NSAIDs

Question 1

Where do COX I and COX II have their effects?

Answer 1

COX I – stomach

COX II – periphery

Question 2

What do NSAIDs block the release of?

Answer 2

Prostaglandins (PGG II)

Question 3

What is a risk of inhibition of the COX pathway?

Answer 3

Shunting to lipoxygenase pathway causing increased allergic reactions

Question 4

List five indications for NSAID use

Answer 4

Arthritis, gout, headache, pain syndromes, chemo

Question 5

State three mechanisms of action of NSAIDs

Answer 5

Anti-inflammatory, antipyretic, analgesic

Question 6

Which arachidonic acid conversion pathway do NSAIDs block?

Answer 6

COX I and II conversion

Question 7

Explain the difference between the effect of NSAIDs and aspirin on platelets

Answer 7

NSAIDs briefly inhibit Cyclooxygenase activity, aspirin irreversibly inhibits activity

Question 8

How is acetaminophen different from NSAIDs?

Answer 8

Acts primarily in hypothalamus to reduce prostaglandin production – Limited anti-inflammatory activity and no anticoagulation

Question 9

How do leukotriene antagonists work?

Answer 9

Block LT receptors which mediate allergic/inflammatory reactions

Question 10

Where do leukotriene antagonists have most of their effect?

Answer 10

On pulmonary system

Question 11

How do corticosteroids work?

Answer 11

Bind receptors in cytoplasm, translocate to nucleus where they module genes encoding for inflammatory cytokines and interleukins

Question 12

What medicine should be given to a newborn with a PDA?

Answer 12

NSAIDs

Question 13

List cautions for NSAIDs

Answer 13

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)

Question 14

What drug can cause Rye Syndrome, and what are the signs?

Answer 14

Aspirin – in children under 16 with Varicella/flu symptoms (can cause encephalitis and seizures, death)

Question 15

What are three signs of ASA syndrome?

Answer 15

Asthma, angioedema, nasal polyps

Question 16

Which drug should be avoided in patients with tartrazine dye allergy?

Answer 16

Aspirin

Question 17

Which condition does aspirin treat at high doses but exacerbate at low doses?

Answer 17

Gout

Question 18

Why must aspirin be used cautiously in patients with PUD?

Answer 18

Causes reduction of mucus blood flow, anticoagulation, high acidity-all exacerbating PUD

Question 19

List symptoms of an aspirin overdose

Answer 19

Tinnitus, headache, metabolic acidosis, can be fatal

Question 20

What is used for reference in treatment of aspirin overdose?

Answer 20

Done nomogram

Question 21

Why does aspirin overdose cause tinnitus?

Answer 21

Causes buildup of arachidonic acid, which is toxic to auditory nerve

Question 22

What is buffered aspirin?

Answer 22

Less harsh on stomach – coated with film that dissolves in basic media like duodenum or jejunum

Question 23

What is nabumetone?

Answer 23

NSAID causing least amount of G.I. distress (Nonacidic)

Question 24

What is oxaprozin?

Answer 24

NSAID with QD dosing

Question 25

What is Arthrotec comprised of?

Answer 25

Diclofenac and misoprostol (an NSAID and a prostaglandin)

Question 26

What is an adverse effect of indomethacin?

Answer 26

Severe frontal lobe headache

Question 27

Which NSAID is the safest to use in renal impairment?

Answer 27

Sulindac

Question 28

Which instead has the longest half life? (40-50 hours)

Answer 28

Piroxicam – should be avoided in elderly patients

Question 29

Which nonselective NSAID is the most selective of COX II?

Answer 29

Meloxicam (Mobic)

Question 30

Name the only approved IV antipyretic

Answer 30

Ibuprofen

Question 31

Name the drug used for PDA in infants?

Answer 31

``` Ibuprofen lysine (NeoProfen) Indomethacin can also be used to treat PDA ```

Question 32

What is Caldolor?

Answer 32

The adjunct to opioid analgesia and antipyretic (IV)

Question 33

What is the only IM NSAID?

Answer 33

Ketorlac (Toradol)

Question 34

Why is five days the max therapy for Toradol?

Answer 34

Renal and G.I. toxicity

Question 35

Name the only approved COX II specific NSAID on the market

Answer 35

Celebrex

Question 36

What drug does Celebrex have cross reactivity potential with?

Answer 36

Sulfa drugs

Question 37

Which three NSAIDs are best for patients with G.I. upset?

Answer 37

Celebrex, Nabumetone, meloxicam

Question 38

Why have several COX II inhibitors been taken off the market?

Answer 38

Linked to cardiovascular events (MI and stroke)

Question 39

Which NSAIDs have inhibitory effects on angiogenesis, and procoagulant effects?

Answer 39

COX II inhibitors

Question 40

Why could COX II inhibitors be used as adjuncts to chemotherapy?

Answer 40

Prevent angiogenesis – no blood supply to tumors

Question 41

What is acetaminophen?

Answer 41

Active metabolite of phenacetin, CNS specific for pain, headache, fever treatment

Question 42

What is used for reference in treatment of acetaminophen overdose?

Answer 42

Rumack–Matthew nomogram

Question 43

Name an interaction of acetaminophen

Answer 43

Ethanol – causes pronounced hepatotoxicity

Question 44

What is the antidote to acetaminophen overdose?

Answer 44

N-acetylcysteine (NAC)

Question 45

Describe NAC uses

Answer 45

Mucolytic in CF (Mucomyst), potent antioxidant – nephroprotective from contrast dye toxicity Con – smells like rotten eggs