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Pharmacology exam 2 > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

What three things do NSAIDs treat?

A

Inflammation
Pain
Fever

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2
Q

Three types of NSAIDs

A

Aspirin/salicylates
Traditional NSAIDs
COX-2 specific inhibitors

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3
Q

Mechanism of action for NSAIDs

A

Inhibition of COX activity by preventing the production of prostaglandins

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4
Q

Are traditional NSAIDs selective?

A

No. They will bind both COX-1 and COX-2

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5
Q

How do NSAIDs inhibit COX enzymes?

A

Preventing the binding of the arachidonic acid substrate

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6
Q

Describe aspirin’s mechanism of action.

A

It covalently attaches an acetyl group to the active site of COX enzymes, irreversibly inhibiting COX-1 activity.

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7
Q

What is the difference between COX-1 and COX-2 inactivation with aspirin?

A

The active site of COX-2 is larger and more flexible, so arachidonic acid can still gain access to the active site. Less potent inhibitor of COX-2 than COX-1.

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8
Q

COX-1 is expressed how, and involved in what?

A

Constitutively expressed; involved in housekeeping functions

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9
Q

COX-2 is expressed where, and involved in what?

A

Mostly in macrophages, synoviocytes, and fibroblasts - is involved in the pro-inflammatory response.

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10
Q

Where is COX-2 constitutively expressed?

A

Kidney, brain, and endothelium.

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11
Q

Describe the effects of low-dose aspirin.

A

Effective anti-thrombotic agent because it pretty much exclusively effects the platelets since they cannot resynthesize their COX-1, but it is easily resynthesized elsewhere.

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12
Q

Key features of ibuprofen

A

Rapid onset, ideal for fever and acute pain

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13
Q

Key features of naproxen

A

Rapid onset of action, only twice daily dosing

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14
Q

Key features of oxaproxin

A

Long serum half-life, only once daily dosing

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15
Q

Key features of indomethacin

A

Potent anti-inflammatory, greater toxicity; used to close patent ductus arteriosus

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16
Q

Key features of diclofenac

A

Relatively selective for COX-2; associated with increased risk of MI/stroke

17
Q

Key features of ketorolac

A

Mainly used as IV/IM analgesic as a replacement for opioids

18
Q

Ten most affected organs

A
  1. GI/stomach
  2. Renal
  3. Cardiovascular
  4. Anti-platelet effects/increased bleeding
  5. Hypersensitivity
  6. CNS
  7. Skin
  8. Liver
  9. Photosensitivity
  10. Ductus arteriosus closure in pregnancy
19
Q

Why do GI issues occur in NSAIDs?

A

Inhibition of COX-1, which inhibits prostaglandin formation responsible for preventing damage to gastric/intestinal epithelial cells

20
Q

When are COX-2 inhibitors indicated?

A

Patients with a prior history of GI bleeds and/or ulcers

21
Q

NSAIDs are contraindicated in what 8 cases?

A
  1. Patients with a GI ulcers
  2. Patients with bleeding disorders
  3. Patients with renal disorders (elderly)
  4. Patients with previous hypersensitivity
  5. Pregnant women
  6. Patients with increased risk of CVD
  7. Children with febrile viral infections
  8. Aspirin contraindicated in gout
22
Q

Interaction between low-dose aspirin and NSAIDs

A

Antagonizes beneficial effects of low-dose aspirin by preventing binding of aspirin

23
Q

Interaction between oral anti-coagulants and all NSAIDs

A

Increased risk of bleeding from platelet COX-1 inhibition

24
Q

Interaction between anti-hypertensives and NSAIDs

A

Decreased ant-hypertensive effect; NSAIDs promote renal vasoconstriction

25
Q

Interactions between diuretic agents and NSAIDs

A

Increased risk of high blood pressure between NSAID renal vasoconstriction and diuretic water/sodium retention

26
Q

Interaction between diuretic agents and oral hypoglycemics

A

Potentiates hypoglycemic effect through protein binding competition

27
Q

Why is it important not to use aspirin in viral illness in children?

A

Reye’s syndrome: fatal liver degenerative disease associated with encephalitis

28
Q

How does acetaminophen work?

A

Metabolized selectively in the brain that inhibits COX-2 in the CNS, as well as act on the endogenous cannabinoid system in the pain and thermoregulatory centers of the CNS

29
Q

What effects does acetaminophen NOT have?

A

Anti-inflammatory and anti-platelet activity (no peripheral activity)

30
Q

Acetaminophen is the preferred analgesic in which patients?

A
  1. Have allergies to aspirin/salicylates
  2. Children with viral infections
  3. Patients with hemophilia/bleeding disorders
  4. Patients with prior history of gastric/peptic ulceres
31
Q

Describe acetaminophen overdose.

A

Toxic build-up of metabolite N-acetylbenzoquinoneimine in the liver

32
Q

What is used as an antidote for acetaminophen poisoning?

A

N-acetylcysteine; replenishes endogenous glutathione levels

Pharmacology exam 2 (10 decks)

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