NSAIDs Flashcards
What does NSAID stand for?
Non-steroidal anti inflammatory analgesic
What are the effects of NSAIDs? (3)
- Analgesia
- Anti-inflammatory
- Antipyretic
T/F: NSAIDs have a shorter duration of effect than opioids.
False- NSAIDs have a longer duration compared with opioids
Do NSAIDs have a sedative effect?
No- opioids do
What are NSAIDs suitable for?
Mild to moderate post op pain or management of long term inflammatory pain (arthritis, otitis, cystitis, dermatitis, etc)
Can NSAIDs be combined with other drugs to control pain?
Yes- commonly combined with opioids post op for synergistic effect
What is the MOA of NSAIDs?
Inhibition of COX enzymes (inflammatory mediators)
Down regulation of inflammatory mediators reduces inflammation and prevents pain
What are the two main types of COX enzymes?
COX-1: constitutive
COX-2: inducible
Which COX enzyme is important for normal function of the GIT, platelets, and kidneys?
COX-1
Which COX enzyme is produced in response to inflammation and leads to development of pain?
COX-2
Which COX enzyme should be selectively managed for relief of pain?
COX-2
T/F: The less COX-2 selective the NSAID is, the more side effects are expected to develop.
True- down regulation of COX-1 interferes with normal organ function
What is COX-3 and do we care yet?
COX-3: identified in CNS of dogs but not humans
Selectively inhibited by acetaminophen
We don’t really care
Do selective COX-2 inhibitors have zero side effects?
No, COX-2 does serve some constitutive function and can produce some side effectss
T/F: Inhibition of COX may increase LOX activity.
True
T/F: Monitoring effects/side effects of NSAIDs is limited and makes accurate dosing difficult.
True- wide range of side effects that can not be accurately monitored
What are some main side effects of NSAIDs?
- GI ulceration, perforation, vomiting, or diarrhea
- Inhibition of platelet function
- Renal impairment
- Hepatotoxicity (carprofen)
- Impair cartilage synthesis
What is the mechanism for renal damage in NSAID use?
With decreased perfusion, PGs mediate vasodilation and keep blood flow and GFR up. NSAIDs inhibit this mechanism
Particularly concerning under anesthesia
Should NSAIDs be given peri or post operatively for best analgesic effect?
Peri operatively
What is a concern with giving NSAID perioperatively?
If excessive bleeding occurs, chances of renal damage are high.
Is it safer to give NSAIDs peri or post operatively?
Post operatively
What is given instead of NSAIDs to provide analgesia during surgeries?
Opioids
What are contraindications to NSAID use?
- Hypovolemia or hypotension
- Organ disease (esp kidney)
- Hemostatic abnormality
- Pregnancy, lactation, conception
- Age extremes
- Concomitant steroid therapy
What are suitable NSAIDs for chronic therapy in dogs and cats?
Dogs: carprogen, meloxicam, coxibs
Cats: meloxicam
T/F: Regular labwork should be performed on animals on chronic NSAIDs.
True- monitor potential kidney or liver damage
What should chronic NSAID dosages be calculated based on?
Lean body weight for the lowest dose necessary and for the shortest possible duration
Should NSAID therapy continue in anorexic animals?
No
Are liquid or pill formulations preferred for cats?
Liquid- easier dosing and feeding
Do cats metabolize NSAIDs faster or slower compared to other animals?
Slower- leads to longer half life and potential for accumulation
What does carprofen do and what are it’s adverse side effects?
Preferential COX-2 inhibitor
Mainly GI effects, rarely renal damage, fatal hepatotoxicity reported
What are the clinical uses for carprofen?
- Perioperative analgesia
- Chronic therapy for dogs
Not approved for catss
What does meloxicam do and are it’s adverse side effects?
Preferential COX-2 inhibitor
Similar side effects to carprofen
What are the clinical uses for meloxicam?
Chronic treatment in cats (injections should only be given once)
Approved for dogs
What does robenacoxib (onisor) do and what are it’s adverse side effects?
Selective COX-2 inhibitor with minimal side effects
What are the clinical uses for robenacoxib?
Cats: post op analgesia up to 3 days
Dogs: Post op analgesia, chronic treatment
What are the other coxib drugs?
Deracoxib and fibrocoxib
Similar to robenacoxib
What does phenylbutazone do and what are it’s adverse side effects?
Non-selective COX inhibitor
Side effects: GI ulceration, nephrotoxicity, residues toxic to humans
What species is phenylbutazone used in?
Horses and cattle
No approved for small animals
What does flunixin meglumine do and what are it’s adverse side effects?
Similar to phenylbutazone
What species is flunixin meglumine?
Horses and cattle
What does ketoprofen do and what are it’s adverse side effects?
Non-selective COX inhibitor’
Side effects: hemostatic abnormality, GI effects
What species is ketoprofen used for?
Horses primarily
Can be used in SA but not best choice
What does acetylsalicylic acid (asprin) do and what are it’s adverse side effects?
Non-selective COX inhibitor
Side effects: GI and hemostatic abnormailiy COMMON
Is acetylsalicylic acid FDA approved for vet med?
No
What is acetylsalicylic acid used for in vet med?
Cheap analgesic in dogs and antithrombotic in cats with HCM
What does acetaminophen cause in cats?
Methemoglobinemia- can be fatal
Is acetaminophen approved for veterinary use?
No- do not use
