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Disease and Defense > NSAIDS > Flashcards

NSAIDS Flashcards

1
Q

reversible inhibition of COX-1 and -2

A

tNSAIDS

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2
Q

reversible inhibition of COX-2

A

COX-2 selective drugs

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3
Q

inhibition of COX-2 in CNS

A

acetaminophen

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4
Q

irreversible inhibition of COX-1 and -2

A

acetyl salicylic acid (aspirin)

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5
Q

contraindications for tNSAIDS

A

GI-related: PUD, advanced age, concurrent glucocorticoid anti-inflammatory use (risk for GI ulceration)

Platelet-related: taking anticoagulants (risk for bleeding)

Kidney-related: HTN, DM, CKD, HF (risk for acute renal failure)

Pregnancy (especially third trimester)

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6
Q

risks/contraindications for COX-2 selective Celecoxib?

A

Platelet-related: increased risk of clotting

CV-related: increased risk of ischemic CVD and HF

Kidney-related: Chronic renal insufficiency, severe heart disease (risk for acute renal failure)

Pregnancy

Sulfa allergy

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7
Q

would you use acetaminophen for rheumatoid arthritis?

A

no because it isn’t anti-inflammatory

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8
Q

What is the best drug to use for dysmenorrhea?

A

Ibuprofen or naproxen (tNSAIDs), because of their inhibition of endometrial prostaglandin

Celecoxib also used for this

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9
Q

Which drug(s) is best for fever?

A

ASA, ACET and tNSAIDs are equal

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10
Q

Which drug(s) is best for pain relief?

A

tNSAIDs

all drugs analgesic (ASA most limited) but tNSAIDs most effective

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11
Q

Which drug(s) is best for inflammation?

A

tNSAIDs, COX-2 selective, ASA are equal

NOT ACET

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12
Q

Which tNSAIDs would you use if worried about liver function?

A

naproxen, ketorolac, indomethacin, nabumetone

not metabolized by liver

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13
Q

Among the tNSAIDS, which drugs pose the highest and lowest risks for GI complications?

A

highest, naproxen; lowest, ibuprofen

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14
Q

Among the tNSAIDS, which drugs pose the highest and lowest risks for cardiovascular complications?

A

highest, ibuprofen (+ celecoxib); lowest, naproxen

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15
Q

Which NSAID would be best for a patient in need of continuous pain management with a history of peptic ulcer disease?

A

Celecoxib

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16
Q

Which NSAID would be best for a patient in need of continuous pain management with a positive history for prior GI bleeding?

A

Celecoxib

17
Q

Which drug can be prescribed along with an NSAID to reduce the risk of GI complications?

A

A PPI (omeprazole)

18
Q

Which NSAID would be best for a patient in need of acute, short-term pain management positive for a history of GI issues (ulcers, bleeds, dypepsia)?

A

Ibuprofen

tNSAIDs for short-term use shouldn’t cause GI side effects

19
Q

Most effective but least well-tolerated of the tNSAIDs

A

Indomethacin

20
Q

When would you use indomethacin?

A

For patients with arthritic conditions that are unresponsive other pain regimens

21
Q

How long do the antithrombotic effects of aspirin last?

A

Lifespan of the platelet (4-7 days), as it is an irreversible inhibitor of COX-1 and -2

22
Q

Overdose of which drugs is most likely to lead to renal failure?

A

tNSAIDs

23
Q

Overdose of which drugs is most likely to lead to liver failure?

A

acetaminophen

24
Q

Overdose of which drugs is most likely to lead to hyperthermia and acidosis?

A

aspirin

25
Q

Which drug is best for antithrombosis?

A

aspirin

26
Q

What are the contraindications for taking acetaminophen?

A

NO contraindications related to GI or renal complications, pregnancy (as long as in short-term therapeutic doses)

Liver-related: alcoholism (huge risk for liver failure with acetaminophen [most common cause for acute liver failure in the US])

27
Q

What is the maximal safe dose of acetaminophen?

A

no more than 4 g (4000 mg) per 24 hours

28
Q

Which drug is best for pregnant women?

A

acetaminophen

29
Q

What type of pain is aspirin most and least effective for?

A

Most effective for pain of inflammatory origin (muscular, dental, postpartum)

Least effective for pain of visceral origin (MI, abdominal, colic)

30
Q

What dosing levels of NSAIDs are required for effectiveness at each parameter?

A

low doses(of ASA) for antithrombotic effects

intermediate doses for analgesic and antipyretic effects

high doses for anti-inflammatory effects

31
Q

Which drug is used as initial therapy for inflammatory joing conditions?

A

aspirin

32
Q

Which drugs are seemingly opposite in their effect on clotting?

A

aspirin and celecoxib

aspirin has more of an effect on TXA2 synthesis and therefore decreases platelet aggregation.

celecoxib has more of an effect on PGI2 and therefore increases platelet aggregation.

33
Q

Which drug is eliminated (in high doses) by zero-order kinetics?

A

aspirin

34
Q

Which drug is eliminated by phase II metabolism at therapeutic doses but phase I metabolism at saturating doses?

A

acetaminophen

Note: product of phase 1 metabolism is hepatotoxic

35
Q

Taking which drug along with NSAIDs would increase a patients hemorrhage risk?

A

Warfarin (heparin)

36
Q

Taking which drug along with NSAIDs would increase risk of gastric irritation?

A

Alcohol

37
Q

contraindications for taking aspirin

A

Reyes syndrome

asthma

pregnancy

Disease and Defense (3 decks)

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