NSAIDS Flashcards

1
Q

What are indications for NSAIDS?

A

Mild chronic pain: osteoarthritis, neoplasia, otitis

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

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2
Q

What patients can you use NSAIDS in?

A

Well hydrated, normotensive, young-middle ages

Normal renal function

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3
Q

Which has a longer action, NSAIDS or opioids?

A

NSAIDS

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4
Q

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

A

False

NSAIDS greater for inflammation

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5
Q

What are the administration routes of NSAIDS?

A

Common: SQ and IM

Less: IV , oral, topical, suppositories

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6
Q

What is the MOA of NSAIDS

A

Inhibit COX (1 or 2)

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7
Q

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

A

Prostacyclin and prostaglandin

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8
Q

How do NSAIDS have an anti-pyretic effect?

A

Inhibit endotoxin or endogenous pyrogens (eg interleukin 1)

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9
Q

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

A

Tepoxalin

Inhibits COX and lipooxygenase

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10
Q

Where do steroids exhibit their anti-inflammatory effects?

A

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

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11
Q

Where is COX1 found? And what are its functions ?

A

Constitutively expressed

Liver
Kidney
Platelet
Gastric mucosa

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

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12
Q

Where is COX2 found and what are its actions?

A

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

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13
Q

Why do we want high selectivity of COX2 inhibition

A

COX1 is good—> gastric mucosa

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

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14
Q

What are the adverse effects on NSAIDS ?

A

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

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15
Q

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

A

Sucralfate : salt binds mucosal defects

Misoprostal: synthetic PG analog

Ranitidine: H2antagonist block gastric secretions

Omeprazole: PPI blocking gastric secretions

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16
Q

What are contraindications for NSAIDS?

A

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

17
Q

Should you give NSAIDS during pregnancy ?

A

No

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

Avoid during AI
Single use after C-section

18
Q

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

A

4weeks

Nephrogenesis is not compete until 3weeks after birth

19
Q

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

A

Only at low dose for short period of time

20
Q

Why are cats predisposed to NSAID toxicity?

A

Deficient in glucuronidases —> slow clearance and longer halflife

21
Q

What are signs of NSAID toxicity in cats?

A

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

Acetaminophen : methemoglobinemia and Heniz body anemia

22
Q

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

A

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

Washout period 4-10days

23
Q

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

A

Robenacoxib (onsior)

Oral or SC

24
Q

What are the selective COX2 inhibitors?

A

Robenacoxib
Firocoxib
Deracoxib

25
Q

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

A

Approved in dogs

Off label - horse and ruminant

SC, IV, oral

26
Q

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

A

Cat and dog

SC and oral

—few side effects, mostly GI

27
Q

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

A

Non-selective

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

28
Q

What are the adverse effects of phenylbutazone ?

A

GI ulcers and renal toxicity

29
Q

What are the non-selective COX inhibitors?

A
Ketoprofen
Phenylbutazone 
Flunixine meglumine 
Acetylsalicylic acid (Asprin) 
Acetaminophen (Tylenol)
30
Q

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

A

Ruminant and horse

Dog and cat (short term)

31
Q

What adverse effect is of concern with ketoprofen

A

Hemorrhage

GI effects

32
Q

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

A

Colic pain in horses

IV or IM

33
Q

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?

A

Bleeding and GI effects

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

34
Q

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

A

Hemolytic anemia, cyanosis, fever, facial edema, and vomiting

Treatment: N-acetylcystine (limits formation of liver and RBC toxic intermediates)