Non-opioid (NSAIDs) analgesics

Question 1

What are nociceptors?

Answer 1

Peripheral sensory neurons detecting temperature, pressure, and injury-related signals.

Question 2

What is nociceptive pain?

Answer 2

Pain originating from nociceptive neurons, such as post-surgical pain, sports injuries, and arthritis.

Question 2

What is neuropathic pain?

Answer 2

Chronic pain resulting from neuronal damage or dysfunction, such as diabetic neuropathy and chemotherapy-induced neuropathy.

Question 3

What causes neuropathic pain?

Answer 3

Disrupted inhibitory pathways leading to pain without a direct stimulus.

Question 4

What is allodynia?

Answer 4

Pain response to normally non-painful stimuli.

Question 5

What is hyperalgesia?

Answer 5

Increased sensitivity to pain.

Question 6

What is the treatment for mild to moderate acute nociceptive pain?

Answer 6

Nonsteroidal anti-inflammatory drugs or acetaminophen.

Question 7

What is the treatment for moderate acute nociceptive pain?

Answer 7

Nonsteroidal anti-inflammatory drugs.

Question 8

What are non-pharmacologic treatments for chronic nociceptive pain?

Answer 8

Exercise, massage, movement therapy, and heat.

Question 8

What is the treatment for moderate to severe acute nociceptive pain?

Answer 8

Nonsteroidal anti-inflammatory drugs plus acetaminophen or opioids plus acetaminophen.

Question 8

What are pharmacologic treatments for chronic nociceptive pain?

Answer 8

Nonsteroidal anti-inflammatory drugs or localized treatments like lidocaine, diclofenac, and capsaicin.

Question 9

What are first-line medications for neuropathic pain?

Answer 9

Tricyclic antidepressants: Amitriptyline, nortriptyline, imipramine.
Serotonin-norepinephrine reuptake inhibitors: Venlafaxine, duloxetine, milnacipran.
Antiepileptics: Gabapentin, pregabalin, carbamazepine, oxcarbazepine.

Question 10

What is used for localized neuropathic pain?

Answer 10

Topical lidocaine or capsaicin.

Question 11

What are key NSAIDs used in dentistry?

Answer 11

Aspirin (salicylate), ibuprofen, naproxen, diclofenac.

Question 12

Is acetaminophen an NSAID?

Answer 12

No, but it is commonly used for pain relief.

Question 13

What is the mechanism of NSAIDs?

Answer 13

Inhibition of cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.

Question 14

What are the functions of NSAIDs?

Answer 14

Analgesic, anti-inflammatory, antipyretic, antiplatelet.

Question 15

What is the role of cyclooxygenase (COX) enzymes?

Answer 15

Convert arachidonic acid into prostaglandin H2 (PGH2), a precursor to prostaglandins and thromboxane.

Question 16

What do prostaglandins and thromboxane regulate?

Answer 16

Inflammation, pain, fever, and clotting.

Question 17

Where is COX-1 found?

Answer 17

Platelets, stomach lining, kidneys.

Question 18

What does COX-1 produce?

Answer 18

• Thromboxane A2 (TXA2), which promotes platelet activation and clotting.
• Prostaglandin E2 (PGE2), which helps secrete protective mucus in the stomach and intestines.

Question 19

What are the effects of COX-1 inhibition?

Answer 19

Reduced clotting (antiplatelet) but increased risk of stomach ulcers and bleeding.

Question 20

Where is COX-2 found?

Answer 20

Inflamed tissues and kidneys.

Question 21

What does COX-2 produce?

Answer 21

Pro-inflammatory prostaglandins that enhance the immune response.

Question 22

What are the effects of COX-2 inhibition?

Answer 22

Anti-inflammatory effects but increased risk of kidney damage due to reduced blood flow in renal glomeruli.

Question 23

What are the effects of aspirin?

Answer 23

Antiplatelet (10-14 days), analgesic, antipyretic, anti-inflammatory.

Question 23

What makes aspirin's mechanism unique?

Answer 23

Irreversibly inhibits COX enzymes, permanently deactivating them.

Question 24

What are the common uses of aspirin?

Answer 24

Analgesic for relief of mild to moderate pain (std. adult dose: 325mg, 1-2 tablets every 4 hours), can combine with opioid analgesics for moderate pain. Antipyretic: 325mg, 1-2 tablets every 4 hours. Anti-inflammatory in patients with rheumatoid arthritis, rheumatic fever, and inflammatory joint conditions (high dose, 3g/day). Prophylaxis of ischemic heart disease and ischemic stroke, to reduce incidence of coronary artery disease (typically low dose 81 mg daily)

Question 25

How does naproxen compare to ibuprofen?

