NSAIDs

Question 1

irreversible COX inhibitor

Answer 1

aspirin

Question 2

close patent ductus arteriosus

Answer 2

doc - ibuprofen
most common - Indomethacin

Question 3

keep open ductus arteriosus

Answer 3

PGE1: Alprostadil

Question 4

Samtar’s triad

Answer 4

aspirin
asthma
ethmoidal polyp in nose

Question 5

NSAID with maximum risk of peptic ulcer

Answer 5

aspirin

Question 6

NSAID with least risk of peptic ulcerr

Answer 6

Coxib (selective cox 2 inhibitor)
Paracetamol (cox 3 inhibitor)

Question 7

NSAID which got banned because of causing analgesic nephropathy

Answer 7

Phenacitin

Question 8

Aspirin

Answer 8

acetyl salicylic acid
covalent bond, hit and run drug, suicide inhibitor

low dose (40-325mg) - antiplatelet (doc in mi, stroke)
medium (<2g) - analgesic and antipyretic ( rarely used due to risk of Reye’s syndrome)
high (2-5)- anti-inflammatory used in treatment of arthritis, doc in kawasaki’s disease, prevention of colorectal cancer in patients w familial adenomatous polyposis)

Question 9

fatal dose of aspirin

Answer 9

30 grams

Question 10

symptoms of aspirin poisoning

Answer 10

hallucinations or pyschosis
ototoxic (tinnitus or deafness - salicylic)
bleeding (antiplatelet)
hyperthermia (uncoupling of oxidative phosphorylation)
respiratory alkalosis followed by HAGMA
hypoglycemia> hyperglycemia

Question 11

antidote to aspirin poisoning

Answer 11

sodium bicarbonate
severe cases- hemodialysis

Question 12

non-selective/ reversible COX inhibitors

Answer 12

Indomethacin for the treatment of all types of arthritis, closure of PDA, premature infants
SE- seizure, sedation, headache, pancreatitis

Sulindac (prodrug) - active form is Indomethacin

Ibuprofen - preferred in children because of less risk of Reye syndrom- dental pain, closure of PDA
SE- aseptic meningitis

Ketoprofen, Flurbiprofen - topical eye or nasal drops in conjunctivitis or rhinitis

Mefenemic acid - doc for menstrual painor dysmennorhea
also blocks Prostanglandins receptor
SE- autoimmune hemolytic anemia

Phenyl butazone - most effective - banned due to bone marrow suppression

Piroxicam, Tenoxicam - longest- undergo enterohepatic reabsorption from bile

Naproxen - date in cardiac disease patient

Ketorolac- iv also- post operative analgesia (doc is opioids)

Namebutone - only basic NSAID

Question 13

NSAID safest in heart disease

Answer 13

Aspirin> Naproxen

Question 14

Safest NSAID in children

Answer 14

Paracetamol > Ibuprofen
(no risk of Reye’s syndrome)

Question 15

Safest NSAID in renal disease

Answer 15

Paracetamol

Question 16

Prefential COX 2 inhibitor

Answer 16

Nimesulide - banned because hepatotoxic, steven johnson syndrome

Meloxicam

Diclofenac (voveron/volini) - when applied to skin, best skin penetration and achieves good concentration in synovial joints - arthritis, sprain

Aceclofenac

Etodolac

Question 17

Selective cox 2 inhibitor (coxibs)

Answer 17

adv: less risk of peptic ulcer
disadv: increase platelet aggregation - increase chance of thromboembolism - mi/stroke

banned- Rofecoxib, Valdecoxib
approved- Celecoxib, Etoricoxib, Parecoxib

Question 18

Antipyretic and analgesic drug but poor anti-inflammatory

Answer 18

Paracetamol/ Acetaminophen
Phenacetin - banned due to analgesis nephropathy
Metamizole- like paracetamol
Nefopam - SNDRi - serotonin norepineph dopamine reuptakd inhibitor - treatment of migraine headache

Question 19

antidote of paracetamol poisoning

Answer 19

doc: N acetyl cysteine( antioxidant which increase glutathione production and help conjugation of NAPQI helping in its removal)
+ methionine

Question 20

monitoring of paracetamol toxicity

Answer 20

Rumack- Matthew normogram
we monitor blood level of paracetamol with time

200 microgram/ml at 4 hrs or 30 microgram/ml at 15 hrs - high chance of fulminant hepatic failure