NSAIDs Flashcards
celecoxib
COX 2 selective inhibitor
meloxicam
COX 2 selective inhibitor
diclofenac
nonselective COX inhibitor
ibuprofen
nonselective COX inhibitor
indomethacin
nonselective COX inhibitor
ketorolac
nonselective COX inhibitor
naproxen
nonselective COX inhibitor
piroxicam
nonselective COX inhibitor
what is contraindicated with gout
ASA - inhibits urate excretion at low doses
tx of gastric damage induced by NSAIDs (3)
misoprotsol
PPI
H2 blockers
only selective COX2 inhibitor in US
celecoxib
rofecoxib and valdecoxib = withdrawn
meloxicam = not as selective for COX-2 as celecoxib
NSAID AE
1) GI: gastric damage
2) CV: inc risk of CV events
3) renal: dec RBF, analgesic nephropathy
3) ASA HS: b/c of excess LK synthesis (shunted after blocked COX)
NSAID contraindications (illnesses)
HTN, HF, CKD pts = can elevate BP and reduce effects of anti-HTN meds, cause fluid retention, worsen kidney function
phenacetin AE
analgesic nephropathy
celecoxib AE
sulfonamide = may cause HS rxn
medications contraindicated with NSAIDs
1) ACE-I
2) corticosteroids
3) warfarin
Triple Whammy
risk of acute kidney injury when ACE-I (or ARB) combined with diuretic and NSAID
- NSAID: constrict afferent = dec GFR
- ACE-I: dilate efferent = dec GFR
- diuretics: dec PV = dec GFR
must monitor these pt for creatinine and K+
ASA effects on CO2
uncouple oxidative phosphorylation = inc CO2 - inc breathing
at toxic levels of ASA = respiratory paralysis
ASA dosage uses
lowest: cardioprotective/antiplatelet
low: analgesic and antipyretic
high: anti-inflam, AE of tinnitus
ASA AE
1) epigastric distress
2) prolonged BT
3) Reye’s
4) Hypersensitivity
5) uricosuric effects: low doses of ASA compete with uric acid for secretion = dec uric acid secretion
6) hepatic effects: hepatic injury with high dose
ASA contraindications
elevated uric acid levels
chronic liver disease
what drug is contraindicated in pt with sulfa allergy
celecoxib
