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Anesthesiology > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

what are 4 uses of NSAIDs?

A
  • Mild to moderate pain relief
  • Anti-inflammatory
  • Analgesic
  • Anti-pyretic
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2
Q

What is the largest group of drugs having adverse effects?

A

NSAIDs

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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

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4
Q

NSAIDs have sparing effects on what other category of drug?

A

Opioids

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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.

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6
Q

Cyclooxygenase (COX) oxidizes arachidonic acid (AA) to what?

A

Prostaglandins (PGs)

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7
Q

Lipoxygenase (LOX) oxidizes AA to what?

A

Leukotrienes

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8
Q

Are prostaglandins continually synthesized?

A

Yes

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9
Q

Are prostaglandins stored?

A

No

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10
Q

Where do prostaglandins act?

A

Locally at site of production.

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11
Q

T/F: Prostaglandins have only a few physiological functions.

A

False - Prostaglandins have many physiological functions.

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12
Q

What can inhibition of prostaglandins result in?

A

Serious side effects.

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13
Q

What are 2 functions of COX 1?

A
  • Mucosal defense

- Platelet function (TxA2)

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14
Q

What effect does COX 2 have on mucosa?

A

Prevents erosions & promotes healing.

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15
Q

Which COX acts as an anti-inflammatory?

How?

A
  • COX 2

- Inhibits leukocyte adherence

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16
Q

Which COX offers renal protection?

A

COX 2

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17
Q

Which COX is involved with fever initiation?

A

COX 3

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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
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19
Q

T/F: Different drugs inhibit COX 1, 2 & 3 variably.

A

True

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20
Q

Which COX is involved with vicero-nociception and thermal stimulation?

A

COX 1

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21
Q

T/F: COX 1 is involved in constitutive functions with COX 2.

A

True

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22
Q

Which COX is inducible?

A

COX 2

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23
Q

Which COX is up-regulated during inflammatory states?

A

COX 2

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24
Q

There is over a 20 times greater presence of which COX at injured sites?

A

COX 2

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25
Q

Which COX has a key role in nociception?

A

COX 2

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26
Q

What are 2 functions of COX 3?

A
  • Pyrexia

- Analgesia

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27
Q

Does COX 3 have better or poorer anti-inflammatory properties than COX 1 & 2?

A

Poorer

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28
Q

COX 3 is derived from what?

A

COX 1 gene

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29
Q

What are 5 drugs that inhibit both COX 1 & 2?

A
  • Aspirin
  • Phenylbutazone
  • Ketoprofen
  • Ketorolac
  • Flunixin meglumine
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30
Q

What are 5 drugs that are COX 2 preferential and have weak COX 1 inhibition?

A
  • Meloxicam
  • Carprofen
  • Etodolac
  • Vedaprofen
  • Tolfenamic acid
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31
Q

What are 3 drugs that are COX 2 selective?

A
  • Deracoxib
  • Firocoxib
  • Robenacoxib
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32
Q

What are 2 drugs that are COX 3 preferential and have weak COX 1 & 2 inhibition?

A
  • Acetaminophen

- Diclofenac

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33
Q

What is an example of a COX & LOX inhibitor?

A

Tepoxalin

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34
Q

What do prostaglandins mediate?

A
  • Pain

- Inflammation

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35
Q

Prostaglandins have what type of central effects?

A

Central anti-nociceptive effects

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36
Q

Are NSAIDs highly protein bound?

How might this affect other drugs?

A
  • Yes

- May displace other drugs and increase their plasma concentration.

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37
Q

What are 2 concerns with giving NSAIDs?

A
  • Patient with underlying organ dysfunction.

- Patient receiving other highly protein-bound drugs with narrow therapeutic index.

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38
Q

Do NSAIDs have a wide or narrow safety margin?

A

Narrow

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39
Q

Can the upper dose limit be exceeded with NSAIDs?

A

No

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40
Q

What dose of NSAIDs should be used?

A

Lowest effective dose

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41
Q

How much time should be waited in between drugs?

A

Minimum of 7 days

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42
Q

How old do patients have to be for NSAIDs?

A

Over 6 weeks old

43
Q

What should the hydration status be?

A

Well-hydrated

44
Q

What are 3 contraindications for the use of NSAIDs?

A
  • Concern for or evidence of GI ulceration
  • Concurrent corticosteroid use
  • Concurrent administration of other NSAID
45
Q

What type of renal and hepatic function is needed?

46
Q

Surgical preemptive use of NSAIDs should be avoided in what for cases?

A
  • Expected hemorrhage
  • Hypotension
  • Prolonged procedure
  • Any contraindications
47
Q

How long does it take for therapeutic effects of NSAIDs to be seen with post-operative administration?
Does route of administration matter?

A
  • 45 minutes or greater

- No

48
Q

Should NSAIDs be given with food?

49
Q

What should be avoided with NSAIDs?

A

Direct contact with gastric mucosa

50
Q

What are 2 types of surgeries NSAIDs can provide post-operative pain management for?

A
  • Orthopedic surgeries

- Soft tissue surgeries

51
Q

What should NSAIDs be co-administered with for post-operative pain management?

