NSAIDS Flashcards

1
Q

what pathways do NSAIDs block?

A

Cyclooxygenase 1 and 2 (and thus prostanoids)

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2
Q

what do eicosanoids bind to?

A

prostaglandins, thrombaxanes, leukotrienes

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3
Q

enzyme expression seen with Cox-1

A

TXA2 in platelets

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4
Q

enzyme expression seen with Cox-2

A

PGE/TXA2 in activated macrophages

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5
Q

For COX-1 and COX-2: which is constitutively expressed and which is induced?

A

COX-1 is constitutive

COX-2 is induce by stress

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6
Q

Major side effect of inhibition of COX-1

A

GI related problems

Prostaglandins regulate stomach acids- inhibition can cause bloody stools, stomach bleeding, anemia…

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7
Q

Major difference between aspirin and other NSAIDs

A

aspirin is an irreversible inhibitor

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8
Q

NSAID uses

A

analgesia, anti-pyretic

only at high doses is it anti-inflammatory

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9
Q

one potential good side effect of NSAIDs, now being researched?

A

cancer prevention

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10
Q

common NSAID side effects

A

GI- pain, nausea, diarrhea, ulcers, perforation
Renal- insufficiency, failure, low efficacy of HTN Rx
MI !!! black box warning

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11
Q

can you use NSAIDs in pregnancy

A

No- prostaglandins involved in uterin fxn

prolonged gestation, post-partum hemorrhage

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12
Q

what is acetylsalicylic acid and why is it special?

A

aspirin
non-selective for COX-1 and and COX-2
Irreversible- acetylates serine- kills enzyme

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13
Q

contraindication of aspirin

A

use in children- Reye’s syndrome

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14
Q

antipyretic effect of aspirin

A

only works at low doses

high doses can induce pyretic effect

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15
Q

therapeutics of aspirin

A

cardioprotective- decreases platelet aggregation for 4-7 days
decrease MI risk (only in at-risk individuals)

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16
Q

where is aspirin secreted

A

proximal tubule and glomerular filtration

need to adjust dose in renal failure

17
Q

how to prevent GI problems (drug)

A

co-formulation with misoprostol (or other proton-pump inhibitor)

18
Q

aspirin hypersensitivity

A

induced effect- neoantigen formation
common in people with nasal polyps
cross sensitivity with NSAIDs

19
Q

side effects with toxic doses of aspirin

A

tinnitus

respiratory and metabolic acidosis

20
Q

only NSAIDs for IV use

A

ibuprofen and ketorolac

21
Q

half-life of ibuprofen

22
Q

max daily dose of ibuprofen

23
Q

half life of naproxen

24
Q

patients have more GI effects on ibuprofen or naproxen?

25
half life of celebrex
11 hours
26
which pathway does celebrex inhibit
cox-2
27
side effect not seen with celebrex that is seen with other NSAIDs
GI problems
28
who is contraindicated for celebrex
CAD or cerebrovascular disease | sulfa allergies
29
what does a COX-2 inhibitor prevent
vasodilation, inhibition of platelet aggregation (i.e. celebrex causes more platelet aggregation)
30
when is misoprostol contraindicated
used to induce labor- don't use in early pregnancy- causes termination
31
toxicity of acetaminophen
liver (depletion of GSH)
32
therapeutic effects of acetaminophen
anti-pyretic analgesic NOT an anti-inflammatory
33
which pathways are inhibited by acetaminophen (irreversibly)
cox-1, cox-2 and possibly cox-3? (unknown)
34
when to not take acetaminophen
when drinking alcohol | favors toxic pathway for acetaminophen metabolism
35
treatment for acetaminophen OD
N-acetylcysteine (stops liver damage)