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Pharm III > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

what do NSAIDs do to the body

A

reduce inflammation by decreasing production of prostaglandins, prostacyclin, and thromboxane in CNS and periphery

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2
Q

MOA of NSAIDs

A

inhibit COX (needed to make PG)

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3
Q

what does COX1 enzyme do?

A

makes PG for routine maintenance (protect stomach mucosa, regulate blood flow to kidneys, allow normal platelet fxn)

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4
Q

what does COX2 enzyme do?

A

activated by inflammation

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5
Q

GI SE of NSAIDs

A

GI upset

ulcerations (increase gastric acids)

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6
Q

what groups are at increased risk of GI complications from NSAIDs?

A

Hx of ulcers
high dose NSAIDs
anticoagulants
steroids

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7
Q

CVS SE of NSAIDs?

A 
increase BP (8-10mmHg)
fluid/salt retention
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8
Q

BB warning for NSAIDs?

A

increased risk of MI & thrombotic events

increases with duration of use

greater risk if other CVD risk factors (increased risk of death or repeat attack w/in 5 years after MI)

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9
Q

liver monitoring/SE of NSAIDs?

A

hepatotoxicity

monitor LFTs for 1st 6 month q2-4 weeks

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10
Q

least hepatotoxic NSAID

A

ibuprofen

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11
Q

allergies to NSAIDs?

A

angioedema (10%): complement activated due to decreased Pg
(avoid ALL NSAIDs)

increased asthma (nasal polyps and Hx of asthma) Try to avoid regular NSAIDs

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12
Q

blood effects by NSAIDs

A

anticoagulants
ASA lasts 8-10 days
nonacetylated salicylates: no effect

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13
Q

liver effects of NSAIDs

A

acute renal failure or increased SCr because no PG means less blood flow to kidneys

don’t give to people with poor kidney function

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14
Q

CNS affects of NSAIDs?

A

HA (increased with tolmetin & indomethacin)

confusion (old ppl)

aseptic meningitis (increased with ibuprofen)

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15
Q

drug interactions of NSAIDs

A

diuretics, ACEI, ARBs (effectiveness)

ACEI & ARBs (hyperkalemia)

SSRIs (PUD)

Clopidogrel, warfarin, and heparins (PUD & GI bleed, perforations)

  • increases in elderly
  • don’t give NSAIDs to these patients
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16
Q

peak plasma feel of ASA?

A

1-2 hours

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17
Q

Doses of aspirin?

A

mild/mod: 325-650 q4 (4g)

high for arthritis: 650 q4 (5.4g)

unstable angina, TIAs, MIs, CABG: 81mg

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18
Q

ASA SE?

A

fecal blood loss (tsp/dose)

salicylism

hyperpnea (resp. alkalosis)

19
Q

what is salicylism?

A

caused by high doses of ASA

vomitting
tinnitus
decreased hearing
vertigo

20
Q

antidote for hyperpnea caused by ASA?

A

stomach irrigation
IV fluids
SODIUM BICARB
dialysis (last resort)

21
Q

which is a more effective COX inhibitor: ASA or Nonacetylated salicylates?

A

ASA

so nonacetylated salicylate help less with inflammation

22
Q

should you use nonacetylated salicylates to anticoagulate?

A

No, use them when you DONT want increased risk of bleeding or asthma

23
Q

SE of celecoxib?

A

sulfa allergy

increased risk of thrombosis, MI, stroke with prolonged use due to inhibition of PG synthesis in vascular endothelium
(higher if known CV risk)

24
Q

benefits of celecoxib?

A

fewer ulcers

25
Q

benefits of meloxicam?

A

less GI upset
no platlet inhibition
less bleeding

26
Q

which drugs have antipyretic, anti-inflammatory, and analgesic effects?

A

COX2 inhibitors
ASA
NSAIDs

Exceptions:
- Ketorolac: not for inflammation

27
Q

max dose of toradol? use?

A

40 mg IM/d for 5 days or less (Due to risk of ulcers)

migraine
labor
delivery
drug addict
respiratory depression (COPD)
28
Q

NSAIDs with long half life (1x daily dosing)

A

oxaprozin
piroxicam
nabumetone

29
Q

when to switch NSAIDs when you see no effect? when you see some effect?

A

no effect: 2 weeks (or increase dose)

chronic dz/some effects at 2 weeks: 6 weeks to 2 months

30
Q

who should avoid NSAIDs?

A 
CHF
renal failure
active PUD
steroids
uncontrolled HTN
steroids?
anticoagulants?
31
Q

when to check BP with Hx of HTN on NSAIDs?

A

before starting
2 weeks after starting
(>10mmHG increase change NSAID or give more BP meds)

32
Q

PUD risk factors and treatment for pain?

A

risk factors: >70 yo, Hx of ulcers, on many NSAIDs

Tx:
celecoxib
OR
NSAID with PPI or misoprostol

33
Q

who needs SCr rechecked when starting NSAIDs? when?

A

pt on diuretic or ACEI

307 days after starting

34
Q

which of the following does acetaminophen not treat: inflammation, coagulation, fever, pain? when does it peak?

A

inflammation & coagulation (no platelet effects)

onset: 30-60 minutes

35
Q

who gets a dose less than 3 grams of APAP?

A

elderly
hepatic dysfunction
alcoholics

36
Q

MOA of acetaminophen?

A

inhibits PG synthesis in CNS

inhibits heat regulating center in hypothalamus

37
Q

Low dose & high dose effects of APAP?

A

low: mild elevation in LFTs
high: dizziness, excitement, disorientation

38
Q

when is APAP favored over NSAIDs and ASA?

A

GI upset
ulcer
child with virus (risk of Reyes)
bleeding disorder

39
Q

MOA of capsaicin

A

releases substance P, than stimulates nerve to deplete substance P which decreases pain

40
Q

SE of capsaicin?

A

erythema

blisters

41
Q

what does capsaicin work best for?

A

post-herpetic neuralgia & arthritis

42
Q

how long does it take lidocaine to work? what is lidocaine/prilocaine mainly used for?

A

20-30 minutes

used in children to decrease pain before IV & circumcisions

43
Q

mild to moderate cancer pain treatment?

A

NSAIDs & narcotics

Pharm III (5 decks)

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