NSAIDs Flashcards
T/F: COX inhibits TXA2 production.
FALSE! COX is actually the enzyme responsible for TXA2 production.
What are the 5 cardinal signs of inflammation?
Heat, redness, swelling, pain and loss of function
which of the following is not one of the 5 cardinal signs of inflammation?
a. calor
b. rubor
c. tumour
d. dolor
e. functiolaesa
f. none of the above
f. none of the above. They are all signs of inflammation
Pain (dolor) promotes healing because you will stop moving the injured area, allowing the immune system to be efficient. If you keep moving that area it’s never gonna heal!
True! Understand this concept
The ________ response = A pathological process characterized by injury or destruction of tissues caused by variety of cytologic and chemical reactions.
INFLAMMATORY response
what 3 things does the inflammatory response do?
- isolate injurious agent
- remove cell debris and pathogens
- prepares site for tissue repair
The inflammatory pathway in the CNS predominantly affects ______ activity.
neuronal activity
Lipocortin (aka lipomodulin) is an annexin protein that inhibits ______?
a. PGH2
b. PGG2
c. PLA2
d. PLA1
e. PGF2a
PLA2 (phospholipase a2)
Which 2 are pro-inflammatory, sensitize nerves to pain, and increase activity of bradykinin + histamine?
a. PGD2
b. PGE2
c. PGI2
d. PGF2a
PGE2 and PGF2a
TXA2 is an antagonist of ______.
a. PGG2
b. PGE2
c. PGI2
d. PGD2
PGI2
T/F: TXA2 is a platelet inhibitor while PGI2 is a platelet aggregator.
False!!! TXA2 causes platelet AGGREGATION while PGI2 inhibits platelets.
_______ is an example of a COX inhibitor.
Aspirin
COX = cyclooxygenase
True!!!
PGE2 is pro-inflammatory and causes edema, hypothermia, and vasoconstriction.
False!!! PGE2 is pro-inflammatory, which means it is capable of producing an inflammatory response. Therefore it causes edema, HYPERthermia, and vasoDILATION.
Arachidonate ——-> PGG2 is caused by which enzyme?
a. acetyl transferase
b. thromboxane synthase
c. phospholipase A2 (PLA2)
d. cyclooxygenase (COX)
e. 5-lipoxygenase
COX!!
T/F? Arachidonate —-> PGG2 —-> PGH2 —–> PGI2, PGE2, PGD2, PGF2a, and TXA2.
True
PGH2 —–> TXA2 is caused by which enzyme?
a. isomerase
b. PLA2
c. thromboxane synthase
d. acetyl transferase
thromboxane synthase
ARACHIDONATE —?—> HPETE —-> LTA4 (other leukotrienes) is caused by what enzyme?
a. isomerase
b. PLA2
c. 5-lipoxygenase
d. PGI2 synthase
5-lipoxygenase
PGH2 – isomerases—> ? ? ? (choose 3)
a. PGE2
b. PGI2
c. PGD2
d. TXA2
e. PGF2a
PGE2, PGF2a, and PGD2 are formed by isomerases.
Note that TXA2 is produced by thromboxane synthase , and PGI2 is produced by PGI2 synthase.
omega3 comes from red meat.
False. omega6 comes from red meat.
most north americans consume enough red meat so they don’t need ______ supplements.
a. omega3
b. omega6
don’t need omega6 supplements
most north americans need to take ______ supplements.
a. omega3
b. omega6
omega3 supplements
T/F: Delta-5-desaturase favors DHLA over eicosatetraenoic acid.
false. it favors eicosatetraenoic acid (omega3 pathway)
what is the source of omega3 for fish?
algae
T/F: Both omega3 and omega6 are essential fatty acids.
True, both are essential, get them from our diet.
T/F: Evening Primrose Oil is associated with Omega3 while Fish and Flaxseed Oils are associated with Omega6.
False!!!
Evening Primrose Oil = Omega6
Fish and Flaxseed Oils = Omega3
T/F: Evening primrose oil consists of linoleic and gamma linolenic acids.
True
Flaxseed oil and Evening primrose oil _____ platelet aggregation.
a. increase
b. reduce
reduce
if patient is taking phenothiazines, which would you NOT want to give him?
a. fish oil
b. evening primrose oil
c. flaxseed oil
do NOT give Evening Primrose Oil. because it may lower the seizure threshold and precipitate seizures.
If patient has ileus (intestinal blockage) or thyroid problem, which oil would you NOT want to give him?
a. fish oil
b. evening primrose oil
c. flaxseed oil
do NOT give flaxseed oil.
Omega6 pathway leads to pro-inflammatory PGs, while Omega3 pathway leads to Anti-inflammatory PGs.
True!!!
A constitutive enzyme, predominantly involved in PG and TXA2 production.
a. COX-1
b. COX-2
COX-1
An inducible enzyme, predominantly involved in PG and Prostacyclin production.
a. COX-1
b. COX-2
COX-2
Generates pro-inflammatory PGs and O2 radicals; creates pain and pyresis from inflammatory focus.
a. COX-1
b. COX-2
COX-2
Which type of leukotriene is chemotactic - activates phagocytes and promotes neutrophil adhesion.
a. LTA4
b. LTB4
c. LTC4
d. LTD4
LTB4
Which 2 types of leukotriene enhance histamine effects?
(bronchoconstriction, constricts coronary arteries, and dilates vessels in inflammation)
a. LTA4
b. LTB4
c. LTC4
d. LTD4
LTC4 and LTD4
Which 2 types of prostaglandins promote production of mucous in the gastric mucosa?
a. PGE2
b. PGI2
c. PGD2
d. PGF2
PGE2 and PGF2
Note: Aspirin can irritate stomach lining because it knocks out PGE2 and PGF2.
