NSAID DRUGS Flashcards

1
Q

What are the 3 principle classes of drugs used for pain relief?

A
  1. Non-narcotics - Paracetamol
  2. Narcotics - opioid
  3. Non-steroidal anti-inflammatory (NSAIDs)
  4. Neuropathic agents
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2
Q

What other aspects of the medical history would you require from the patient before prescribing a NSAID?

A
  • Asthma
  • Co-morbidities - heart failure, Renal disease, hepatic cirrhosis
  • Allergies
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3
Q

How does aspirin differ from other NSAIDs? What additional effects does it have in CVD & what is the mechanism of its action?

A

The only NSAID to IRREVERSIBLY inhibit cyclooxygenease activity by acetylation.

Has an anti-thrombotic effect a_t low dos_e> reduce risk of CVD & MI

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4
Q

What other aspects of the medical history would you require from the patient before prescribing a NSAID?

A

Asthma
Co-morbidities - heart failure, Renal disease, hepatic cirrhosis
Allergies

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5
Q

what should be done if NSAIDS r used for those with high risk of GI events?

A

PPI or misprostol should be given as well to prevent NSAIDS-induces ULCERS

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6
Q

NSAIDS

  • LIST ONLY therapeutic uses?
  • contraindications?
A
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7
Q

Appreciate the mechanism of action of NSAID as:

asanalgesics, anti-inflammatory and antipyretics

A

Anti-inflammatory

COX inhbition diminshes formation of PG (which act as inflammatory mediators) & inhibit inflammation in osteoarthritis, gout, RA

ANALGESICS

PGE2 sensitizes nerve-endings to the action of bradykinin & hisimine.

mild to moderate pain (less effective than opiates)

ANTIPYRETIC

inhibits PGE2 form hypothalamus

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8
Q

List therapeutic uses of NSAIDS as:

asanalgesics, anti-inflammatory and antipyretics

A

Myalgia

Gout

arthritis

headache

Dysmenorrhea

fever

my girlfriend arthie had dysmenorhhea & fever

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9
Q

LIST the major ADRs associated with NSAIDs

A

long term use in elderly> bc ability to clear drug is less

  1. GI> stomach pain, heartburn, nausea, ulceration, Gi bleed, dyspepsia
  2. Increaed bleeding risk (vascular)
  3. kidney
  4. Heart
  5. asthma attack
  6. Hypersensitivty
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10
Q

Why ADR in GI?

how to offset it?

A

Gastric COX-1 PGE2 >> inhibits gastric section, stimulate synthesis of protective mucous in somtach and intestine.

increased acid secretion, no mucous, increased GI bleeding risk and ulcers

agents w/ high selectivity for COX1 have higher risk of GI RISK!

give PPI of misoprostol

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11
Q

Why ADR in renal? outcomes?

A

PG responsible for proper BF

less BF, less GFR, more Na and water retention> HYPERTENSION RISK & EDEMA

mainaly in those whose renal function is already compromised!

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12
Q

list syndromes u can get as an ADR from NSAIDS

A

( there r 2 s’s in th word NSAIDS)

  1. Steven Johnsen syndrome
  2. Reyers syndrome
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13
Q

other ADR?

A

Hypersensitivity

  • Skin rashes > Stevens Johnson syndrome*
  • Bronchial asthma

Reyes Syndrome (paediatric)

• Rare serious brain/liver injury – usually in viral infections treated with aspirin risk of damage.

* Can occur with other drug groups - not just NSAIDs

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14
Q

Nsaids & interaction with ASTHMA?

A

nsaid inhbit COX> Pg

BUT DO NOT INHIBIT THE ACTION OF LEUKOTRINES!

so inhibtion of PG can cause a shift to making more LEUKOTRINES> increases exacerbation in asthma!!

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15
Q

what is steven johnsons syndrome?

A
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16
Q

Describe the major DDI associated with NSAIDs

A

NSAID protein** **binding can affect PK/PDs

• Highly protein bound drugs affected by NSAIDs include

Sulphonylurea - Warfarin - Methotrexate

Sulphonylurea - Hypoglycaemia
Warfarin – Increased Bleeding

Methotrexate – Wide ranging serious ADRs

“nsait ina i had diabetes and i went to war with a T-rex”

17
Q

NSAIDs in combination for treating pain?

what about Nsaids combination with other drugs in general?

A

NSAIDs given in combination increase risk of ADRs

es: NSAIDs + low dose Aspirin – Compete for COX-1 binding sites - may interfere with cardioprotective action of Aspirin

18
Q

Understand the mode of action of NSAIDs on platelet function exemplified by aspirin

A
19
Q

Appreciate the special case of paracetamol as an analgesic / antipyretic

half life?

A

Very effective for mild/moderate analgesia and fever

Agent of choice for moderate pain and fever

t1⁄2 ≈ 2-4 hrs

20
Q

Recognise the main features of paracetamol overdose and toxicity.

A