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Anesthesia Pharm I > non-steroidal anti-inflammatory drugs (NSAIDS) > Flashcards

non-steroidal anti-inflammatory drugs (NSAIDS) Flashcards

1
Q

what is the MOA of NSAIDS

A
  • COX enzyme inhibitor
  • inhibits the cyclooxygenase (COX) and the prostaglandin synthesis pathway that is responsible for mediating information about pain to the brain
  • not as much pain stimuli making it to the brain
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2
Q

what are normal effects from COX 1 pathway?

A

homeostasis of:

  • GI blood flow
  • renal system
  • platelet aggregation
  • macrophages
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3
Q

what are normal effects from COX 2 pathway?

A
  • bronchodilation

- vasodilation

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4
Q

what are problems with cox inhibitors?

A
  • multiple side effects
  • frequent allergic reactions
  • several require daily dosing for efficacy
  • ceiling effects
  • cox 2 have fewer complications BUT more specific cardiac effects
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5
Q

what are benefits of NSAIDS?

A
  • analgesics
  • anti inflammatory effects
  • antipyretic effects
  • not typically abused
  • no respiratory depression
  • absence of cognitive effects
  • long duration of action
  • have ceiling effects
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6
Q

what are effects of COX 2 inhibitors?

A
  • risk of acute MI or CVA increases with prolonged use (prostaglandin protective mechanism)
  • reduced side effects in comparison with NSAIDS as a class
  • lack platelet effects
  • decreased GI effects
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7
Q

when are NSAIDS contraindicated?

A
  • allergic to aspirin
  • renal failure (renal elimination)
  • asthmatics have higher incidence of aspirin allergy and NSAID allergy (10%), especially if they also have nasal polyps (20%)
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8
Q

describe pharmacokinetics of NSAIDS

A
  • well absorbed form GI tract (oral doses)
  • CP450 metabolism
  • 2% renally excreted unchanged
  • conflicted studies on whether crosses BBB or not
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9
Q

what pts. typically benefit from NSAIDS?

A
  • joint disease
  • orthopedic surgery
  • C-section
  • Gyn procedures
  • Big surgeries
  • Back surgery
  • arthritis
  • musculoskeletal conditions
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10
Q

what pts. should NSAIDS not be used on?

A
  • history of GI bleed
  • renal injury/failure
  • liver disease/malfunction
  • bleeding disorders
  • history of MI, esp. acute (within a year)
  • ASA produces irreversible inactivation of platelets for the life of the platelet (7-10 days)- reasons should be stopped for a week prior to surgery
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11
Q

what are GI effects of NSAIDS?

A
  • 15-30% incidence of ulcers with chronic use

* administer with H2 receptor antagonist (Pepcid, Prilosec)

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12
Q

what are coagulation effects of NSAIDS?

A

-COX 1 inhibitors cause platelet issues

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13
Q

what are cardiac effects of NSAIDS?

A

-increased risk of MI more with COX 2 inhibitors
-hypertension
prostaglandins improve HTN by relaxing vascular tone in arterial smooth muscle and also counteract responses to vasoconstrictive hormones
**so when prostaglandins are blocked, vasodilation is inhibited
*usually only a minor change in BP

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14
Q

what are renal effects of NSAIDS?

A
  • little effect in healthy pts.
  • renal medullary ischemia can occur d/t inhibition of prostaglandins
  • renally impaired pts. may have a significant decrease in renal blood flow
  • nephrotoxic if used chronically
  • decreased GFR, Na+ retention leads to edema and HTN
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15
Q

what are hepatic effects of NSAIDS?

A
  • may be hepatotoxic
  • worse in chronically ill
  • can lead to hepatic failure
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16
Q

what are NSAID effects on asthma patients?

A
  • triggers bronchoconstriction (COX 2)
  • stimulates a pro inflammatory leukotriene (1 & 2)
  • enhanced reaction if has had aspirin induced asthma events
  • causes more reactive airway- wheezing
  • just don’t give to asthma pts.
17
Q

what are bone effects of NSAIDS?

A
  • may delay bone healing

* don’t give to spinal fusion pts. (no toradol)

18
Q

what are NSAID effects r/t meningitis?

A
  • asepsis effects with chronic use
  • may be delayed for weeks
  • reflects an acute hypersensitivity reaction which is worsened by immunosuppression
  • most common in females
  • S/S: periorbital edema, conjunctivitis, hypotension, pancreatitis, fatigue, seizures, and fever
19
Q

what are drug reactions noted with NSAIDS?

A
  • primarily interactions with anticoagulants since cause same effects
  • potassium sparing diuretics increase the risk of hyperkalemia
  • renally excreted drugs (dig, lithium, antibiotics)
  • beta blockers and ACE inhibitors have reduced effectiveness since effects are counteracted by prostaglandin inhibition
20
Q

describe aspirin

A
  • irreversible platelet damage 7-10 days
  • D/C week before surgery
  • no histamine release
  • mild prostaglandin inhibitor
  • liver metabolized
  • renally excreted 5-85% unchanged (highly variable)
21
Q

what are aspirin uses?

A
  • antipyretic
  • anti inflammatory
  • analgesic for low intensity pain
  • antiplatelet therapy
  • excellent for pts. experiencing angina or MI
  • little effect above therapeutic dose
  • elevated bleeding times
22
Q

what are major side effects of aspirin?

A
  • GI tract dysfunction
  • platelet inhibition
  • hepatic dysfunction
  • renal dysfunction
23
Q

what are uses of ketorolac?

A
  • excellent anti inflammatory
  • excellent analgesic
  • little or no biliary effects and fewer GI effects
24
Q

when should ketorolac be given?

A
  • about time start suturing, not up front
  • IM peak 45-60 min
  • IV peak 20-30 min
25
Q

how should dosing be altered in elderly and children for ketorolac?

A
  • not approved in children (may still see given)
  • half dose in elderly to 30 mg
  • if over 60 y/o, check BUN and Creat, if normal can give 1/2 dose. if abnormal don’t give
26
Q

what are side effects of ketorolac?

A
  • inhibits platelet production and aggregation (irreversible for 7-10 days
  • bronchospasm (cox 2)
  • don’t give to asthma or COPD pts., nasal polyps, or ASA allergy
  • less renal toxicity than other NSAIDS
27
Q

what must be considered r/t bleeding when using ketorolac in general anesthesia?

A
  • does not cause bleeding with just one or two doses
  • does cause bleeding with spinal anesthesia which is more platelet dependent
  • don’t give in true spinal surgeries
28
Q

what are doses and uses of IV acetaminophen?

A
  • pain relief: 1000mg IVPB over 15 min every 6 hrs
  • hyperpyrexia: 650 mg IVPB over 15 min every 4 hrs
  • start infusion as start closing at end of surgery
  • ok pain relief for smaller surgeries

Anesthesia Pharm I (28 decks)

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