Which prostaglandin DECREASES acid secretion in the Gastrointestinal Tract?
a. PGE2
b. PGI2
c. PGD2
d. PGF2
PGI2
Which prostaglandins are associated with the KIDNEYS and promote maintenance of renal blood flow by stimulating RENIN RELEASE?
a. PGE2
b. PGI2
c. PGD2
d. PGF2
PGE2 and PGI2 stimulate RENIN RELEASE in the kidneys.
What are the 3 relief mechanisms for PAIN?
- Peripheral
- Anesthesia (interrupts efferent pathway)
- Central
bradykinin, potassium ions, norepi, and histamine ______ pain fibers.
a. sensitize
b. stimulate
STIMULATE
Prostaglandins (PGE, PGF2a), leukotrienes, and substance P ______ pain fibers.
a. sensitize
b. stimulate
SENSITIZE
What is this called: Decreased pain tolerance due to increased pain fiber sensitization.
ALLODYNIA
What is this? Naturally occurring opioid induced by Tricyclic Antidepressants. Precursor of adrenocorticotrophic hormone (ACTH) and has a melatonin backbone. Released by hypothalamus.
ENDORPHINS
T/F: Tylenol is a salicylate based drug.
False! its a non-salicylate drug
T/F: Tylenol is classified as a NSAID.
False! Tylenol is NOT a NSAID because it is Non- salicylate.
T/F : Aspirin is a NSAID.
True!!
Which opioid has moved from drug schedule III to II effective Oct. 2014, and is no longer available for ODs to prescribe?
a. Oxymorphone
b. Oxycodone
c. Hydrocodone
d. Hydromorphone
hydrocodone (a semisynthetic opioid)
Recall, in the state of CA we can prescribe UP TO which drug class?
a. I
b. II
c. III
d. IV
Up to class III. We cannot prescribe classes I and II . they are very dangerous and high risk.
Which two opioids are natural?
a. methadone
b. morphine
c. hydrocodone
d. codeine
e. none of the above
morphine and codeine are natural.
Which is NOT a semi-synthetic opioid?
a. hydrocodone
b. hydromorphone
c. oxycodone
d. methadone
d. methadone is NOT a semi-synthetic; it is FULLY synthetic
What is E-A Dosing?
Equi-Analgesic Dosing
E-A Dosing refers to the required dose that is needed to achieve the SAME analgesic effect as ____mg of morphine IV/SC.
a. 1000 mg
b. 100 mg
c. 10 mg
d. 20 mg
10 mg of morphine IV/ SC
Which is the following opioids is NOT fully synthetic?
a. methadone
b. fentanyl
c. hydrocodone
d. meperidine
e. none of the above
hydrocodone is NOT fully synthetic.
Methadone, meperidine, and fentanyl are the 3 fully synthetic opioids!!!
T/F: Schedule II Drug can be telephone Rx or written Rx.
False!! Schedule II Drug is considered high abuse and high risk of dependency, therefore ONLY WRITTEN RX is ACCEPTED.
T/F: Schedule III Drug can be telephone Rx, and refills are OK.
True!
Which four opioids have the MOST potential for HISTAMINE RELEASE?
a. hydrocodone
b. morphine
c. hydromorphone
d. codeine
e. meperidine
morphine, codeine, hydrocodone, and meperidine!!!
You should be cautious using opioids on patients with what type of hypersensitivity?
a. Type I hypersensitivity
b. Type II hypersensitivity
c. Type III hypersensitivity
Type I hypersensitivity reaction.
Opioids are good for which 3 purposes?
a. analgesic
b. euphoria
c. anti-diarrhea
d. anti-constipation
analgesic, euphoria (high), and anti-diarrhea.
opioids actually cause constipation (one of its adverse effects)
T/F: Opioids can help diarrhea and also suppress cough.
True!
Which of the following is not an adverse effect of opioids?
a. nausea and vomiting
b. delayed gastric emptying
c. mydriasis
d. sedation
e. respiratory suppression
Mydriasis is NOT an adverse effect. should be MIOSIS!!! (smaller pupils, which is why Police check your eyes when they pull you over).
T/F: Tylenol is a salicylate based drug and an NSAID; Aspirin (ASA) is a non-salicylate based drug and is NOT an NSAID.
False! It’s the opposite.
Tylenol = non-salicylate = NOT NSAID.
Aspirin = salicylate = NSAID!
If patient is getting surgery soon (in the next week), you should tell him to NOT take which drug, so as to not affect platelet formation?
a. tylenol
b. aspirin
c. morphine
aspirin!!
because aspirin irreversibly inhibits COX-1 enzyme, which is responsible for producing TXA2 (thromboxin A2), a platelet aggregator.
what is the usual dosage for baby aspirin?
usually 80 mg
what is the lifespan of platelets?
a. 1-2 days
b. 7-10 days
c. 30 days (1 month)
7-10 day lifespan
T/F: Aspirin is good for treating both central and peripheral pain.
False! Aspirin is good for peripheral pain, but not that effective for central pain.
T/F: ASA (aspirin) is the gold standard NSAID and the #1 choice for treating rheumatoid arthritis (RA).
true!!
what is the usual dosage of aspirin for pain relief or fever?
a. 80 - 160 mg
b. 160 - 325 mg
c. 325 - 650 mg
160 - 325 mg, and the half life is 2-3 hours.
Which was the first NSAID approved for treating ACUTE pain?
a. celebrex (celecoxib)
b. suprofen
c. ketorolac
d. ketoprofen
ketorolac!!
Which salicylate-like NSAID is a COX-2 inhibitor?
a. celebrex (celecoxib)
b. suprofen
c. ketorolac
d. ketoprofen
celebrex (celecoxib)
