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Anesthesiology > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

What does NSAID stand for?

A

Non-steroidal anti inflammatory analgesic

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2
Q

What are the effects of NSAIDs? (3)

A
  1. Analgesia
  2. Anti-inflammatory
  3. Antipyretic
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3
Q

T/F: NSAIDs have a shorter duration of effect than opioids.

A

False- NSAIDs have a longer duration compared with opioids

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4
Q

Do NSAIDs have a sedative effect?

A

No- opioids do

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5
Q

What are NSAIDs suitable for?

A

Mild to moderate post op pain or management of long term inflammatory pain (arthritis, otitis, cystitis, dermatitis, etc)

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6
Q

Can NSAIDs be combined with other drugs to control pain?

A

Yes- commonly combined with opioids post op for synergistic effect

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7
Q

What is the MOA of NSAIDs?

A

Inhibition of COX enzymes (inflammatory mediators)

Down regulation of inflammatory mediators reduces inflammation and prevents pain

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8
Q

What are the two main types of COX enzymes?

A

COX-1: constitutive

COX-2: inducible

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9
Q

Which COX enzyme is important for normal function of the GIT, platelets, and kidneys?

A

COX-1

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10
Q

Which COX enzyme is produced in response to inflammation and leads to development of pain?

A

COX-2

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11
Q

Which COX enzyme should be selectively managed for relief of pain?

A

COX-2

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12
Q

T/F: The less COX-2 selective the NSAID is, the more side effects are expected to develop.

A

True- down regulation of COX-1 interferes with normal organ function

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13
Q

What is COX-3 and do we care yet?

A

COX-3: identified in CNS of dogs but not humans

Selectively inhibited by acetaminophen

We don’t really care

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14
Q

Do selective COX-2 inhibitors have zero side effects?

A

No, COX-2 does serve some constitutive function and can produce some side effectss

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15
Q

T/F: Inhibition of COX may increase LOX activity.

A

True

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16
Q

T/F: Monitoring effects/side effects of NSAIDs is limited and makes accurate dosing difficult.

A

True- wide range of side effects that can not be accurately monitored

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17
Q

What are some main side effects of NSAIDs?

A
  • GI ulceration, perforation, vomiting, or diarrhea
  • Inhibition of platelet function
  • Renal impairment
  • Hepatotoxicity (carprofen)
  • Impair cartilage synthesis
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18
Q

What is the mechanism for renal damage in NSAID use?

A

With decreased perfusion, PGs mediate vasodilation and keep blood flow and GFR up. NSAIDs inhibit this mechanism

Particularly concerning under anesthesia

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19
Q

Should NSAIDs be given peri or post operatively for best analgesic effect?

A

Peri operatively

20
Q

What is a concern with giving NSAID perioperatively?

A

If excessive bleeding occurs, chances of renal damage are high.

21
Q

Is it safer to give NSAIDs peri or post operatively?

A

Post operatively

22
Q

What is given instead of NSAIDs to provide analgesia during surgeries?

A

Opioids

23
Q

What are contraindications to NSAID use?

A
  • Hypovolemia or hypotension
  • Organ disease (esp kidney)
  • Hemostatic abnormality
  • Pregnancy, lactation, conception
  • Age extremes
  • Concomitant steroid therapy
24
Q

What are suitable NSAIDs for chronic therapy in dogs and cats?

A

Dogs: carprogen, meloxicam, coxibs

Cats: meloxicam

25
Q

T/F: Regular labwork should be performed on animals on chronic NSAIDs.

A

True- monitor potential kidney or liver damage

26
Q

What should chronic NSAID dosages be calculated based on?

A

Lean body weight for the lowest dose necessary and for the shortest possible duration

27
Q

Should NSAID therapy continue in anorexic animals?

A

No

28
Q

Are liquid or pill formulations preferred for cats?

A

Liquid- easier dosing and feeding

29
Q

Do cats metabolize NSAIDs faster or slower compared to other animals?

A

Slower- leads to longer half life and potential for accumulation

30
Q

What does carprofen do and what are it’s adverse side effects?

A

Preferential COX-2 inhibitor

Mainly GI effects, rarely renal damage, fatal hepatotoxicity reported

31
Q

What are the clinical uses for carprofen?

A
  • Perioperative analgesia
  • Chronic therapy for dogs

Not approved for catss

32
Q

What does meloxicam do and are it’s adverse side effects?

A

Preferential COX-2 inhibitor

Similar side effects to carprofen

33
Q

What are the clinical uses for meloxicam?

A

Chronic treatment in cats (injections should only be given once)

Approved for dogs

34
Q

What does robenacoxib (onisor) do and what are it’s adverse side effects?

A

Selective COX-2 inhibitor with minimal side effects

35
Q

What are the clinical uses for robenacoxib?

A

Cats: post op analgesia up to 3 days

Dogs: Post op analgesia, chronic treatment

36
Q

What are the other coxib drugs?

A

Deracoxib and fibrocoxib

Similar to robenacoxib

37
Q

What does phenylbutazone do and what are it’s adverse side effects?

A

Non-selective COX inhibitor

Side effects: GI ulceration, nephrotoxicity, residues toxic to humans

38
Q

What species is phenylbutazone used in?

A

Horses and cattle

No approved for small animals

39
Q

What does flunixin meglumine do and what are it’s adverse side effects?

A

Similar to phenylbutazone

40
Q

What species is flunixin meglumine?

A

Horses and cattle

41
Q

What does ketoprofen do and what are it’s adverse side effects?

A

Non-selective COX inhibitor’

Side effects: hemostatic abnormality, GI effects

42
Q

What species is ketoprofen used for?

A

Horses primarily

Can be used in SA but not best choice

43
Q

What does acetylsalicylic acid (asprin) do and what are it’s adverse side effects?

A

Non-selective COX inhibitor

Side effects: GI and hemostatic abnormailiy COMMON

44
Q

Is acetylsalicylic acid FDA approved for vet med?

A

No

45
Q

What is acetylsalicylic acid used for in vet med?

A

Cheap analgesic in dogs and antithrombotic in cats with HCM

46
Q

What does acetaminophen cause in cats?

A

Methemoglobinemia- can be fatal

47
Q

Is acetaminophen approved for veterinary use?

A

No- do not use

Anesthesiology (27 decks)

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