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PR - MUSCULOSKELETAL > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

What are the 2 effects of NSAIDs?

A

Analgesic
Antinflammatory

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2
Q

NSAIDs- MOA

A

NSAIDs reduce the production of prostaglandins by inhibiting COX enzymes

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3
Q

NSAIDs selectivity

A

Vary in their selectivity for inhibiting different types of cyclo-oxygenase;
- Non-selective COX-1/COX-2 inhibitors
- Selective COX-2 inhibitors

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4
Q

Which type of NSAID is associated with less gastro-intestinal intolerance.

A

selective inhibition of cyclo-oxygenase-2 (COX-2)

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5
Q

Non-selective COX-1/COX-2 inhibitors

A

Aspirin
Diclofenac
Ibuprofen
Indometacin
Mefenamic acid
Meloxicam
Naproxen
Piroxicam
Phenybutazone
Tiaprofenamic acid

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6
Q

Selective COX-2 inhibitors

A

Celecoxib
Etorocoxib
Parecoxib

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7
Q

NSAIDs - side effects

A

Hypersensitivity
Photosensitivity (topical)
Nephrotoxicity
Sodium + fluid retention
GI events
CV events

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8
Q

High risk - GI side effects

A

Piroxicam
Ketoprofen
Ketorolac

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9
Q

Medium risk - GI side effects

A

Indometacin
Diclofenac
Naproxen

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10
Q

Low risk - GI side effects

A

Ibuprofen

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11
Q

Lowest risk - GI side effects

A

Selective COX-2 inhibitors

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12
Q

High risk - CV side effects

A

Selective COX-2 inhibitors
Ibuprofen 2.4g
Diclofenac

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13
Q

Low risk - CV side effects

A

Naproxen
Ibuprofen 1.2g

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14
Q

Side effects - GI events

A

All NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly.
Offer PPI

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15
Q

Hypersensitivity reactions -

A

C/I if history of hypersensitivity to NSAIDs or aspirin
- Bronchospasms
- Rash
- Angioedema
- Hives
- Rhinitis

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16
Q

Photosensitivty

A

Topical preparations
Esp ketoprofen

17
Q

Sodium + fluid retention

A

Caution in:
- Renal impairment
- Liver impairment
- Congestive HF
- Hypertension

18
Q

Nephrotoxicity

A

Caution in renal impairment
Reduce eGFR and are renally cleared
Temporarily stop on sick days = AKI

19
Q

Renal impairment

A
  • Avoid in renal impairment (risk of fluid retention and further impairment)
20
Q

Pregnancy

A
  • Avoid in pregnancy - caution in breastfeeding
21
Q

Pregnancy MHRA

A

use of systemic NSAIDs from week 20 of pregnancy onwards may be associated with an increased risk of:

  • oligohydramnios resulting from fetal renal dysfunction—this may occur shortly after treatment initiation, although usually reversible upon discontinuation;
  • constriction of the ductus arteriosus—most reported cases resolved after treatment cessation
22
Q

Paracetamol vs NSAIDs

A

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

23
Q

NSAIDs - interactions

A

Asthmatics
Low dose aspirin
Alcohol

24
Q

NSAIDs + low-dose aspirin →

A

increase GI bleed risk (use only if necessary)

25
Q

NSAIDs + alcohol →

A

increase GI bleed risk
* Use stomach protection (Usually a PPI)

26
Q

NSAIDs + asthma →

A

Bronchospasms

27
Q

NSAIDs + MTX/lithium →

A

Reduces clearance

28
Q

NSAIDs + ciprofloxacin →

A

Increases risk of seixures

29
Q

NSAIDs + blood thinner →

A

Increases risk of bleeding

30
Q

NSAIDs + drugs which cause hyperkalaemia →

A

hyperkalaemia

31
Q

NSAIDs + drugs which cause renal failure →

A

AKI

32
Q

Interactions - increased risk of AKI

A

ACEi
Diuretics
Ciclosporin
Tacrolimus

33
Q

Interactions - increased risk of bleedin

A

Warfarin
- Displaced by NSAID = high free drug concentrations
NOACs
Antiplatelets
Low dose aspirin
Heparin
SSRI
Venlafaxine
Steroid

34
Q

Interactions - increased risk of hyperkalaemia

A

Potassium sparing diuretics

PR - MUSCULOSKELETAL (7 decks)

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