the liver?

A

NAPQI

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4
Q

Clinical presentation of APAP OD

A

First 24hrs: minimal/no symptoms

24-72hrs: ab pain, liver tender, inc. transaminases, dec. urine, maybe jaundice

4days - 2wks: resolution or death from hepatic failure

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5
Q

Antidote to APAP OD

A

N-acetylcysteine (Mucomyst)- metabolized to cysteine (a glutathione precursor)
-when not used for this, primarily used for chronic bronchopulm disease, CF, atelectasis from mucous obs.

Acetadote: injectable antidote for APAP OD

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6
Q

How do you treat APAP OD immediately before the antidote?

A

Activated charcoal

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7
Q

Max adult dose of APAP remains what currently? (Daily)

A

4g/day

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8
Q

What is the children’s dose for APAP?

A

10-15mg/kg/dose every 4-6 hrs

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9
Q

AHA recommendations for pain in PTs w/CV risk in order or precedence:

A

APAP -> ASA -> Tramadol -> Opioids -> Non-acetylated salicylates -> NSAIDs with low COX-2 -> NSAIDs with some COX-2 -> COX-2 selective (celecoxib)

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10
Q

See purple chart for NSAID-related ulcer complications

A

…

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11
Q

NSAID preferred to lower the risk of CV complications

A

Naproxen

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12
Q

ASA should be used cautiously in respiratory patients because of what illness?

A

Asthma

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13
Q

Caution when NSAIDs are combined with ACEI/ARBs because of what?

A

ACEI/ARB can decrease renal function…and so can NSAIDs

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14
Q

In the presence of both NSAIDs and ACEI/ARB we see a decrease in perfusion pressure of the glomerular, leading to what?

A

Low GFR

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15
Q

Salicylate toxicity can lead to hyperventilation, children may not have this response, which leads to respiratory alkalosis…sodium bicarbonate is then excreted leading to metabolic acidosis…what is this called?

A

Mixed acid/base disorder

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16
Q

As little as how much ASA can be fatal?

A

3000mg…severe intoxication is >300mg/kg

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17
Q

There is no antidote for salicylate toxicity, so what do we do?

A

Activated charcoal and gastric lavage, O2, glucose if there is AMS, REPLENISH BICARBONATE EVEN IF PH IS UP TO 7.55

18
Q

All NSAIDs are equally effective

Lower doses are for?
Higher doses are for?

A 
Lower = analgesia
Higher = inflammation
19
Q

NSAIDs should be avoided in the 1st and 3rd trimesters, why?

A

Can lead to cleft pallet and premature closure of the ductus arteriosus

APAP is the preferred analgesic/antipyretic during pregnancy

20
Q

List of common NSAIDs

A

Non-A Salicylates: Salsalate

Aspirin
Toradol
Naproxen
Indomethacin
Ibuprofen
Nabumetone
Meloxicam
Diclofenac 
Celecoxib (Celebrex)
21
Q

All salicylates cross the BBB and placenta and are absorbed through intact skin, with one exception that doesn’t cross the BBB…

A

Diflunisal

22
Q

Non-A Salicylates are less effective than ASA, but also have less effects on platelets, fewer GI SEs, less renal toxicity, and may be preferred when?

A

When COX-1 inhibition is undesirable in pts with asthma, clotting issues, or renal dysfunction

23
Q

The Non-A Salicylates, including salsalate, trilisate, and diflunisal are all primarily indicated to treat what?

A

Rheumatic things, RA and OA…pepto (bismuth subsalicylate) is for GI, AE is the black/dark tongue

24
Q

Anti-platelet effect of ASA lasts how long?

A

7-10 days, aka the life of the platelet b/c it’s irreversible

25
Q

Higher doses of ASA double the risk of what?

A

GI bleed

26
Q

Can Toradol be used in kids?

A

No

27
Q

This NSAID may decrease the opioid requirement by 25-50%, it’s used IV for moderately severe pain and oral for continuation treatment following IV/IM…

A

Toradol

28
Q

BB warning for Toradol is for bleeding risk, use must be less than 5 days without exceeding max daily doses, which are? (IM/IV)

A

IM: Max 30mg per dose
IV: Max 15mg per dose

Max daily dose for both is 60mg

29
Q

Can toradol be used in pregnancy and why?

A

No, adverse effects on fetal circulation/inhibition of uterine contractions

30
Q

FDA approved NSAIDs for treating Gout attacks:

A

Naproxen

INDOMETHACIN IS THE DOC FOR ACUTE GOUTY ATTACKS, there’s also an ophthalmic version and it can be sued to ACCELERATE CLOSURE OF A PDA, FIRST NSAID THAT SHOWED THAT

31
Q

What is the children’s dose for ibuprofen?

A

5-10 mg/kg/dose Q6hrs

ASA is 10-15

32
Q

Prodrug ketone converted to acetic acid derivative NSAID used for OA/RA…it’s expensive and more COX-2 selective (less GI issues)

A

Nabumetone

33
Q

This NSAID is more COX-2 selective (for inhibition, which means moderate CV risk) and it’s used for once daily dosing of OA and RA?

A

Meloxicam

34
Q

This NSAID has high selectivity for COX-2, can be used for MSK stuff or OA/RA, has both ophthalmic and topical formulations, and comes in a combo product with misoprostol.

A

Diclofenac

35
Q

COX-2 selective NSAID used for OA, RA, JRA, AS, primary dysmenorrhea, specifically developed to minimized SEs of gastric irritation (but you lose that if it’s combined with ASA), has a HIGH CV risk, and contains A SULFA GROUP

A

Celecoxib (celebrex)

36
Q

What is really the only two ophthalmic NSAIDs that we use?

A

DICLOFENAC*

Ketorolac

37
Q

Best NSAIDs for renal insufficiency?

A

Non-A Salicylates may be best

38
Q

NSAID with the least CV risk

A

Naproxen

39
Q

Celebrex or non-selective NSAID with a PPI or misoprostol best for?

A

Pts with risk for a GI bleed

40
Q

LOOK AT THE PURPLE CHART

A

DO ITT

PHARM II TEST 1 (6 decks)

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