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Roomies Collab Deck 3: Surgery, Anesthesiology, Pain, and Urology > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

In single doses non-steroidal anti-inflammatory drugs (NSAIDs) have analgesic activity comparable to that of _______________, but _______________ is preferred, particularly in the elderly.

A

paracetamol

paracetamol

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2
Q

In regular full dosage NSAIDs have both a lasting ________________ and a(n) ______________ effect which makes them particularly useful for the treatment of continuous or regular pain associated with inflammation.

A

analgesic

anti-inflammatory

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3
Q

Although paracetamol often gives adequate pain control in ______________, NSAIDs are more appropriate than paracetamol or the opioid analgesics in the ________________________ and in some cases of advanced _____________ due to their anti-inflammatory properties

A

osteoarthritis

inflammatory arthritides (e.g. rheumatoid arthritis)

osteoarthritis

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4
Q

NSAIDs can also be of benefit in the less well defined conditions of _____________ and ______________.

A

back pain

soft-tissue disorders

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5
Q

Differences in _____________ activity between NSAIDs are small, but there is considerable variation in _____________ and _____________ to these drugs.

A

anti-inflammatory

individual response

tolerance

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6
Q

About _______% of patients will respond to any NSAID; of the others, those who do not respond to one may well respond to another.

A

60

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7
Q

Pain relief starts ___________ after taking the first dose and a full analgesic effect should normally be obtained within ____________, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to _____________. If appropriate responses are not obtained within these times, another NSAID should be tried.

A

soon

a week

3 weeks

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8
Q

NSAIDs reduce the production of _______________ by inhibiting the enzyme _______________.

A

prostaglandins

cyclo-oxygenase

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9
Q

NSAIDs vary in their selectivity for inhibiting different types of cyclo-oxygenase; selective inhibition of cyclo-oxygenase-2 (COX-2) is associated with less _____________.

A

gastro-intestinal intolerance

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10
Q

Ibuprofen is a propionic acid derivative with __________, ____________, and ____________ properties. It has fewer side-effects than other non-selective NSAIDs but its anti-inflammatory properties are weaker

A

anti-inflammatory

analgesic

antipyretic

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11
Q

Ibuprofen is a propionic acid derivative with anti-inflammatory, analgesic, and antipyretic properties. It has ____________ (greater/fewer) side-effects than other non-selective NSAIDs but its anti-inflammatory properties are ___________ (stronger/weaker)

A

Fewer

Weaker

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12
Q

Is ibuprofen suitable for conditions in which inflammation is prominent?

A

No; due to its weak anti-inflammatory properties compared to other non-selective NSAIDs

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13
Q

______________ is the active enantiomer of ibuprofen. It has similar properties to ibuprofen and is licensed for the relief of mild to moderate pain and inflammation.

A

Dexibuprofen

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14
Q

____________ is one of the first choices of NSAIDs because it combines good efficacy with a low incidence of side-effects (but more than ibuprofen).

A

Naproxen

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15
Q

_____________ may be slightly more effective than naproxen, and is associated with slightly more gastro-intestinal side-effects than ibuprofen.

A

Flurbiprofen

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16
Q

Ketoprofen has anti-inflammatory properties similar to ibuprofen and has ___________ (more/fewer) side-effects

A

More

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17
Q

Tiaprofenic acid is as effective as naproxen; it has ___________ (more/fewer) side-effects than ibuprofen.

A

More

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18
Q

Which NSAIDs are propionic acid derivatives? (5)

A

Naproxen
Flurbiprofen
Ketoprofen and dexketoprofen
Tioprofenic acid

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19
Q

Diclofenac sodium and aceclofenac are similar in efficacy to _____________.

A

naproxen

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20
Q

__________ is comparable in efficacy to naproxen; it is licensed for symptomatic relief of osteoarthritis and rheumatoid arthritis

A

Etodolac

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21
Q

Indometacin has an action equal to or superior to that of naproxen, but with a high incidence of side-effects including…? (3)

A
  1. headache
  2. dizziness
  3. gastro-intestinal disturbances
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22
Q

Indometacin has an action equal to or superior to that of ____________, but with a high incidence of side-effects including headache, dizziness, and gastro-intestinal disturbances

A

naproxen

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23
Q

_______________ has an action equal to or superior to that of naproxen, but with a high incidence of side-effects including headache, dizziness, and gastro-intestinal disturbances

A

Indometacin

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24
Q

_______________ has minor anti-inflammatory properties. It has occasionally been associated with diarrhoea and haemolytic anaemia which require discontinuation of treatment

A

Mefenamic acid

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25
Q

Mefenamic acid has minor anti-inflammatory properties. It has occasionally been associated with ______________ and ___________ which require discontinuation of treatment

A

diarrhea

haemolytic anaemia

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26
Q

Mefenamic acid has ____________ (major/minor) anti-inflammatory properties. It has occasionally been associated with diarrhoea and haemolytic anaemia which require discontinuation of treatment

A

Minor

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27
Q

Meloxicam is licensed for the short-term relief of pain in ____________ and for long-term treatment of _____________ and _______________.

