NSAIDs Flashcards
1
Q
what are 4 uses of NSAIDs?
A
- Mild to moderate pain relief
- Anti-inflammatory
- Analgesic
- Anti-pyretic
2
Q
What is the largest group of drugs having adverse effects?
A
NSAIDs
3
Q
The use of lower doses of multiple drug classes provides higher safety and less negative side effects is known as what?
A
Multi-modal analgesia
4
Q
NSAIDs have sparing effects on what other category of drug?
A
Opioids
5
Q
What is the rate-limiting step of the arachidonic acid cascade?
A
Release of AA from membrane phospholipid catalyzed by enzyme phospholipase A2.
6
Q
Cyclooxygenase (COX) oxidizes arachidonic acid (AA) to what?
A
Prostaglandins (PGs)
7
Q
Lipoxygenase (LOX) oxidizes AA to what?
A
Leukotrienes
8
Q
Are prostaglandins continually synthesized?
A
Yes
9
Q
Are prostaglandins stored?
A
No
10
Q
Where do prostaglandins act?
A
Locally at site of production.
11
Q
T/F: Prostaglandins have only a few physiological functions.
A
False - Prostaglandins have many physiological functions.
12
Q
What can inhibition of prostaglandins result in?
A
Serious side effects.
13
Q
What are 2 functions of COX 1?
A
- Mucosal defense
- Platelet function (TxA2)
14
Q
What effect does COX 2 have on mucosa?
A
Prevents erosions & promotes healing.
15
Q
Which COX acts as an anti-inflammatory?
How?
A
- COX 2
- Inhibits leukocyte adherence
16
Q
Which COX offers renal protection?
A
COX 2
17
Q
Which COX is involved with fever initiation?
A
COX 3
18
Q
What are 4 functions COX inhibition affects?
A
- Primary plug formation of platelets
- Renal & gastric mucosa vascular tone
- Smooth muscle contraction
- Temperature regulation
19
Q
T/F: Different drugs inhibit COX 1, 2 & 3 variably.
A
True
20
Q
Which COX is involved with vicero-nociception and thermal stimulation?
A
COX 1
21
Q
T/F: COX 1 is involved in constitutive functions with COX 2.
A
True
22
Q
Which COX is inducible?
A
COX 2
23
Q
Which COX is up-regulated during inflammatory states?
A
COX 2
24
Q
There is over a 20 times greater presence of which COX at injured sites?
A
COX 2
25
Which COX has a key role in nociception?
COX 2
26
What are 2 functions of COX 3?
- Pyrexia
| - Analgesia
27
Does COX 3 have better or poorer anti-inflammatory properties than COX 1 & 2?
Poorer
28
COX 3 is derived from what?
COX 1 gene
29
What are 5 drugs that inhibit both COX 1 & 2?
- Aspirin
- Phenylbutazone
- Ketoprofen
- Ketorolac
- Flunixin meglumine
30
What are 5 drugs that are COX 2 preferential and have weak COX 1 inhibition?
- Meloxicam
- Carprofen
- Etodolac
- Vedaprofen
- Tolfenamic acid
31
What are 3 drugs that are COX 2 selective?
- Deracoxib
- Firocoxib
- Robenacoxib
32
What are 2 drugs that are COX 3 preferential and have weak COX 1 & 2 inhibition?
- Acetaminophen
| - Diclofenac
33
What is an example of a COX & LOX inhibitor?
Tepoxalin
34
What do prostaglandins mediate?
- Pain
| - Inflammation
35
Prostaglandins have what type of central effects?
Central anti-nociceptive effects
36
Are NSAIDs highly protein bound?
| How might this affect other drugs?
- Yes
| - May displace other drugs and increase their plasma concentration.
37
What are 2 concerns with giving NSAIDs?
- Patient with underlying organ dysfunction.
| - Patient receiving other highly protein-bound drugs with narrow therapeutic index.
38
Do NSAIDs have a wide or narrow safety margin?
Narrow
39
Can the upper dose limit be exceeded with NSAIDs?
No
40
What dose of NSAIDs should be used?
Lowest effective dose
41
How much time should be waited in between drugs?
Minimum of 7 days
42
How old do patients have to be for NSAIDs?
Over 6 weeks old
43
What should the hydration status be?
Well-hydrated
44
What are 3 contraindications for the use of NSAIDs?
- Concern for or evidence of GI ulceration
- Concurrent corticosteroid use
- Concurrent administration of other NSAID
45
What type of renal and hepatic function is needed?
Normal
46
Surgical preemptive use of NSAIDs should be avoided in what for cases?
- Expected hemorrhage
- Hypotension
- Prolonged procedure
- Any contraindications
47
How long does it take for therapeutic effects of NSAIDs to be seen with post-operative administration?
Does route of administration matter?
- 45 minutes or greater
| - No
48
Should NSAIDs be given with food?
Yes
49
What should be avoided with NSAIDs?
