NSAIDS Flashcards
- What are three results of the COX-1 enzyme?
Gastric protection, maintenance of renal function, and platelet aggregation
- What are six results of the COX-2 enzyme?
Inflammation, pain, fever, promotion of colon cancer, maintenance of renal function, vasodilation
- Give one benefit of inhibiting COX-1.
Prevention of platelet aggregation
- List four benefits of inhibiting
COX-2.
Suppress inflammation, relieve pain, reduce fever, reduce risk of colorectal cancer
- Inhibiting cyclooxygenase (COX) interferes with the production of what?
Prostaglandins
- Name two COX inhibitors that do not suppress inflammation.
Acetaminophen (Tylenol), ketorolac (Toradol)
- Give four adverse effects of inhibiting COX-1.
Gastric ulceration, renal impairment, bleeding, increased risk of MI & stroke (except ASA & Tylenol)
- Name three adverse effects of selective COX-2 inhibitors other than gastric ulceration with bleeding.
Renal impairment, vasoconstriction, increased risk of MI & stroke
- Which COX inhibitor has an irreversible action?
Acetylsalicylic acid (Aspirin)
- What syndrome can occur with the administration of aspirin to children who have chickenpox or influenza?
Reye’s syndrome
- How long does aspirin suppress platelet aggregation?
8 days
- Should aspirin be recommended to pregnant women?
No – detrimental to mother and fetus
- Give four signs of early salicylism.
Tinnitus, dizziness, sweating, headache
- List three conditions which increase the risk of hypersensitivity with salicylates.
Asthma, allergic rhinitis, nasal polyps
- Acute poisoning with salicylates begins with hyperventilation or hypoventilation?
Hyperventilation
- How does ibuprofen (Motrin, Advil) alter the action of aspirin?
Blocks ASA access to COX-1 receptors. on platelets, preventing ASA from inhibiting platelet aggregation. Give ibuprofen 2 hrs after aspirin.
- An allergy to what class of drugs is a contraindication for celecoxib (Celebrex)?
Sulfonamides
- Where does inhibition of prostaglandins occur with acetaminophen (Tylenol)?
CNS, no anti-inflammatory effects.
- What pathway can create toxic metabolites when metabolizing large amounts of Tylenol?
Minor pathway
- What is the maximum recommended dosage of Tylenol per day for nondrinkers? Patients who drink or have liver disease? Patients with malnutrition?
4 g per day. 2 g per day for drinkers or liver disease. 3 g per day for patients with malnutrition.
- What drug is given for Tylenol toxicity?
Acetylcysteine
- Why does alcohol increase the likelihood of Tylenol toxicity?
It induces the minor pathway & alcoholics have depleted glutathione stores.
- How long before surgery should NSAIDs be stopped?
1 week or 5 half-lives.
- Which drugs increase the risk of stroke and myocardial infarction?
COX-1 inhibitors, not including aspirin or acetaminophen.
COX-2 inhibitors
- What serotonin receptors are activated by sumatriptan (Imitrex)?
5-HT (serotonin)1B/1D receptors
- How does 5-HT activation reduce the symptoms of migraines?
Causes vasoconstriction of cranial blood vessels and suppresses release of pro-inflammatory neuropeptides.
- What are major contraindications or cautions for the use of sumatriptan (Imitrex)?
Cardiovascular and cerebrovascular disorders. (May cause vasospasm.)
- When should sumatriptan (Imitrex) be taken?
At the first sign of a headache.
- What restrictions are placed on patients receiving intra-articular injections with glucocorticoids? How long may the pain from the injection last?
Restrict movement for 1-2 days. Pain should only last 1-2 days.
- What disease process is a contraindication for glucocorticoids? What vaccines?
Systemic fungal infections.
Live virus vaccines.
