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Pharmacology & Anesthesiology > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

what are the non-pharmacological interventions to reduce inflammation

A

1) rest
2) heat/cold
3) weight loss
4) surgery

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2
Q

what are the 2 pharmacological interventions to reduce inflammation

A

1) NSAIDS
2) GLUCOCORTICOIDS

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3
Q

what is the mechanism of aspirin action

A

inhibition of prostaglandin synthesis

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4
Q

what is the oldest NSAID

A

aspirin

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4
Q

T/F NSAIDs are a family of chemically similar drugs

A

F

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5
Q

what are the three main benefits of all NSAIDs

A

1) anti-inflammatory
2) antipyretic
3) analgesic

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6
Q

prostaglandins are synthesized from ________________ by ______ and _____ enzymes

A

arachidonic acid; COX 1; COX 2

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7
Q

what are the 3 main prostaglandins

A

thromboxane, prostacyclin, other PGs

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8
Q

which of the COX enzymes is a housekeeping enzyme present at low levels in most tissues

A

COX1

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9
Q

what is COX2 important for

A

homeostasis of renal medulla and gastric mucosa

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10
Q

what is the role of:
1) thromboxane (TXA2)
2) other PGs (PGD2, PGE2, etc)
3) prostacyclin (PGI2)

A

1) made in platelets; promotes platelet aggregation
2) maintain tissue blood flow
3) inhibit platelet aggregation; vasodilation; gastric mucosa protection

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11
Q

what happens to the COX enzymes when there is inflammation

A

COX2 is locally upregulated -> prostacyclin produces vasodilation -> cardinal signs of inflammation

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12
Q

what are the signals of inflammation to the COX enzymes

A

plasma membrane damage or inflammatory mediator release

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13
Q

T/F most enzymes inhibit both COX1 and COX2

A

T

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14
Q

how to NSAIDS limit the cardinal signs of inflammation

A

block COX enzymes -> inhibition of production of prostaglandins -> no vasodilation (because prostacyclins blocked) -> no cardinal signs

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15
Q

a major benefit of NSAIDs is ___________ to ___________

A

reduction in blood flow; site of injury

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16
Q

what is the most common adverse effect of NSAIDs and why

A

gastric bleeding +/- ulceration; inhibition of prostaglandin synthesis means decreased secretion of bicarb/mucus, increased acid secretion and decreased blood flow to gastric mucosa (from prostacyclin and PGE2)

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17
Q

what are the 3 main adverse effects of NSAIDs

A

1) gastric bleeding
2) increased general tendency to bleed
3) renal medullary hypoxia and necrosis

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18
Q

What is the key takeaway of NSAIDs that preferentially target COX2

A

they produce fewer adverse GI affects as long as GI lesions are not already present (in which case they would be exacerbated)

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19
Q

T/F coxibs cause more bleeding

A

F; they cause less because platelet aggregation is not inhibited

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20
Q

what are the 4 shared pharmacokinetic properties of NSAIDs

A

1) weak acids
2) highy protein bound
3) hepatic metabolism (phase 2 conjugation)
4) variable elimination

21
Q

T/F NSAIDs are associated with decreased uterine motility

A

T

22
Q

what are some contraindications of NSAIDS

A

renal disease, gastric ulcers, hepatic disorders, hypoproteinemia, dehydration, cardiac disease

23
Q

what is the shared clinical use of all NSAIDs

A

to reduce musculoskeletal and inflammatory pain

24
Q

what is the only NSAID that irreversibly blocks COX enzymes

A

aspirin

25
Q

what animals is aspirin approved for

A

cattle and horses

26
Q

what is a consequence of aspirin binding irreversibly to COX enzymes

A

prolonged effects, even at low doses

27
Q

in vitro, aspirin acts to inhibit, but in vivo it acts to inhibit

A

COX1 and COX2; mainly COX1

28
Q

what is an adverse effect of aspirin and why

A

bleeding; inhibits COX1 therefore blocks thromboxane production

29
Q

aspirin should not be used in what species and why

A

cats; deficient in glucuronide conjugation

30
Q

what is the most popular NSAID for horses

A

phenylbutazone

31
Q

phenylbutazone
- species
- enzymes blocked
- duration of action in target species
- therapeutic margin is narrow/wide
- formulations available

A
  • horses
  • COX1 and COX2
  • 24h
  • narrow
  • oral and IV
32
Q

aspirin:
- species
- enzymes blocked
- duration of action
- therapeutic margin is narrow/wide
- formulations available

A
  • cattle and horses
  • COX1 and COX2 in vitro, mainly COX1 in vivo
  • 1h
  • narrow
  • oral only
33
Q

what is an adverse effect of IM phenylbutazone

A

tissue necrosis

34
Q

carprofen:
- approved species
- enzymes blocked
- therapeutic margin is narrow/wide

A
  • dogs
  • COX2
  • narrow
35
Q

what is a possible ADR associated with carprofen and what does this mean to us as vets

A

Type B idiosyncratic: acute hepatotoxicity; need to closely monitor

36
Q

what is a benefit of carprofen compared to some other NSAIDs and why

A

less likely to see GI ulceration and perforation because it is selective to COX2

37
Q

what are the most common adverse effects of carprofen

A

vomiting, diarrhea and anorexia

38
Q

T/F carprofen can be used in cats

A

F

39
Q

ketoprofen:
- approved species
- enzymes blocked
- therapeutic margin is narrow/wide
- half life

A
  • approved in most species
  • COX and LOX
  • narrow
  • 2h in serum but 24h in tissues
40
Q

what is the most common adverse effect of ketoprofin

A
  • vomiting
41
Q

what NSAID inhibits leukotriene and bradykinin production in addition to inhibiting PG synthesis

A

ketoprofin

42
Q

flunixin:
- approved species
- enzymes inhibited
- therapeutic margin is narrow/wide
- duration of action

A
  • horses and cattle
  • COX1 and COX2; leukocytes
  • narrow
  • 30h
43
Q

meloxicam:
- approved species
- enzymes blocked
- therapeutic margin is narrow/wide
- duration of action in cats and in dogs

A
  • dogs, cats, pigs, cattle
  • both but more so COX2
  • narrow but safer than other NSAIDs
  • cats: 15h; dogs: 24h
44
Q

what are the 3 coxibs

A

1) deracoxib
2) robenacoxib
3) firocoxib

45
Q

what are the main concerns with excessive coxib use

A

1) renal papillary necrosis
2) pro-aggregatory effect with long-term use

46
Q

T/F all coxibs can be used in dogs

A

T

47
Q

which coxib is available for use in cats

A

robenacoxib

48
Q

T/F if used properly, serious adverse effects of NSAIDs are uncommon

A

T

49
Q

what is the mechanism of action of acetaminophen and what does this mean in regards to the 3 main effects of NSAIDs

A

inhibits PG synthesis centrally; antipyretic and analgesic but no anti-inflammatory effect

Pharmacology & Anesthesiology (12 decks)

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