Direct contact with gastric mucosa
50
What are 2 types of surgeries NSAIDs can provide post-operative pain management for?
- Orthopedic surgeries
| - Soft tissue surgeries
51
What should NSAIDs be co-administered with for post-operative pain management?
Opioid
52
What needs to be done with long-term NSAID use?
Monitor the patient
53
Are coagulopathies a contraindication for NSAID use?
Yes
54
Are breeding/pregnancy a contraindication for NSAID use?
Yes
55
What are 2 side effects seen with aspirin?
- GI ulceration
| - Decreased platelet activity
56
What formulation does aspirin come in?
Tablet
57
What type of COX inhibitor is aspirin?
Non-selective COX inhibitor (Inhibits 1 & 2)
58
Phenylbutazone is commonly used in what 2 species?
| What species is it not recommended in?
- Horses & cattle
| - Dogs
59
What are 3 formulations that phenylbutazone comes in?
- Powder
- Paste
- Parenteral
60
What is the duration of phenylbutazone?
12 hours
61
There is a high risk of what 2 side effects with phenylbutazone?
- GI ulceration
| - Nephrotoxicity
62
Residues of phenylbutazone are toxic to what species?
| Should be avoided in cattle of what age?
- Humans
| - Greater than 20 months old
63
What type of COX inhibitor is phenylbutazone?
COX 1 & 2
64
What 2 species is flunixin meglumine used in?
| What species in Europe?
- Ruminants
- Horses
- Dogs in Europe
65
What is the DOA for flunixin meglumine?
12-24 hours
66
What are 4 side effects seen with flunixin meglumine?
- Local swelling
- GI ulceration
- Nephrotoxicity
- Hepatotoxicity
67
What type of COX inhibitor is flunixin meglumine?
COX 1 & 2
68
What species is carprofen widely used in?
What species in Europe?
In UK?
- Dogs
- Cats
- Horses
69
What are 2 formulations for carprofen?
- Tablet
| - Parenteral
70
What is the DOA of carprofen?
12-24 hours
71
What are 4 side effects seen with carprofen?
- Nephrotoxicity
- Hepatotoxicity
- GI ulceration
- Hemostatic deficiencies
72
Hepatotoxicity from carprofen is seen particularly in what dog breed?
Labs
73
What type of COX inhibitor is carprofen?
COX 2 preferential
74
What are 4 species meloxicam can be used in?
- Dogs
- Cats
- Horses
- Cattle
75
What are 3 formulations for meloxicam?
- Oral liquid
- OTM spray
- Parenteral
76
What is the DOA for meloxicam?
12-48 hours
77
What are 4 side effects seen with meloxicam?
- Vomiting
- Diarrhea
- Increase in liver/kidney enzymes
- Decrease in appetite
78
What type of COX inhibitor is meloxicam?
COX 2 preferential
79
What formulation does deracoxib come in?
Tablet
80
What is the DOA for deracoxib?
24 hours
81
What are 5 side effects of deracoxib?
- Vomiting/diarrhea
- Hematochezia
- Melena
- Anorexia
- Renal issues
82
What type of COX inhibitor is deracoxib?
COX 2 selective
83
What formulation does firocoxib come in for dogs?
| What 2 forms for horses?
- Dog: tablet
| - Horse: paste & parenteral
84
What is the DOA for firocoxib?
24 hours
85
What are 5 side effects seen with firocoxib?
- Abdominal pain
- Diarrhea
- Urticaria
- PU/PD
- Renal
86
What type of COX inhibitor is firocoxib?
COX 2 selective
87
What 2 formulations does robenacoxib come in?
- Tablet
| - Parenteral
88
What is the DOA of robenacoxib?
24 hours
89
What are 3 side effects seen with robenacoxib?
- Vomiting/diarrhea
- GI ulceration
- Renal toxicity
90
What type of COX inhibitor is robenacoxib?
COX 2 selective
91
What 2 formulations does acetaminophen come in?
- Tablet
| - Oral suspension
92
Is acetaminophen approved for use in veterinary patients?
No
93
What is the DOA?
8 hours
94
What species should acetaminophen not be used in?
Cats
95
What are 3 side effects seen with acetaminophen?
- Hepatic damage
- Renal damage
- GI ulceration
96
What type of COX inhibitor is acetaminophen?
COX 3 preferential
97
What species is tepoxalin used in?
Dogs
98
What formulation does tepoxalin come in?
Dissolvable wafer
99
What is the DOA of tepoxalin?
24 hours
100
Is tepoxalin commercially available?
No
101
What type of inhibitor is tepoxalin?
COX 1, 2 and LOX
102
What does LETD stand for?
Locally enhanced topical delivery
103
What is an example of a topical NSAID?
| Use?
- Surpass (diclofenac)
| - Equine osteoarthritis
104
Are there any ophthalmic topical NSAIDs approved for veterinary use?
No
