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High Risk Drugs > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

What’s their MoA?

A

Inhibits COX enzymes involved in prostaglandin synthesis.

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2
Q

How long does it take to reach its full effect?

A
  • mild to moderate pain relief - with first dose
  • analgesic full effect - takes 1 week
  • Anti-inflammatory effect - takes 3 weeks
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3
Q

Which drugs are selective COX-2 inhibitors?

A
  • Celecoxib
  • Etoricoxib
  • Parecoxib (post-operative pain)
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4
Q

Pregnancy?

A

AVOID. Esp in 3rd trimester.

It delays labour, causes pulmonary HTN in new-born child, premature closure of foetal ductus artiosus.

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5
Q

SEs?

A
  • asthma and NSAIDs
  • NSAID hypersensitivity
  • Photosensitivity with topical NSAIDs
  • nephrotoxicity
  • Na and fluid retention
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6
Q

NSAIDs and asthma

A

Take caution as it may worsen asthma.
Can cause bronchospasm.
C/I if history of asthma attack with NSAIDs

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7
Q

NSAID hypersensitivity

A

C/I if history of sensitivity to NSAIDs or aspirin = bronchospasm, rash, angioedema, hives and rhinitis

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8
Q

Photosensitivity with topical NSAIDs

A

Esp. ketoprofen

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9
Q

Nephrotoxicity?

A

Caution in renal impairment
NSAIDs reduce glomerular filtration (eGFR) and are renally cleared
Temporarily stop on “sick days” = acute kidney injury

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10
Q

Na and fluid retention

A

Caution in renal and liver impairment, congestive heart failure, HTN

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11
Q

Interactions?

A

Increased risk of acute kidney injury
- ACEi, cyclosporin, tacrolimus, diuretics
Increased risk of bleeding
- warfarin, DOACs, antiplatelet, low-dose aspirin, heparin, SSRI, venlafaxine, steroids
Reduced renal excretion = increased toxicity
- methotrexate, Li
Increased risk of high K+
- K+ sparing diuretics
Increased risk of convulsions
- Quinolones
Enhanced effect of sulfonylureas
NSAIDs antagonise hypotensive effects
- BB, CCB, ACEi, nitrates, alpha-blockers, A2RA

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12
Q

Regarding GI toxicity in NSAIDs, which NSAIDs has the highest risk?

A

Ketoproen
Ketolorac
Piroxicam

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13
Q

Regarding GI toxicity in NSAIDs, which NSAIDs has the medium risk?

A

Naproxen
Diclofenac
Indomethacin

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14
Q

Regarding GI toxicity in NSAIDs, which NSAIDs has a low risk?

A

Ibuprofen

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15
Q

Regarding GI toxicity in NSAIDs, which NSAIDs has the LOWEST risk?

A

COX-2 selective NSAIDs

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16
Q

What would you give to pts (e.g. elderly) if they are at high risk but need to take NSAIDs?

A

PPI for gastroprotection

Pts over 45 years who are prescribed NSAIDs for lower back pain should be co-prescribed PPIs.

17
Q

GI TOXICITY in NSAIDs - pt counselling and CI?

A
  • causes stomach irritation, thus, take with or after food
    GI bleeding/ulcers/perforation:
    C/I -
  • active GI bleeding/ulcers
  • ketoprofen/piroxicam/ketorolac - any history
  • other non-selective NSAIDs >2 eps
  • history of NSAID-induced ulcer/bleeding
18
Q

Regarding cardiovascular events in NSAIDs, which NSAIDs has the highest risk?

A
  • high dose ibuprofen 2.4g OD
  • dexibuprofen
  • COX-2 SELECTIVE
  • diclofenac / acelofenac

Low-dose ibuprofen and naproxen are associated with the lowest risk of CVS risk.

19
Q

Why are cardiovascular events with NSAIDs dangerous?

A

There’s a small increased risk of thrombotic events, e.g. MI or stroke.
In severe HF => all NSAIDs are CI.

20
Q

What are additional C/Is for NSAIDs in terms of cardiovascular events?

A
  • IHD
  • Cerebrovascular disease
  • Peripheral arterial disease
  • mild to severe HF
  • Left ventricular dysfunction
  • HTN
  • pts with oedema for any other reason; may precipitate CHF
  • pts with risk factors for CVD events
21
Q

Monitoring?

A

BP (esp after dosing changes)
Renal function
LFT
Hb in those with risk factors for GI bleeding

22
Q

Warning signs?

A
  • black stools or coffee-ground vomit, suggesting chronic GI bleed
  • iron-deficiency anaemia, suggesting chronic GI bleed (fatigue, dizziness, pale skin, SoB)
  • progressive unintentional weight loss or difficulty swallowing
  • pregnancy and breastfeeding
  • swollen ankles or feet
  • unexplained, persistent recent-onset dyspepsia
  • worsening of asthma
23
Q

Which NSAIDs have a preference for COX-2?

A

Meloxicam
Etodoloac
Nabumetone
Diclofenac

24
Q

Which NSAIDs are non-selective?

A

Menfenamic acid
Ibuprofen
Naproxen
Indometacin

High Risk Drugs (14 decks)

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