NSAIDS

Question 1

What are NSAIDs, and give examples?

Answer 1

Drugs that relieve pain, fever, and inflammation by inhibiting cyclooxygenase enzymes. Examples: Aspirin, ibuprofen, naproxen, diclofenac, celecoxib.

Question 2

What does the COX pathway do?

Answer 2

Converts arachidonic acid to prostaglandins, mediating pain, fever, and inflammation.

Question 3

What does the LOX pathway do?

Answer 3

Converts arachidonic acid to leukotrienes, involved in bronchoconstriction and vascular permeability.

Question 4

What are the roles of COX-1?

Answer 4

Constitutive enzyme involved in homeostatic functions like gastric protection and platelet aggregation.

Question 5

What are the roles of COX-2?

Answer 5

Inducible enzyme expressed during inflammation, promoting the inflammatory response.

Question 6

What are the pharmacokinetic properties of NSAIDs?

Answer 6

Weak acids, well-absorbed, highly protein-bound, metabolized in the liver, and renally excreted.

Question 7

What are the major side effects of NSAIDs?

Answer 7

GI irritation/ulcers, nephrotoxicity, hepatotoxicity, and hypersensitivity reactions.

Question 8

How does aspirin irreversibly inhibit COX enzymes?

Answer 8

Acetylates COX, permanently reducing prostaglandin and thromboxane synthesis for the platelet’s lifespan.

Question 9

Which NSAIDs are nonselective for COX-1 and COX-2?

Answer 9

Ibuprofen and naproxen.

Question 10

Which NSAID is COX-1 preferential?

Answer 10

Aspirin.

Question 11

Which NSAID is COX-2 selective?

Answer 11

Celecoxib.

Question 12

How do NSAIDs reduce fever?

Answer 12

Inhibit prostaglandin E2 synthesis, reversing hypothalamic vasodilation and heat dissipation.

Question 13

What causes GI upset with NSAIDs?

Answer 13

Inhibition of COX-1 reduces protective gastric prostaglandins, leading to irritation and ulcers.

Question 14

What are the black box warnings associated with NSAIDs?

Answer 14

Increased risk of cardiovascular events and GI bleeding, ulceration, and perforation.

Question 15

How is aspirin toxicity evaluated?

Answer 15

By serum salicylate levels and time since ingestion. Symptoms include tinnitus, metabolic acidosis, and hyperventilation.

Question 16

How is severe aspirin toxicity treated?

Answer 16

Emergent dialysis.

Question 17

What are the benefits of COX-2 selective inhibitors?

Answer 17

Reduced GI toxicity compared to nonselective NSAIDs.

Question 18

What are the drawbacks of COX-2 selective inhibitors?

Answer 18

Increased cardiovascular risk due to reduced prostacyclin without inhibiting thromboxane A2.

Question 19

What are the specific uses for diclofenac?

Answer 19

Osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

Question 20

What are the specific uses for indomethacin?

Answer 20

Gout and patent ductus arteriosus.

Question 21

What factors influence NSAID selection?

Answer 21

GI risk (use COX-2 inhibitors), renal function, cardiovascular risk, and cost.

Question 22

Why is acetaminophen not classified as an NSAID?

Answer 22

It lacks significant anti-inflammatory activity and weakly inhibits COX in peripheral tissues.

Question 23

What are the acute effects of glucocorticoids?

Answer 23

Anti-inflammatory, immune suppression, and improved cognitive function.

Question 24

What are the chronic effects of glucocorticoids?

Answer 24

Immunosuppression, diabetes, hypertension, osteoporosis, and muscle wasting.

Question 25

How do glucocorticoids work?

Answer 25

Bind glucocorticoid receptors, modulating transcription of anti-inflammatory genes and suppressing cytokines.