A

osteoarthritis

rheumatoid arthritis

ankylosing spondylitis

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28
Q

_____________ is licensed for the short-term relief of pain in osteoarthritis and for long-term treatment of rheumatoid arthritis and ankylosing spondylitis.

A

Meloxicam

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29
Q

Nabumetone is comparable in effect to ____________.

A

naproxen

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30
Q

Phenylbutazone is licensed for _____________, but is not recommended because it is associated with serious side-effects, in particular haematological reactions; it should be used only by a specialist in severe cases where other treatments have been found unsuitable.

A

ankylosing spondylitis

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31
Q

________________ is licensed for ankylosing spondylitis, but is not recommended because it is associated with serious side-effects, in particular haematological reactions; it should be used only by a specialist in severe cases where other treatments have been found unsuitable.

A

Phenylbutazone

32
Q

Phenylbutazone is licensed for ankylosing spondylitis, but is not recommended because it is associated with serious side-effects, in particular ________________; it should be used only by a specialist in severe cases where other treatments have been found unsuitable.

A

haematological reactions

33
Q

Piroxicam is as effective as naproxen and has a _____________ (short/long) duration of action which permits ______________

A

Long

once-daily administration

34
Q

______________ has more gastro-intestinal side-effects than most other NSAIDs, and is associated with more frequent serious skin reactions

35
Q

Piroxicam has more gastro-intestinal side-effects than most other NSAIDs, and is associated with more frequent ______________

A

serious skin reactions

36
Q

Sulindac is similar in tolerance to _____________.

37
Q

Tenoxicam is similar in activity and tolerance to ____________. Its long duration of action allows once-daily administration.

38
Q

Tolfenamic acid is licensed for the treatment of __________.

39
Q

Ketorolac trometamol and the selective inhibitor of cyclo-oxygenase-2, parecoxib, are licensed for the short-term management of _________________

A

postoperative pain

40
Q

The selective inhibitors of COX-2, ___________ and ____________, are as effective as non-selective NSAIDs such as diclofenac sodium and naproxen.

A

etoricoxib

celecoxib

41
Q

Although selective COX-2 inhibitors can cause serious gastro-intestinal events, available evidence appears to indicate that the risk of serious upper gastro-intestinal events is lower with selective inhibitors compared to non-selective NSAIDs; this advantage may be lost in patients who require concomitant _______________.

A

low-dose aspirin

42
Q

Available evidence appears to indicate that the risk of serious ________________ is lower with selective COX-2 inhibitors compared to non-selective NSAIDs; this advantage may be lost in patients who require concomitant low-dose aspirin.

A

upper gastro-intestinal events

43
Q

Celecoxib and etoricoxib are licensed for the relief of pain in _______________, ______________, and _______________; etoricoxib is also licensed for the relief of pain from _____________.

A

osteoarthritis

rheumatoid arthritis

ankylosing spondylitis

acute gout

44
Q

______________ and ______________ are licensed for the relief of pain in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; _____________ is also licensed for the relief of pain from acute gout.

A

Celecoxib

etoricoxib

etoricoxib

45
Q

Aspirin has been used in high doses to treat ______________, but other NSAIDs are now preferred

A

rheumatoid arthritis

46
Q

Most mild to moderate dental pain and inflammation is effectively relieved by ____________

47
Q

Which NSAIDs are used in the management of mild to moderate dental and orofacial pain? (3)

A
  1. Ibuprofen
  2. Diclofenac sodium
  3. Diclofenac potassium
48
Q

The use of NSAIDs in the elderly is potentially inappropriate if co-prescribed with a ____________, _____________, or ______________

A

Vit K antagonist
Direct thrombin inhibitor
Factor Xa inhibitor

(Due to increased risk of major GI bleed)

49
Q

The use of NSAIDs in elderly patients is potentially inappropriate if prescribed with concurrent ______________ without PPI prophylaxis

A

Antiplatelet agent(s)

Due to increased risk of PUD

50
Q

The use of NSAIDs in elderly patients is potentially inappropriate in a history of PUD or GI bleeding UNLESS concurrent __________ or ___________ are prescribed

A

PPIs

H2-receptor antagonists

(Due to risk of peptic ulcer relapse; COX-2 selective NSAIDs are not included)

