NSAIDs

Question 1

reversible inhibitor of COX1/2

Answer 1

Ibuprofen (tNSAID)

Question 2

should be avoided in hepatic dysfucnction?

Answer 2

acetaminophen

Question 3

COX-1 inhibitor side effects (3)

Answer 3

GI ulceration
Bleeding
Renal dysfunction

Question 4

COX-2 inhibitor side effects (2)

Answer 4

renal dysfunction
delayed labor
increased thrombosis (endothelial cells)

Question 5

Safest otc med for pain in patients with ulcers?

Answer 5

acetaminophen (cox1/2 irreveresible)

celebrex is not otc

Question 6

safest treatment for patients taking oral anticoagulants

Answer 6

acetaminophen

Question 7

lowest GI risk NSAID?

Answer 7

Ibuprofen (antiCOX2>COX1)

Question 8

lowest CV risk NSAID?

Answer 8

Naproxen (antiCOX1>COX2)

Question 9

Celecoxib side effects? (celebrex)

Answer 9

reduce PGI2 antithrombic effect (COX2 mediated) so increased risk of clots

Question 10

best treatment for patient non-responsive to acetaminophen who has significant CV risk?

Answer 10

naproxen with omeprezole

Question 11

greater cox-2 activity means

Answer 11

increased CVS risk

ibuprofen>naproxen

Question 12

greater relative cox-1 activity means

Answer 12

increased GI risk

naproxen>ibuprofen>celebrex

Question 13

what is the potentially biggest danger of celebrex?

Answer 13

sulfonamide sensitivity

Question 14

what is the primary reason for making drugs that selectively inhibit COX2?

Answer 14

lower the risk of GI toxicity associated with cox-1 agents

Question 15

what makes acetaminophen unique from other NSAIDs?

Answer 15

no anti-inflmmatory effect (only works in CNS)

Question 16

Why acetaminophen no anti-inflammatory effect?

Answer 16

peroxide formation inhibits activity at site of inflammation

Question 17

major concern of acetaminophen?

Answer 17

hepatotoxicity

-

Question 18

treatment overdose acetaminophen?

Answer 18

n-acetylcysteine -

Question 19

safest drug to treat msk pain in patients with kidney dysfunction?

Answer 19

actaminophen

Question 20

relative to ibuprofen, agents that inhibit cox2 preferentially over cox1 will cause higher incidence of?

Answer 20

clotting related disorders

Question 21

aspirin clinical use

Answer 21

pain of inflammatory origin
antiplatelet effects
high dose –> anti-inflammatory

Question 22

aspirin at low dose?

Answer 22

cox1 selective –> decreased tendency for clotting

Question 23

tinnitis associated wtih mild ________ toxicity?

Answer 23

aspirin

Question 24

aspirin anti-platelet effect via?

Answer 24

TXA2

Question 25

severe aspirin toxicity (3)

Answer 25

hyperthermia
metabolic acidosis
coma

Question 26

Fever?

Answer 26

COX-2

Question 27

Inflammation?

Answer 27

COX-2

Question 28

Protection of GI?

Answer 28

COX-1

Question 29

Vasodilation of kidney?

Answer 29

COX-1 and COX-2

Question 30

Activation of platelet aggregation

Answer 30

COX-1

Question 31

Contraction of uterine SM

Answer 31

COX-2

Question 32

Opening of DA?

Answer 32

COX-2

Question 33

What is Ketorolac?

Answer 33

tNSAID (rev cox1/2) in IM/IV

Question 34

Dyspepsia and gastric ulceration is a concern with NSAID (COX1) what can we do to help?

Answer 34

PPIs omeprazoel

Question 35

Why are we concerned for patients with bleeding disorders when taking NSAIDs?

Answer 35

Reversible COX1/2
COX-1 inhibition - inhibits platelet aggregation (but only for 2 days)
COX-2 inhibition - inhibits endothelial anti-platelet aggregation –> increased clot
balance between the two

if taking aspiring - take NSAID 1 HOUR later