NSAIDs Flashcards
Aspirin
10 important things
- Irreversibly blocks COX
- Low dose (1st order elimination), High dose (0 order elimination)
- Decreases risk of TIAs, unstable angina, cataracts and colon cancer
- DOC for fever
- For muscular, vascular, dental, postpartum and arthritis pain (not for visceral pain)
- Enteric coated is best (decreases gastritis)
- 2g or less can increase serum uric acid levels (>4g decrease levels)
- Reye’s Syndrome in children (use tylenol instead)
- Salicylism: tinnitus, decreased hearing and vertigo
- Interactions: corticosteriods, spironolactone, penicillin, etc
Ibuprofen
5 important things
- 2nd DOC for fever
- Good for bone pain and children
- Can decrease anti-inflammatory effect if used with ASA
- Risk for stroke
- Least irritant on GI
Naproxen
5 important things
- Competes with ASA for binding sites
- Antacids delay absorption
- GI upset (3rd most NSAID)
- Prolongs pro-thrombin time
- Safest for CV risks
Fenoprofen
2 important things
- Causes interstitial nephritis
- Not for diabetics or patients with renal dysfunction
Flurbiprofen
2 important things
- Topical opthalmic formulation (eye inflammation)
- Monitor LFTs
Ketoprofen
2 important things
- Inhibits both pathways (COX and Lipooxygenase)
- Better for asthmatics
Oxaprozin
3 important things
- Once daily dosing
- Useful in gout (don’t give for acute gout, can increase uric levels)
- Doesn’t interfere with INR
Diclofenac
5 important things
- More COX II selective
- High concentrations can inhibit leukotrienes
- Also comes in a topical preparation
- Severe hepatic reactions (hepatitis)
- Risk for stroke and CV death
Sulindac
4 important things
- Prodrug (enterohepatic circulation)
- Causes SJS
- Increased risk of acute liver injury
- Only NSAID that doesn’t interact with diuretics
Tolmetin
1 important thing
-Good for children (JRA)
Etodolac
2 important things
- Selective for COX II
- Post-op analgesia
Meloxican
2 important things
- Selective for COX II
- Causes hepatotoxicity
Nabumetone
2 important things
- Selective for COX II
- Prodrug
Meclofenamate and Mefenamic Acid
2 important things
- Enhance oral anticoagulation therapy
- Don’t use for more than 1 week
Piroxicam
3 important things
- Once daily dosing
- Very good anti-inflammatory
- Most likely NSAID GI irritant
Diflusinal
3 important things
- Derived from salicylic acid
- Little anti-pyretic activity
- For OA, RA, pain
Indomethican
6 important things
- One of the most potent inhibitors of PG synthesis
- More effective than ASA
- For gouty arthritis, pericarditis, and management of PDA in premature infants
- Great amount of GI upset (2nd most NSAID)
- Antagonizes furosemide
- Caution in asthma, angioedema, nasal polyps, peptic ulcer, psych disorders
Ketorolac
2 important things
- IV (only 5 day mix) or PO
- Analgesic post-op
Celecoxib
4 important things
- Selective COX II inhibitor
- Not for asthmatics or those allergic to Sulfas
- May protect against colon cancer
- Does not affect platelet aggregation or bleeding time
Acetaminophen
4 important things
- No anti-inflammatory properties
- For pain and fever
- T1/2 unaffected by renal dysfunction
- Can cause hepatic necrosis
Tramadol
3 important things
- Binds mu receptor
- Not a true NSAID, Opioid or Sedative
- Can cause serotonin syndrome
NSAIDS
8 important things
- Reversible
- Found in synovial fluid (so good for arthritis, gout, etc)
- Not affected by food
- Lack of response to one NSAID does not preclude response to another NSAID
- Decrease effectiveness of thiazides (antagonize diuretics)
- NOT for asthmatics
- COX II inhibitors of have less ADRs
- All induce nephrotoxicity
GI Irritants in order
- Piroxicam
- Indomethicin
- Naproxen
- Sulindac
- Diclofenac
- Ketoprofen
- Ibuprofen
3 NSAIDs safe for children
- Ibuprofen
- Indomethicin
- Tolmetin
5 NSAIDs selective for COX II
- Meloxicam
- Etodolac
- Nabumetone
- Celecoxib
- Diclofenac
3 injectable NSAIDs
- Indomethicin
- Ketorolac
- Ibuprofen
