NSAID and APAP Flashcards
APAP clinical indications
fever
mild/mod pain
antidote for APAP OD
acetylcystiene
dose of APAP for kids
160mg/5mL
dose of APAP for adults
max= 1000mg
who gets hepatotoxicity from APAP?
chronic drinkers
does ASA help with pain?
no
Carboxylic acids
ASA
Propionic acids
ibuprofen
naproxen
who uses naproxen? why?
adults–longer 1/2 life
acetic acid derivatives
diclofenac
ketoralac
enolic acid
piroxicam and meloxicam
clinical indication for NSAID
inflammation
pain
fever
dysmenorrhea
what NSAID is only IM/IV?
ketorolac
what form should you use diclofenac in?
topical
who should not recieve NSAIDS if possible d/t risk
high GI or high CV risk
who should NEVER recieve NSAIDS?
AMI patients
what systems is diclofenac toxic to?
cardiac
hepatic
GI
labs for NSAID use
CBC; d/t risk of bleed
CMP; d/t renal/liver functions
GI ADR from nsaid
dyspepsia
gastritis
PUD–esp if old & on high dose
CV ADR from nsaid
thrombosis
lowest thrombotic risk nsaid
naproxen
highest thrombotic risk nsaid
diclofenac
what happens to asthmatics that take aspirin
they can have an exacerbation
what do NSAIDS decrease the efficacy of?
ACEI/ARB/diuretic
what do NSAIDS increase the conc. of?
Lithium
what drug combination can cause AKI in those >65 y/o, or with CKD, or HF?
NSAID + diuretic + ARB
how do NSAIDS interact with platelets?
they are anti-platelet
if NSAIDS are anti-platelet..what drug should you be careful with?
warfarin
what 3 drugs minimize GI effects of NSAIDS?
misoprostol
H2RA
PPI
what NSAID is least GI toxic?
Ketorolac
1st line NSAID
ibuprofen/naproxen
2nd line NSAID
piroxicam/meloxicam
3rd line NSAID
ketorolac
4th line NSAID
diclofenac
low GI + low CV risk NSAID
Celecoxib
low GI risk + high CV risk NSAID
napoxen
mod GI risk + low CV risk NSAID
celecoxib
mod GI risk + high CV risk NSAID
napoxen + PPI
high GI risk + low CV risk NSAID
AVOID NSAID
–if you must celecoxib + PPI or misoprostol
high GI risk + high CV risk NSAID
AVOID NSAID
what does celecoxib bind to?
cox 2 only
does celecoxib bind platelets
NO
what is celecoxib used in?
RA/OA/Sponylo/Gout–chronic pain issues
ADR of celecoxib that is allergen
sulfa
what is celecoxib a substrate of?
2C9
what is the reason some Cox 2 inhibitors were removed from the market?
prothrombotic
best GI NSAID=
celecoxib
best heart NSAID=
naproxen
3 muscle relaxants we USE
cyclobenzprine
baclofen
dantrolene
cyclobenzaprine MOA:
identical to amytriptyline
–acts on serotinergic pathways to reduce somatic motor activity
cyclobenzaprine clinical indications
msk conditions
SHORT TERM USE
muscle relaxant with evidence for efficacy
cyclobenzaprine
who shouldn’t recieve cyclobenza?
AMI, HF, arrhythmia pts
dose for cyclobenzaprine?
5 mg
Main ADRs for cyclobenzaprine?
QT prolongation
sedation
dizziness
xerostomia
what can you NOT combine cyclobenza with?
CNS depressants
MAOI
TRAMADOL
what is a rare rxn from use of carsoprodol?
transient quadriplegic
what is tizanidine similar too? means we do what if we have to discontinue it?
clonidine–MUST taper d/t hypotension
Baclofen clinical indications
MS or SC injury
Dantrolene clinical indications
Malignant hyperthermia–prevention and management
dantrolene has what ADR?
dose-dependent hepatotoxicity
