NSAIDs Flashcards
Where do COX I and COX II have their effects?
COX I – stomach
COX II – periphery
What do NSAIDs block the release of?
Prostaglandins (PGG II)
What is a risk of inhibition of the COX pathway?
Shunting to lipoxygenase pathway causing increased allergic reactions
List five indications for NSAID use
Arthritis, gout, headache, pain syndromes, chemo
State three mechanisms of action of NSAIDs
Anti-inflammatory, antipyretic, analgesic
Which arachidonic acid conversion pathway do NSAIDs block?
COX I and II conversion
Explain the difference between the effect of NSAIDs and aspirin on platelets
NSAIDs briefly inhibit Cyclooxygenase activity, aspirin irreversibly inhibits activity
How is acetaminophen different from NSAIDs?
Acts primarily in hypothalamus to reduce prostaglandin production – Limited anti-inflammatory activity and no anticoagulation
How do leukotriene antagonists work?
Block LT receptors which mediate allergic/inflammatory reactions
Where do leukotriene antagonists have most of their effect?
On pulmonary system
How do corticosteroids work?
Bind receptors in cytoplasm, translocate to nucleus where they module genes encoding for inflammatory cytokines and interleukins
What medicine should be given to a newborn with a PDA?
NSAIDs
List cautions for NSAIDs
Renal disease (patency of renal arteriole), highly protein bound, avoid alcohol (G.I. toxicity), monitor guaiac stools, those with asthma (increased leukotrienes), and pregnancy (patent ductus arteriosus)
What drug can cause Rye Syndrome, and what are the signs?
Aspirin – in children under 16 with Varicella/flu symptoms (can cause encephalitis and seizures, death)
What are three signs of ASA syndrome?
Asthma, angioedema, nasal polyps
Which drug should be avoided in patients with tartrazine dye allergy?
Aspirin
Which condition does aspirin treat at high doses but exacerbate at low doses?
Gout
Why must aspirin be used cautiously in patients with PUD?
Causes reduction of mucus blood flow, anticoagulation, high acidity-all exacerbating PUD
List symptoms of an aspirin overdose
Tinnitus, headache, metabolic acidosis, can be fatal
What is used for reference in treatment of aspirin overdose?
Done nomogram
Why does aspirin overdose cause tinnitus?
Causes buildup of arachidonic acid, which is toxic to auditory nerve
What is buffered aspirin?
Less harsh on stomach – coated with film that dissolves in basic media like duodenum or jejunum
What is nabumetone?
NSAID causing least amount of G.I. distress (Nonacidic)
What is oxaprozin?
NSAID with QD dosing
What is Arthrotec comprised of?
Diclofenac and misoprostol (an NSAID and a prostaglandin)
What is an adverse effect of indomethacin?
Severe frontal lobe headache
Which NSAID is the safest to use in renal impairment?
Sulindac
Which instead has the longest half life? (40-50 hours)
Piroxicam – should be avoided in elderly patients
Which nonselective NSAID is the most selective of COX II?
Meloxicam (Mobic)
Name the only approved IV antipyretic
Ibuprofen
Name the drug used for PDA in infants?
Ibuprofen lysine (NeoProfen) Indomethacin can also be used to treat PDA
What is Caldolor?
The adjunct to opioid analgesia and antipyretic (IV)
What is the only IM NSAID?
Ketorlac (Toradol)
Why is five days the max therapy for Toradol?
Renal and G.I. toxicity
Name the only approved COX II specific NSAID on the market
Celebrex
What drug does Celebrex have cross reactivity potential with?
Sulfa drugs
Which three NSAIDs are best for patients with G.I. upset?
Celebrex, Nabumetone, meloxicam
Why have several COX II inhibitors been taken off the market?
Linked to cardiovascular events (MI and stroke)
Which NSAIDs have inhibitory effects on angiogenesis, and procoagulant effects?
COX II inhibitors
Why could COX II inhibitors be used as adjuncts to chemotherapy?
Prevent angiogenesis – no blood supply to tumors
What is acetaminophen?
Active metabolite of phenacetin, CNS specific for pain, headache, fever treatment
What is used for reference in treatment of acetaminophen overdose?
Rumack–Matthew nomogram
Name an interaction of acetaminophen
Ethanol – causes pronounced hepatotoxicity
What is the antidote to acetaminophen overdose?
N-acetylcysteine (NAC)
Describe NAC uses
Mucolytic in CF (Mucomyst),
potent antioxidant – nephroprotective from contrast dye toxicity
Con – smells like rotten eggs
