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Pharmacology > Non-Opioid Lecture part 2 > Flashcards

Non-Opioid Lecture part 2 Flashcards

1
Q

Pharmacologic class of Aspirin?

A

Salicylate

  • Most useful salicylate for analgesia
  • Used historically to reduce fever
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2
Q

Chemistry of Aspirin

A 
acetylsalicylic acid (ASA)
- Acetic acid (HA) and salicylic acid (SA)
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3
Q

Explain the effect’s of aspirin or in other words the mechanism by which it functions

A
  • It inhibits the synthesis of prostaglandins
  • Prostaglandins are synthesized locally by inflammatory stimuli. They sensitize pain receptors (nociceptors) to substances such as bradykinin. The more synthesis, the more they sensitize and you feel pain. Therefore, reduction in prostaglandins results in reduction in pain
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4
Q

When is aspirin more effective? Is it more effective against throbbing pain (inflammation) or stabbing pain (direct irritation of nerve endings)?

A

If given BEFORE painful stimuli are experienced.

-more effective against throbbing pain

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5
Q

Aspirin produces peak effect on empty stomach after how long?

A

30 minutes

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6
Q

Describe the Aspirin half-life

A

Dose-dependent

  • With a small dose, half life is 2-3 hours
  • With a high dose, a half-life of 15-30 hours can be attained
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7
Q

Is aspirin first-order kinetics or zero-order kinetics?

A

Zero-order kinetics

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8
Q

5 main effects of aspirin

A
  1. Analgesic
  2. Antipyretic
  3. Anti-inflammatory
  4. Uricosuric
  5. Anti-platelet effect
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9
Q

What might be a side effect of the anti-inflammatory effect of aspirin?

A

Dosing used for pain control (analgesic) is not enough for anti-inflammatory effects. It is difficult to take the dosage needed for anti-inflammatory results. This could lead to GI ulceration and bleeding.

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10
Q

What is the danger of taking low dose aspirin and it’s effect of being uricosuric?

A

At low doses, there is uric acid retention. If a patient has gout and is taking probenecid to excrete the uric acid, aspirin can antagonize these effects.

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11
Q

Describe the mechanism to how aspirin can have an Anti-platelet effect

A

Aspirin inhibits cyclooxygenase which inhibits the formation of thromboxane A2

  • Thromboxane A2 normally causes vasoconstriction and platelet aggregation
  • By inhibiting these mechanisms, aspirin reduces risk for blood clots and stroke
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12
Q

What dosage is aspirin used to prevent stroke and heart attack

A

Low dose (81 mg)

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13
Q

Gastrointestinal adverse effects of aspirin occur because of 3 things

A
  1. Direct gastric irritation and inhibition of cytoprotective prostaglandins (mucus in stomach)
  2. Stimulation of chemoreceptor trigger zone in the CNS (nausea and vomiting)
  3. Exacerbates pre-existing ulcers, gastritis, hiatal hernia, reflux disease
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14
Q

Bleeding as an adverse effect of aspirin might have what presentation clinically?

A

Bleeding may be occurring in the gingiva. It may appear as gingivitis but in fact it is drug-induced bleeding. Important to ask about aspirin use.

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15
Q

Name the three adverse effects of aspirin

A
  1. Gastrointestinal: dyspepsia, nausea, vomiting, gastric bleeding
  2. Bleeding - Irreversible effects on platelets
  3. Reye’s syndrome - aspirin contraindicated in children/adolescents with viral infections
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16
Q

How does Reye’s syndrome manifest?

A

fluid in the brain (encephalitis)

hepatotoxicity = often fatal

17
Q

Why do we use acetaminophen instead of aspirin in children?

A

Aspirin is contraindicated in children/adolescents with viral infections. We generally assume that when kids are sick, it is viral in nature unless proven otherwise.

18
Q

What is Salicylism?

A

Toxicity of aspirin

= confusion, tinnitus, dizziness, nausea, vomiting, headache

19
Q

What is the clinical sign of Salicylism?

A

Tinnitus and ringing in the ears

20
Q

How common is an allergy to aspirin

A

Less than 1% incidence

- Many report allergy but not true allergy = usually stomach problems

21
Q

What constitutes a true allergy to aspirin?

A

Rash, wheezing, urticaria (hives), angioneurotic edema, anaphylaxis

22
Q

Allergy to aspirin may have cross-sensitivity to what?

A

NSAIDS

- Ask patients if they have taken aspirin or ibuprofen before if allergic to one or the other.

23
Q

Who are more likely to have hypersensitive reaction to aspirin?

A

Asthmatics

- 5-15%

24
Q

Aspirin hypersensivitiy triad:

A
  1. Aspirin hypersensitivity
  2. Asthma
  3. Nasal polyps
  • No aspirin for these folks
25
Q

Mechanism of aspirin allergy

A

Shift in COX cascade to inhibit bronchodilating PGE2

- Shifts to favor unopposed lipoxygenase pathway and formation of leukotrienes (bronchoconstrictors)

26
Q

What is aspirin burn? Mechanism?

A

Topically applied aspirin is caustic to oral tissues. Some people think that if they have a toothache, they can lay an aspirin against their gingiva to relieve pain.
- When aspirin is applied directly to mucosa, ester in water splits to acetic acid and salicylic acid which creates the “burn”

27
Q

Contraindications to aspirin?

A
  1. Allergy - manifests as bronchial reaction
  2. Chronic gastritis = greater chance for GI ulceration and bleeding
  3. Gout = interaction with probenecid
  4. Anticoagulants = such as warfarin, increases risk for hemorrhage
    - Aspirin displaces warfarin from plasma proteins
28
Q

Aspirin is contraindicated in what stage of pregnancy?

A

Contraindicated in third trimester - FDA category C/D

29
Q

What is the reason for aspirin being contraindicated during pregnancy

A

Can prolong labor; decreases prostaglandins responsible for uterine contractions

  • Increases risk for bleeding complications in mother
  • Risk of premature closing of the ductus arterioles in fetus, resulting in pulmonary vasculature abnormalities
30
Q

What is the full strength dose of aspirin?

A

325 mg; administer during heart attack to improve survival

  • Remember that daily dose for cardiovascular prevention is 81 mg
31
Q

Dosing for analgesia and fever reduction:

  • Adults?
  • Children?
A
  • Adults: 325-659 mg every 4-6 hours, up to 4 grams per day

- Children: 10-15 mg/kg/dose every 4-6 hours, up to a total of 4 grams per day

32
Q

Do you need to discontinue aspirin prior to dental treatment?

A
  • Low dose aspirin therapy (81 mg daily) = no need to discontinue.
  • For highly invasive surgeries, must weigh risk to patient versus bleeding risks
33
Q

Can we take patients off of aspirin therapy?

A

If patient is taking aspirin because of cardiac history, then consult the patient’s physician before advising the patient to discontinue the drug = benefit must outweigh risks to the patient.

34
Q

how long does the aspirin effect last?

A

Lasts for life of platelet. Platelet function returns when new platelets form (10 days)

Pharmacology (24 decks)

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