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Pharm 4 > NSAIDS > Flashcards

NSAIDS Flashcards

1
Q

What are the clinical features of inflammation?

A

Swelling, redness, pain & heat

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2
Q

What is the enzyme that breaks down phospholipids?

A

Phospholipase

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3
Q

What is Phospholipids broken down to?

A

Arachidonic acid

  • -> Leukotriene
  • -> Prostaglandins
  • -> Thromboxane
  • -> Prostacyclin
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4
Q

What are Prostaglandins (PGE2) responsible for?

A

Uterine contraction
Vasodilation- contraction of GI smooth muscles
Inhibition of gastric acid secretion

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5
Q

What are Thromboxane responsible for?

A

Platelet aggregation

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6
Q

What are Prostacyclins (PGI2) responsible for?

A

Inhibits platelet aggregation
Vasodilation
Gastric xytoprotection

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7
Q

What are Leukotrienes responsible for?

A

Chemotaxis
Hyperalgesia (hyper sensitivity to pain)
Broncho-constricion
Edema

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8
Q

What condition would your body produce a lot of Leukotrienes for? Specifically LTC4, LTD 4, LTE4

A

Asthma

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9
Q

How to corticosteroids work?

A

Work on Cyclo-oxygenase, shutting off the Cox 1 & Cox 2 pathways

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10
Q

Is Acetominophen (tylenol) an NSAID?

A

NO!

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11
Q

Is Aspirin an NSAID?

A

YES!

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12
Q

What is also known as the Constitutive pathway?

A

COX 1

Because it will always be there

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13
Q

What is know as the inducible pathway?

A

COX 2

Because this is not always available, you have to turn this on when needed.

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14
Q

Why would you not want COX 2 to always be on?

A

Because It makes you more sensitive to pain, so only turn on when needed

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15
Q

What do NSAIDs inhibit?

A

COX 1 & COX 2 pathways

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16
Q

Where is Prostacycline (PGI2) located?

A

Vascular endothelium

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17
Q

Where is the Cyclooxygenase (COX) pathway located?

A

Endoplastmatic reticulum

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18
Q

What are the 3 Isoforms of COX?

A 
COX 1 (constitutive) -->Pysiological conditions
COX 2 (Inducible) ---> inflammation, pain
COX 3 --> Brain
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19
Q

Are NSAIDs selective or nonselective COX inhibitors?

A

NON selective

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20
Q

What is Acetylsalicylic acid?

A

Aspirin

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21
Q

What are some examples of Nonselective COX 1/COX 2 inhibitors?

A 
Acetylsalicylic acid
Diclofenac
Indomethacin
Sulindac
Piroxicam
Piroxicam beta-cyclodextrin (prodrug)
Lornoxicam
Tenoxicam
Flurbiprofen
Ibuprofen
Ketoprofen
Naproxen
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22
Q

What are the benefits of NSAIDs?

A
  • Analgesia–> Prevents pain
  • Antipyresis–> reduces body temp
  • Reduces inflammation
  • Anti-thrombotic action–> in low doses prevents clotting/platelet aggregation
  • Closes the Patent Ductus Arteriosus (Indomethacin)
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23
Q

What are some side effects of NSAIDs?

A 
Gastric mucosal damage
Bleeding
Decreased renal flow
Delay/prolonged labor/contractions
Asthma/anaphylaxis
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24
Q

What is a direct result of NSAID use that can cause ulcers

A

Direct toxicity “Ion trapping”

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25
Q

What are the 2 compounds that Aspirin splits into when metabolized?

A

Acetic Acid

Salicylate

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26
Q

What happens to the Aspirin metabolites if oxidized?

A

Can become Gentisic Acid

27
Q

What happens to the Aspirin metabolites if conjugated with glycine?

A

Become Salicyluric acid

28
Q

What are some risks of Aspirin in children with rheumatoid arthritis?

A

Hepatic encephalopathy (Reyes Syndrome)

29
Q

What is the lower age limit for Aspirin?

A

Under 15, unless specifically indicated for Juvenile arthritis

30
Q

What is an effect of being on chronic Aspirin?

A

Thinning of blood, increased risked of hemorrhagic stroke

31
Q

What happens in an Aspirin OD?

A 
Fever
N/V
Decreased urination
Diplopia
Restlessness/irritability
Dizzy/confused
LOC, impaired cognition
Drowsy
Hallucinations
32
Q

What is the interaction of ACE inhibitors with NSAIDs?

