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Pharmacology > NSAIDS > Flashcards

NSAIDS Flashcards

1
Q

What is the mechanism of action of NSAIDS?

A

Inhibit cyclooxygenase- reduces formation of prostaglandin precursors and thromboxanes from arachidonic acid

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2
Q

What are the 2 different categories of NSAIDS?

A
  1. Selective - COX2 inhibitors
  2. Non-selective - COX1 & COX2 inhibitors
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3
Q

When’s the peak of NSAIDS and what are their half-life?

A

Peaks in 1-2 hours, half life varies by product

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4
Q

What are the actions of NSAIDS?

A
  • Analgesic
  • Anti-inflammatory
  • Antipyretic
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5
Q

What is the action of NSAIDS on platelets?

A

Reversible - effect lasts only as long as the drug is in the bloodstream

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6
Q

Do you discontinue NSAIDS before surgery?

A

Yes - based on it’s half-life - if needed for dental surgery, count back 4 to 5 half lives

  • ibuprofen - 1 day
  • naproxen - 4 days
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7
Q

What can happen when you take aspirin (chronic) and NSAIDS together?

A

ibuprofen can interfere with the antiplatelet effect of low-dose aspirin (81mg) potentially rendering aspirin less effective when used for cardioprotection and stroke prevention

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8
Q

What does the FDA recommend for patients on aspirin therapy and taking NSAIDS to avoid attenuation of aspirin’s effect?

A
  • Dose ibuprofen at least 30 minutes or longer after aspirin ingestion … or ….
  • More than 8 hours before aspirin ingestion
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9
Q

Is occasional use of ibuprofen or other NSAIDS while taking aspiring harmful?

A

No- poses little risk because the effects of aspirin on the patelets are permanent

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10
Q

What are the indications for NSAIDS?

A
  • Dental
    • Pain, fever, inflammation
  • Medical
    • Osteoarthritis, rheumatoid arthritis, gouty arthritis, fever, dysmenorrhea, pain
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11
Q

What are some examples of non-selective NSAIDS?

A
  • ibuprofen - Advil, Midol, Motrin (prescription), Ultraprin
  • naproxen - Aleve, (Anaprox, Naprosyn - prescription)
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12
Q

Which NSAID is a red flag in that it causes the most drug interactions?

A

indomethacin - Indocin

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13
Q

What are some common adverse events with NSAIDS?

A
  • Increased risk of MI, stroke
  • Hypertension
  • Comprised renal function
  • Gastrointestinal ulceration, irritation, bleeding and perforation (elderly especially)
  • CNS effects
  • Skin reactions
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14
Q

What does excessive or chronic use of NSAIDS lead to?

A

Nephotoxicity, elderly more susceptible to kidney damage

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15
Q

When are NSAIDS contraindicated?

A
  • In patients with advanced renal disease
  • (avoid) - patients with aspirin allergy
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16
Q

What happens in patients that become hypersensitive to NSAIDS?

A
  • Hives, ithcing, angioneurotic edema, chills, fever, Steven-Johnson syndrome, bronchospasm, anaphylaxis
17
Q

What is the target organ for NSAIDS to effect?

A

Kidney - inhibiting prostaglandins shuts down renal blood flow –> renal necrosis

18
Q

For ibuprofen, what is the OTC and prescription dose, rate of onset of anaglesia, and half-life?

A
  • OTC - 200 mg tablets
  • Rx - 400 - 800 mg tablets
  • Rapid onset of analgesia (30-60 min)
  • Short half-life (2-4 hours)
19
Q

What is the dental dosing (analgesic/fever reduction) for ibuprofen (Motrin)?

A
  • Children: 4-10 mg/kg per dose every 6-8 hours
  • Adults: 200-400 mg/ dose every 4-6 hours for a max daily dose of 1200mg
20
Q

What is the preoperative dose of ibuprofen (Motrin) and why take a preoperative dose?

A
  • 400-600 mg every 6 hours for 24 hours before appointment
  • Decreases postoperative edema and hastens healing time
21
Q

What is the ceiling effect of ibuprofen (Motrin)?

A

Optimal analgesia occurs at 400mg dose

beyond this dose = very little additional analgesia, mainly for inflammation

22
Q

What is the rate of onset, half-life and duration of action for naproxen?

A
  • Rate of onset: 1 hour
  • Long half-life: 12-17 hours
  • Duration: analgesia < 7 hours, anti-inflammatory < 12 hours, peaks after 2 weeks
23
Q

What is the dental dosing for naproxen?

A
  • Adults: 500 mg initially, then 250 mg every 6-8 hours (amp up above steady state)
  • Max: 1250 mg/day
24
Q

What is the longest active of all NSAIDS?

A

piroxicam (Feldene)

45-50 hour half-life

25
Q

What are the 4 other important NSAIDS used in dentistry?

A
  • piroxicam (Feldene)
  • flurbiprofen (ANSAID)
  • ketorolac (Toradol)
  • diflunisal (Dolobid)
26
Q

Which NSAID is known as “super aspirin”?

A

difunisal (Dolobid)

no greater efficacy than aspirin

27
Q

What are the 2 ways to write a prescription for pain?

A
  1. As needed for pain “prn”
  2. Every 6 hours

So that blood level never falls below therapeutic blood level

28
Q

What are some psychological considerations when prescribing medications?

A
  • Prescription drug gives more relief than an OTC
  • More relief with expensive drug vs cheap
  • More relief from colored pills vs white pills
29
Q

What is the only selective NSAID (COX2 inhibitor) available?

A

celecoxib (Celebrex)

30
Q

How do selective NSAIDS spare the GI?

A

COX2 inhibitors inhibit prostaglandins associated with inflammation

Not expressed by GI tract, platelets or kidneys

31
Q

What are some benefits of Celebrex?

A
  • Reduces risk for adenocarcinoma of colon
  • Improvements in lung and oral cancer
  • Delays onset and severity of Alzheimer’s disease
32
Q

How is celecoxib (Celebrex) prescribed for acute dental pain?

A
  • Initial 400 mg dose, followed by additional 200 mg dose if needed on day 1
  • Maintenance dose: 200 mg twice daily as needed
33
Q

What are COX-2 inhibitors contraindicated with?

A
  • In aspirin/NSAID allergic patients (cross-sensitivity)
  • History of gastritis/gastric ucler/ GI bleeding
  • Pregnancy
34
Q

What does Celebrex contain that people may be allergic to?

A

Sulfa atom

Pharmacology (25 decks)

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