NSAIDS

Question 1

What are indications for NSAIDS?

Answer 1

Mild chronic pain: osteoarthritis, neoplasia, otitis

Anesthesia/surgery: acute peri-surgical pain in combo with opioids

Question 2

What patients can you use NSAIDS in?

Answer 2

Well hydrated, normotensive, young-middle ages

Normal renal function

Question 3

Which has a longer action, NSAIDS or opioids?

Answer 3

NSAIDS

Question 4

T/F: Opioids have higher efficacy in inflmmatory conditions like dermatitis, polyarthtis, mastitis, or otitis than NSAIDS

Answer 4

False

NSAIDS greater for inflammation

Question 5

What are the administration routes of NSAIDS?

Answer 5

Common: SQ and IM

Less: IV , oral, topical, suppositories

Question 6

What is the MOA of NSAIDS

Answer 6

Inhibit COX (1 or 2)

Question 7

NSAIDS have their anti-inflammatory effects by inhibiton of what mediators ?

Answer 7

Prostacyclin and prostaglandin

Question 8

How do NSAIDS have an anti-pyretic effect?

Answer 8

Inhibit endotoxin or endogenous pyrogens (eg interleukin 1)

Question 9

What is a water soluble tablet NASID registered for osteoarthritis in dogs?

Answer 9

Tepoxalin

Inhibits COX and lipooxygenase

Question 10

Where do steroids exhibit their anti-inflammatory effects?

Answer 10

Inhibit phospholipase to prevent formation of arachadonic acid from cell membrane phospholipids

Question 11

Where is COX1 found? And what are its functions ?

Answer 11

Constitutively expressed

Liver
Kidney
Platelet
Gastric mucosa

—> mucosal blood flow, mucous production, gastric se creations acidity, gastric epithelium cell turnover

Question 12

Where is COX2 found and what are its actions?

Answer 12

Indictable in damaged or inflamed tissue —> monocytes, macrophages, or neutrophils

Question 13

Why do we want high selectivity of COX2 inhibition

Answer 13

COX1 is good—> gastric mucosa

COX2 is bad—> inflammatory
Less adverse effects if you selectively inhibit COX2

Question 14

What are the adverse effects on NSAIDS ?

Answer 14

GI- vomiting diarrhea and ulceration

Platelet aggregation —> impaired thromboxane

CV: prothrombotic state

Renal: block renal vasodilator COX2 induced PG —> not to be used in renal insufficiency

Liver: impaired hepatic blood flow

Question 15

What can you give prophylactically to reduce GI ulcers caused by NSAIDS?

Answer 15

Sucralfate : salt binds mucosal defects

Misoprostal: synthetic PG analog

Ranitidine: H2antagonist block gastric secretions

Omeprazole: PPI blocking gastric secretions

Question 16

What are contraindications for NSAIDS?

Answer 16

GIT disorder: GI ulcer/vomiting/diarrhea
Concurrent with steroids

Dehydration
Hypotension
Low circulating volume : CHF/acities/diuretics
Severe pulmonary dz

Shock or trauma
Acute renal insufficiency
Hepatic insufficiency

Thrombocytopenia
Pediatric/geriatric

Question 17

Should you give NSAIDS during pregnancy ?

Answer 17

No

COX2 expressed at ovulation, implantation, and Labour—> nessesary for nephrogenesis

Avoid during AI
Single use after C-section

Question 18

How many weeks after birth must you wait after birth before you can give NSAIDS to pediatric patients?

Answer 18

4weeks

Nephrogenesis is not compete until 3weeks after birth

Question 19

COX2 is essential for fracture healing, can NSAIDs be given to treat these animals?

Answer 19

Only at low dose for short period of time

Question 20

Why are cats predisposed to NSAID toxicity?

Answer 20

Deficient in glucuronidases —> slow clearance and longer halflife

Question 21

What are signs of NSAID toxicity in cats?

Answer 21

Fever, methemoglobinemia, hemorrhagic gastritis, kidney, and liver injury

Acetaminophen : methemoglobinemia and Heniz body anemia

Question 22

What precautionary measures can be taken to reduce the adverse effects of NSAIDS?

Answer 22

Food and water provision
CV load maintained
BP control inc ritical cases

Washout period 4-10days

Question 23

What selective COX2 inhibitor is approved for used in dogs and cats for up to 3days?

Answer 23

Robenacoxib (onsior)

Oral or SC

Question 24

What are the selective COX2 inhibitors?

Answer 24

Robenacoxib
Firocoxib
Deracoxib

Question 25

Carprofen is a preferential COX2 inhibitor, what species can it be used in? How can it be administered?

Answer 25

Approved in dogs Off label - horse and ruminant SC, IV, oral

Question 26

What species is meloxicam approved in and what are its admin routes?

Answer 26

Cat and dog SC and oral —few side effects, mostly GI

Question 27

Is phenylbutazone, a selective or non-selective COX inhibitor? What species is it used in?

Answer 27

Non-selective Cattle and horse -prolonged halflife in cattle (causes residues, not used in cattle over 20months)

Question 28

What are the adverse effects of phenylbutazone ?

Answer 28

GI ulcers and renal toxicity

Question 29

What are the non-selective COX inhibitors?

Answer 29

``` Ketoprofen Phenylbutazone Flunixine meglumine Acetylsalicylic acid (Asprin) Acetaminophen (Tylenol) ```

Question 30

What is the route of admin of ketoprofen and what species is it used in?

Answer 30

Ruminant and horse | Dog and cat (short term)

Question 31

What adverse effect is of concern with ketoprofen

Answer 31

Hemorrhage GI effects

Question 32

What is the main use of flunixine meglumine? How is it administered?

Answer 32

Colic pain in horses IV or IM

Question 33

Asprin is not approved for vet use by USFDA but can be used at very low doses in cats and dogs. What are the most serious adverse effects?

Answer 33

Bleeding and GI effects —> dogs and cats often present for toxicity due to owner overdose

Question 34

Acetaminophen is very toxic to cats. What are signs of toxicity? How can you treat?

Answer 34

Hemolytic anemia, cyanosis, fever, facial edema, and vomiting Treatment: N-acetylcystine (limits formation of liver and RBC toxic intermediates)