A

Decreases the affect of ACE (decrease antiHTN effect)

33
Q

What is the interaction of Cyclosporine with NSAIDs?

A

Increased Nephrotoxicty

34
Q

What is another name for Ibuprofen?

A

Advil

35
Q

What is Ibuprofen a derivative of?

A

Phenylpropionic acid

36
Q

How is oral Ibuprofen usually prescribed?

A

In a low dose b/c is has anlagesic but not anti-inflammatory effects

37
Q

What would a liquid gel preparation of Ibuprofen be used for?

A

Postsurgical dental pain

38
Q

What are some difference between Ibuprofen and Indomethocin?

A

Ibuprofen decreases urine output and causes less fluid retention

39
Q

Are NSAIDs useful in closing the ductus arteriosus in preterm infants?

A

YES

40
Q

What is Ketoprofen used for?

A

RA
Osteoarthritis
Gout
Dysmenorrhea

41
Q

What is Indomthacin used for?

A 
Juvenile rheumatoid arthritis
Gout
Ankylosing spondylitis
Postepisiotomy pain
Treats patent ductus arteriosus
reduces conjunctival inflammation 
Reduces pain after traumatic corneal abrasion
Gingival inflammation
42
Q

What are the side effects of Indomethacin?

A 
GI and CNS side effects --> At high doses
GI bleeding
Diarrhea
Frontal headache
Mental confusion
43
Q

What is Diclofenac used for>?

A 
Prophylaxis for postoperative ophthalmic inflammation
Intra-ocular lens implantation
Strabismus surgery
Solar Keratoses
Analgesia
Postoperative Nausea
44
Q

What are the AEs of Diclofenac?

A

GI distress
Occult bleeding
Gastric ulceration

45
Q

What happens when you combine Diclofenac and Misoprostol?

A

Decreases upper GI ulceration or Diarrhea

46
Q

What are the indications for Piroxicam?

A

Rheumatic indications

47
Q

What happens when Prioxicam is given at high doses?

A

Increases risk of peptic ulcer & bleeding (10x higher risk)

48
Q

What is the MOA of Piroxicam?

A

A non-selective COX-1/COX-2 inhibitor inhibits polymorphonuclear leukocyte migration

It decreases oxygen radical
production, and inhibits lymphocyte function

49
Q

What is the MOA of Indomethacin?

A

Non-selective COX inhibitor
It can inhibit phospholipase A and C, reduce
neutrophil migration, and decrease T cell and B cell
proliferation

50
Q

What are some examples of COX 2 inhibitors?

A

Celecoxib
Meloxicam
Nabumetone

51
Q

Which of the 3 COX 2 inhibitors is preferentially selective instead of highly selective?

A

Meloxicam

52
Q

What is the main risk with COX 2 inhibitors?

A

Infertility

Prothrombotic cardiovascular risk

53
Q

What is the DOC for Acute rheumatic fever?

A

Aspirin

54
Q

Which med is as effective as other NSAIDs in the
treatment of rheumatoid arthritis and osteoarthritis,
and in trials it has caused fewer endoscopic ulcers
than most other NSAIDs, probably because it is a sulfonamide?

A

Celecoxib

55
Q

What makes Acetominophen different Aspirin?

A

It is not an anti-inflammatory

56
Q

What is the preferred drug for patients who are allergic to Aspirins or Salicylates?

A

Acetomoniphen

57
Q

What is Acetominophen used for?

A

Mild to moderate pain –> HA, myalgia, postpartum pain

58
Q

Would you give Aspirin or Acetominophen to a child with a viral infection?

A

Acetominophen

59
Q

What are the AEs of Acetominophen?

A

Acute acetaminophen poisoning
Hepatic toxicity
Nephrotoxicity

60
Q

What would you used to an alcoholic with side effects from Acetominophen?

A

Activated charcoal

61
Q

What meds would you give for an acute Gout attack?

A 
Colchicine PLUS pain reliever -->
Diclofenac
Indomethacin
Naproxen
Piroxiam
62
Q

What meds would you give for chronic Gout?

A

Uricostatics (Xantine Oxidase inhibitors)
Allopurinol (DOC)
Febuxostat

Uricosurics
Probenecid, benzbromarone
Sulfinpyrazone

Uricolytics: Uricase, Rasburicase

63
Q

What is a combo drug that could be used for Gout?

A

Harpagin (allopurinol & benzbromarone)

Pharm 4 (4 decks)

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