51
Q

The use of NSAIDs in elderly patients is potentially inappropriate if prescribed with concurrent ______________ without PPI prophylaxis

A

Corticosteroids

*also antiplatelets
Increased risk of PUD

52
Q

The use of NSAIDs in elderly patients is potentially inappropriate in patients with an eGFR less than _______________

A

50 mL/min/1.73 m2

Risk of deterioration in renal function

53
Q

The use of NSAIDs in elderly patients is potentially inappropriate if prescribed in patients with ____________ or _______________

A

Severe HTN

Severe HF

(Risk of exacerbation)

54
Q

The use of NSAIDs in elderly patients is potentially inappropriate if prescribed for ___________ symptom relief of osteoarthritis where ____________ has not been tried

A

long-term (longer than 3 mo)

paracetamol

55
Q

The use of NSAIDs in elderly patients is potentially inappropriate (STOPP criteria) if prescribed for chronic treatment of __________ where there is no contraindication to a(n) _____________

A

Gout

Xanthine-oxidase inhibitor

56
Q

The use of NSAIDs in elderly patients is potentially inappropriate (STOPP criteria) if a _____________ is prescribed in patients with concurrent _______________

A

COX-2 selective NSAID

CVD

(Increased risk of MI and stroke)

57
Q

Any degree of worsening of ____________ may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.

58
Q

Any degree of worsening of asthma may be related to the ingestion of ___________, either prescribed or (in the case of ___________ and others) purchased over the counter.

A

NSAIDs

ibuprofen

59
Q

All NSAID use (including COX-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of ______________ (e.g. __________ and __________)

A

thrombotic events

myocardial infarction

stroke

  • independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term
60
Q

The greatest risk of thrombotic events in patients taking NSAIDs may be in those receiving ____________________

A

High doses long term

61
Q

Which 3 NSAIDs are associated with an increased risk of thrombotic events?

A

COX-2 selective inhibitors (eg. etoricoxib, celecoxib)
diclofenac (150 mg daily) and aceclofenac
ibuprofen (2.4 g daily)

62
Q

Although there are limited data regarding the thrombotic effects of ___________, treatment advice has been updated in line with diclofenac, based on ___________’s structural similarity to diclofenac and its metabolism to diclofenac

A

aceclofenac

aceclofenac

63
Q

Which NSAIDs are considered to have the lowest thrombotic risk? (2)

A
  1. Naproxen

2. Low dose ibuprofen (1.2 g daily or less)

64
Q

____________ (1 g daily) is associated with a lower thrombotic risk, and low doses of _____________ (1.2 g daily or less) have not been associated with an increased risk of myocardial infarction

A

Naproxen

ibuprofen

65
Q

The ______________ of NSAID should be prescribed for the ______________ to control symptoms and the need for long-term treatment should be ________________.

A

lowest effective dose

shortest period of time

reviewed periodically

66
Q

All NSAIDs are associated with serious ________________; the risk is higher in ___________.

A

gastro-intestinal toxicity

the elderly

67
Q

Which NSAIDs are associated with the highest risk of serious upper GI side effects? (3)

A
  1. Piroxicam
  2. Ketoprofen
  3. Ketorolac
68
Q

Which NSAIDs are associated with moderate risk of serious upper GI side effects? (3)

A
  1. Indomethacin
  2. Diclofenac
  3. Naproxen
69
Q

Which non-selective NSAID is associated with the lowest risk of serious upper GI side effets?

A

Ibuprofen (although high doses have been associated with intermediate risk)

70
Q

Selective inhibitors of COX-2 are associated with a lower risk of ________________ side-effects than non-selective NSAIDs.

A

serious upper gastro-intestinal

71
Q

Recommendations are that NSAIDs associated with a low risk of serious upper GI side effects e.g. ______________ are generally preferred, to start at the _________________ and not to use more than __________ oral NSAID at a time

A

ibuprofen

lowest recommended dose

one

72
Q

What consideration should be taken regarding NSAIDs and alcohol?

A

Alcohol increases the risk of gastro-intestinal haemorrhage associated with NSAIDs.

73
Q

Alcohol increases the risk of _______________ associated with NSAIDs.

A

gastro-intestinal haemorrhage

74
Q

Specialist sources recommend that concurrent use of NSAIDs need not be avoided with ___________ alcohol intake, but greater caution is warranted in those who drink more than ____________.

A

moderate

the recommended daily limits

75
Q

Some cases of _______________ have been attributed to use of NSAIDs and acute excessive alcohol consumption

A

acute kidney injury

76
Q

Some cases of acute kidney injury have been attributed to use of NSAIDs and ________________

A

acute excessive alcohol consumption

Roomies Collab Deck 3: Surgery, Anesthesiology, Pain, and Urology (12 decks)

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