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Pharmacology for finals > NSAIDS > Flashcards

NSAIDS Flashcards

1
Q

what is the pharm class of Aspirin?

A

NSAID

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2
Q

How does Aspirin help with pain?

A
  • When there is an injury, the pain site releases PGI2, bradykinin, leukotrienes, By blocking the PGI2, it sensitises the nociceptive fibres to other stimulating factors.
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3
Q

What is analgesic ceiling?

A

there is a limit to its effectiveness as aspirin only blocks the sensitisation, it activate the nociceptive fibres.

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4
Q

what does PGI2 and PGE2 do when there is pain?

A

vasodilation, increases vascular permeability, pain.

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5
Q

What does aspirin help with (anti-?)

A

antipyretic, antiplatelet

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6
Q

how does aspirin act as an antiplatelet?

A

it blocks the
1) thromboxane TXA2 which helps with platelet aggregation.
- takes 1-2 weeks to restore with new platelets.
2) PGI2, also platelet aggregation. takes 3-4 hours to restore it with new COX synthesis

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7
Q

Is aspirin a reversible or irreversible COX inhibitor?

A

irreversible.

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8
Q

How does aspirin help with fever?

A

when there is inflammation, neutrophils are released, cytokines, COX enters blood brain barrier to hypothalamus- body core temp, reset body temp.

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9
Q

Does NSAID alter the body temperature?

A

No.

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10
Q

Are children allowed to consume aspirin?

A

No, it causes Reye’s syndome. Children with viral infections are at higher risk.

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11
Q

What is reye’s syndome and its signs and symptoms?

A

swelling of the brain ( encephalitis) and liver swelling,
- vomit
- personality changes
- listlessness
- LOC
-delirium
-convulsions

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12
Q

what are examples of other NSAIDs

A

naproxen, indometacin, diclofenac

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13
Q

What are the characteristics for naproxen? eg, half life

A
  • more effective in women
  • used for dysmenorrhea
    -half life is 12-24 hours, BD dose is sufficient
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14
Q

what are the characteristics of indometacin

A
  • strong anti inflammatory drug with steroid like phospholipase A
  • 15-25% reported CNS adverse effects eg. depression, psychosis, hallucination, confusion.
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15
Q

what are the characteristics of diclofenac?

A

half life- 2 hours, reduces GI risk.
- longer half life in synovial fluid in joints- great for inflammatory joint pain.
- exists in cream form too.

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16
Q

what are the adverse effects of NSAIDs? aspirin

A

1) reye’s syndrome.
2) GI: dyspepsia, n/v, ulcer, haemorrhage.
- blocks prostaglandin: increases mucus secretion, lowers gastric acid secretion, increases bicarb secretion, mucosal blood flow.

3) renal: blocks PGI2, PGE2.
PGI2: 1) hyper k
2) AKI
3) suppression of renin- aldosterone secretion.

PGE2: retain water and sodium- oedema, HTN.

4) pseudo allergic like reaction: rash, nasal congestion, anaphylactic shock.

5) asthma due to overproduction of leukotrienes.

17
Q

when should you use NSAIDs with caution?

A

urticaria
asthma
nasal polyps

18
Q

what are the risk factors of NSAID induced AKI?

A

1) old age above 65 years old, has htn and atherosclerosis.
- narrowing of renal arterioles may reduce the capacity of renal afferent dilatation.

2) pre-existing glomerular/renal disease - renal afferent dilatation needed to maintain GFR

3) volume depletion-
- reduces renal glomerular afferent arteriolar pressure and activates angiotensin 2.

4) ACE-i, ARB, Diuretics/ triple whammy.
- prevent efferent arteriolar vasoconstriction- required to maintain GFR.

19
Q

which type of NSAID causes greater risk of GI side effects? COX-1, COX2?

A

COX-1

20
Q

what class is etoricoxib?

A

COX-2inhibitor

21
Q

where is COX -2 found in?

A

CNS, kidneys, reproductive organs, synovial fluid.

22
Q

What is COX-2 good for?

A

it has lesser side effects compared to COX -1

23
Q

What are the adverse effects of Etoricoxib?

A

1) renal toxicity
2) Affects ovulation- delayed follicular release
3) Premature closure of ductus arteriosus in fetal
4) Impaired wound healing- #, PUD
5) Increases risk for thrombosis, increases TXA2, platelet aggregation.

24
Q

What are the contraindications of Etoricoxib? 7

A

1)Severe renal failure
2) Heart failure
3) GI bleed
4) Bleeding disorders
5) 3rd trimester in pregnancy ( ALL NSAIDs)
6) systemic corticosteroids, antiplatelets, anticoagulant
7) multiple risk factors for NSAIDs toxicity

25
Q

What should you do if patient has renal toxicity and there is an etoricoxib order?

A

consult dr

26
Q

What should you do if patient has risk for heart toxicity and there is an etoricoxib order?

A

Do not give COX-2 inhibitor, give celecoxib/ibuprofen for less than 5 days. OR give panadol alone

27
Q

What should you do if patient has GI issues and there is an etoricoxib order?

A

Do not give non selective COX inhibitor eg. ibuprofen.
give celecoxib with caution, administer with PPI.

28
Q

What should you do if patient has pseudoallergy reactions and there is an etoricoxib order?

A

Do not give non selective COX inhibitor eg. ibuprofen.
give celecoxib with caution,

29
Q

What are the advices that you may offer to your patients on Etoricoxib?5

A

1) Take medication regularly, not PRN
2) Do not take with food, it will reduce the efficacy.
3) take for short duration, less than 5 days
4) if patient needs to take it for more than 5 days, consult a dr.
5) take NSAIDs with panadol then cease NSAIDs and continue panadol.

30
Q

How much tramadol is equivalent to IV morphine 5mg

A

150mg

31
Q

How much codeine is equivalent to IV morphine 5mg?

A

100mg

32
Q

How much of PO morphine is equivalent to IV morphine 5mg?

A

15mg

33
Q

How much of oxycodone is equivalent to IV morphine 5mg?

A

10mg

34
Q

How much of transdermal fentanyl patch is equivalent to IV morphine 5mg?

A

0.0625mg/hr

35
Q

what is the max dosage for PO tramadol?

A

100mg

36
Q

what is the max dosage for PO codeine?

A

60mg

37
Q

what are the adverse effects of morphine?

A
  • hormonal changes
    -depression
    -death
  • sedation
    -drowsiness
  • hyperalgesia
  • falls, injuries
  • constipation, nausea/vomiting
  • respiratory depression.
    -dependence, withdrawal, abuse
38
Q

what are the risk factors for morphine ?

A

1) pregnancy
2) hepatic/renal insufficiency
3) age>65 years old
4) alrdy on another opiod- risk for diversion
5) family/personal hx of substance use abuse
6) combine with CNS depressant- benziodiazepine, gabapentinoids, anti -depressants.

Pharmacology for finals (4 decks)

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