52
Q

What needs to be done with long-term NSAID use?

A

Monitor the patient

53
Q

Are coagulopathies a contraindication for NSAID use?

54
Q

Are breeding/pregnancy a contraindication for NSAID use?

55
Q

What are 2 side effects seen with aspirin?

A
  • GI ulceration

- Decreased platelet activity

56
Q

What formulation does aspirin come in?

57
Q

What type of COX inhibitor is aspirin?

A

Non-selective COX inhibitor (Inhibits 1 & 2)

58
Q

Phenylbutazone is commonly used in what 2 species?

What species is it not recommended in?

A
  • Horses & cattle

- Dogs

59
Q

What are 3 formulations that phenylbutazone comes in?

A
  • Powder
  • Paste
  • Parenteral
60
Q

What is the duration of phenylbutazone?

61
Q

There is a high risk of what 2 side effects with phenylbutazone?

A
  • GI ulceration

- Nephrotoxicity

62
Q

Residues of phenylbutazone are toxic to what species?

Should be avoided in cattle of what age?

A
  • Humans

- Greater than 20 months old

63
Q

What type of COX inhibitor is phenylbutazone?

64
Q

What 2 species is flunixin meglumine used in?

What species in Europe?

A
  • Ruminants
  • Horses
  • Dogs in Europe
65
Q

What is the DOA for flunixin meglumine?

A

12-24 hours

66
Q

What are 4 side effects seen with flunixin meglumine?

A
  • Local swelling
  • GI ulceration
  • Nephrotoxicity
  • Hepatotoxicity
67
Q

What type of COX inhibitor is flunixin meglumine?

68
Q

What species is carprofen widely used in?
What species in Europe?
In UK?

A
  • Dogs
  • Cats
  • Horses
69
Q

What are 2 formulations for carprofen?

A
  • Tablet

- Parenteral

70
Q

What is the DOA of carprofen?

A

12-24 hours

71
Q

What are 4 side effects seen with carprofen?

A
  • Nephrotoxicity
  • Hepatotoxicity
  • GI ulceration
  • Hemostatic deficiencies
72
Q

Hepatotoxicity from carprofen is seen particularly in what dog breed?

73
Q

What type of COX inhibitor is carprofen?

A

COX 2 preferential

74
Q

What are 4 species meloxicam can be used in?

A
  • Dogs
  • Cats
  • Horses
  • Cattle
75
Q

What are 3 formulations for meloxicam?

A
  • Oral liquid
  • OTM spray
  • Parenteral
76
Q

What is the DOA for meloxicam?

A

12-48 hours

77
Q

What are 4 side effects seen with meloxicam?

A
  • Vomiting
  • Diarrhea
  • Increase in liver/kidney enzymes
  • Decrease in appetite
78
Q

What type of COX inhibitor is meloxicam?

A

COX 2 preferential

79
Q

What formulation does deracoxib come in?

80
Q

What is the DOA for deracoxib?

81
Q

What are 5 side effects of deracoxib?

A
  • Vomiting/diarrhea
  • Hematochezia
  • Melena
  • Anorexia
  • Renal issues
82
Q

What type of COX inhibitor is deracoxib?

A

COX 2 selective

83
Q

What formulation does firocoxib come in for dogs?

What 2 forms for horses?

A
  • Dog: tablet

- Horse: paste & parenteral

84
Q

What is the DOA for firocoxib?

85
Q

What are 5 side effects seen with firocoxib?

A
  • Abdominal pain
  • Diarrhea
  • Urticaria
  • PU/PD
  • Renal
86
Q

What type of COX inhibitor is firocoxib?

A

COX 2 selective

87
Q

What 2 formulations does robenacoxib come in?

A
  • Tablet

- Parenteral

88
Q

What is the DOA of robenacoxib?

89
Q

What are 3 side effects seen with robenacoxib?

A
  • Vomiting/diarrhea
  • GI ulceration
  • Renal toxicity
90
Q

What type of COX inhibitor is robenacoxib?

A

COX 2 selective

91
Q

What 2 formulations does acetaminophen come in?

A
  • Tablet

- Oral suspension

92
Q

Is acetaminophen approved for use in veterinary patients?

93
Q

What is the DOA?

94
Q

What species should acetaminophen not be used in?

95
Q

What are 3 side effects seen with acetaminophen?

A
  • Hepatic damage
  • Renal damage
  • GI ulceration
96
Q

What type of COX inhibitor is acetaminophen?

A

COX 3 preferential

97
Q

What species is tepoxalin used in?

98
Q

What formulation does tepoxalin come in?

A

Dissolvable wafer

99
Q

What is the DOA of tepoxalin?

100
Q

Is tepoxalin commercially available?

101
Q

What type of inhibitor is tepoxalin?

A

COX 1, 2 and LOX

102
Q

What does LETD stand for?

A

Locally enhanced topical delivery

103
Q

What is an example of a topical NSAID?

Use?

A
  • Surpass (diclofenac)

- Equine osteoarthritis

104
Q

Are there any ophthalmic topical NSAIDs approved for veterinary use?

Anesthesiology (19 decks)

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