Answer 25

Similar but has a longer half-life (13 hours).

Question 25

What are the major adverse effects of aspirin?

Answer 25

Gastrointestinal: Peptic ulcers, GI bleeding. Respiratory: Aspirin-exacerbated respiratory disease. Renal: Nephrotoxicity. Reye's Syndrome: Avoid in children with viral infections. Overdose: Salicylism (nausea, vomiting, tinnitus, confusion).

Question 26

What are the adverse effects of ibuprofen?

Answer 26

GI bleeding (lower risk than aspirin), edema, nephrotoxicity.

Question 26

What is the mechanism of ibuprofen?

Answer 26

Competitive, reversible COX inhibitor.

Question 27

How does ibuprofen compare to aspirin?

Answer 27

More effective as an analgesic with reversible antiplatelet effects.

Question 28

What is the maximum daily dose of ibuprofen?

Answer 28

3200 mg/day.

Question 29

What is the maximum daily dose of naproxen?

Answer 29

1375 mg/day (prescription) or 660 mg/day (OTC).

Question 30

How does diclofenac compare to ibuprofen?

Answer 30

More potent.

Question 31

What are the common forms of diclofenac?

Answer 31

Oral (stronger than ibuprofen) and topical (Voltaren) for osteoarthritis.

Question 32

What is the half-life of diclofenac?

Answer 32

~2 hours.

Question 33

How selective is celecoxib for COX-2 compared to COX-1?

Answer 33

9 times more selective for COX-2.

Question 34

What are the advantages of celecoxib?

Answer 34

Less GI irritation due to reduced COX-1 inhibition.

Question 35

What are the risks of celecoxib?

Answer 35

Increased cardiovascular risks (heart attack, stroke).

Question 36

How do NSAIDs affect antihypertensive medications?

Answer 36

Reduce antihypertensive efficacy by increasing water and sodium retention.

Question 37

Why should NSAIDs not be combined with anticoagulants?

Answer 37

Increased bleeding risk due to platelet inhibition and GI ulceration.

Question 38

What should be considered for chronic NSAID use in hypertensive patients?

Answer 38

Switching to a calcium channel blocker.

Question 39

If a patient is allergic to aspirin, which medications should they avoid?

Answer 39

All NSAIDs except acetaminophen.

Question 40

What populations have a higher renal risk with NSAIDs?

Answer 40

Elderly, heart failure patients, those on ACE inhibitors.

Question 41

Why should aspirin be avoided in pregnancy?

Answer 41

It increases bleeding risks and complications.

Question 42

Why should NSAIDs be avoided in the third trimester?

Answer 42

They can cause premature closure of the ductus arteriosus and increase preeclampsia risk.

Question 43

How do non-aspirin NSAIDs affect cardiovascular health?

Answer 43

They increase the risk of heart attack and stroke.

Question 44

How does acetaminophen work?

Answer 44

Inhibits COX at a distinct site, reducing fever and pain but not inflammation.

Question 45

What are the advantages of acetaminophen over NSAIDs?

Answer 45

No significant gastrointestinal toxicity, no effect on platelets, and safe in pregnancy.

Question 46

How does an acetaminophen overdose cause toxicity?

Answer 46

Saturates glucuronidation/sulfation pathways, leading to hepatotoxicity.

Question 47

What is the leading cause of liver failure related to acetaminophen?

Answer 47

Combining acetaminophen with other medications containing it (opioids, cold remedies).

Question 48

How is acetaminophen normally metabolized?

Answer 48

Via glucuronidation and sulfation.

Question 49

What happens when acetaminophen is taken in excess?

Answer 49

It overwhelms normal pathways, shifting metabolism to CYP2E1, producing toxic NAPQI.

Question 50

What does NAPQI do?

Answer 50

Depletes glutathione, leading to liver cell death.

Question 51

What are symptoms of acetaminophen toxicity?

Answer 51

Nausea, vomiting, jaundice, liver failure.

Question 52

What is the antidote for acetaminophen toxicity?

Answer 52

N-acetylcysteine (replenishes glutathione).

Question 53

What are common over-the-counter doses of acetaminophen?

Answer 53

325-500 mg tablets (Tylenol, Datril).