Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

anesthesia pharm > NSAIDS > Flashcards

NSAIDS Flashcards

1
Q

common uses for NSAIDS

A

acute and chronic pain conditions
cancer-associated pain syndromes
treatment of dysmenorrhea
prevention of thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

example of carboxylic acid

A

acetylated: ASA
nonacetylated: sodium salicylate, salicylamide, difunisal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

examples of acetic acids

A

indomethicin, sulindac, tolmetin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

examples of proprionic acids

A

ibuprofen, naproxen, COX 2 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

examples of enolic acids

A

phenylbutazone, piroxicam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

examples of pyrrolopyrrole

A

ketorolac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

common therapuetic actions of NSAIDS

A

analgesic, antiinflammatory, antipyretic, platelet inhibitory effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MOA of COX inhibition

A

resulting in decrease in peripheral synthesis of prostaglandins, inhibition of prostaglandin synthesis decreases inflammatory response to surgical trauma, thus decreases peripheral nocioception and pain perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Two forms of COX

A

COX-1 is present in all tissues

COX-2 inhibitor-specific dugs reduced likelihood of GI toxicity. Is produced primarily at the site of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

NSAID pharmacokinetics

A
  • well absorbed from the GI tract
  • low first pass hepatic extraction
  • highly bound (>95%) to plasma albumin
  • exhibit small volumes of distribution
  • most are weakly acidic. with pK of 3-5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

NSAID adverse reactions

A

dyspepsia, renal problems, skin reactions, CNS issues, inhibition of platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

rare NSAID reactions

A

blood dyscrasias, erythema, uticaria, pneumonitis, aseptic meningitis, aplastic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

NSAIDS and gastric acid

A

prostaglandins go to the paraietal cells and block gastric acid production. If COX is blocked so is prostaglandins, so acid will keep building up causing dyspepsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NSAID and renal

A

rarely have effects on renal function in healthy individuals.
Renal toxicity can occur, which is likely due to NSAID induced inhibition of prostaglandin synthesis, which inhibits the compensatory mechanism response for renal medullary ischemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What NSAID can be prescribed with absolute safety with respect to renal effects

A

ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

NSAIDS and HTN

A

prostaglandins modulate systemic BP by effects on vascular tone in arteriolar smooth muscle and control of extracellular fluid volume.
Prostaglandins counteract response to vasoconstrictor hormones and can influence sodium balance
NSAIDS may interfere with the pharmacologic control of HTN
Usually clinically insignificant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

NSAIDS and coags

A

due to the reversable inhibition of COX NSAIDS inhibit platelet aggregation, lasts about 5 elimination half times (24-96hrs)
Increasing period use, especially ketorolac has sparked debates among surgeons regarding postop bleeding…
conversely- useful after microvascular surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ASA and coags

A

ASA induces irreversible inactivation of platelet COX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

NSAIDS and aseptic meningitis

A

may follow systemic drug administration especially ibuprofen and H2 receptor agonists
Syndrome is greater in females with underlying autoimmune or collagen vascular disease.
S/S appear within hours but may delay for weeks
Most patietns recover fully when drug is discontinued
Fever is common
Other usual features of meningitis, periorbital edema, conjunctivitis, hypotension, parotitis, fatigue, and seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NSAIDS and drug reactions

A

elderly patients are at greatest risk:
most common- oral anticoags and NSAIDS= increased risk of GI hemorrhage
Potassium sparing diuratics + NSAIDS= increased risk of hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

NSAID induced decrease in renal function may interfere with clearance of:

A

digoxin, lithium, amoniglycoside antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

NSAIDs may interfere with the antihypertensive actions of

A

beta blockers, diuretics, and ACEI

23
Q

Periop considerations of NSAIDS

A

decrease postop pain and requirements for opioids
adjuvants with neuroaxial opioids
IV is better than IM
exhibit ceiling effect when used for post op pain

24
Q

ASA

A

a salicylate that produces analgesia through its ability to irreversibly acetylate the COX enzyme, leading to a decrease in the synthesis and release of prostaglandins
The leukotriene pathway remains intact in the presence of ASA.
ASA does OT interact with opioid receptors.
And has LITTLE effect on release of histamine or serotonin.

25
Q

ASA pharmacokinetics

A

Rapidly absorbed from the small intestine
Alkalinization of urine may increase urinary excretion, requiring larger doses to achieve plasma concentration.
Buffered effervescent preparations undergo a more rapid absorption and achieve higher plasma concentrations with less GI irritation.

26
Q

Is ASA a weak acid or weak base?

A

Weak acid. pKa 3.5

27
Q

ASA clearance

A

After absoprtion into systemic circulation, ASA is rapidly hydrolyzed in the liver to salicylic acid.
Metabolism occurs in the liver where it conjugates with glycine to form salicylic acid
Renal excretion of free s.a. is highly variable from up to 85% of alkaline to as low as 5% in acidic
Plasma concentrations increase in presence of renal dysfunction.
Elimination half time is 2/3 hours.

28
Q

Clinical uses of ASA

A

A) analgesic for symptomatic relief of low-intensity pain associated with: HA and arthritis
B) Antipyretic
C) Anti-platelet- mainstay therapy/prevention of MI and angina and some ischemic strokes.

29
Q

ASA side effects

A

GI upset, hemorrhagic events, easy bruising, melena, epistaxis, CNS stim, hepatic and renal dysfunction, metabolic alterations, uterine effects, allergic rxn

30
Q

how does ASA increase bleeding time

A

induces functional defect in platelets that is clinically detectable as prolonged bleeding time.
prevention of the formation of thromboxane, platelets are sensitive to small doses.
irreversible, lasts the lifespan of the platelet.

31
Q

Avoid is ASA in patients with…

A

severe hepatic dysfunction, vit K deficiency, hypoprothrombinemia, hemophelia

32
Q

ASA and CNS stim

A

excessive dosing of ASA may produce:

  • hyperventilation due to direct stim of medullary vent center
  • seizures
  • tinnitus
  • hyperthermia and dehydration may be the life threatening result of salicylate overdose
  • metabolic and resp acidosis
33
Q

ASA hepatic dysfunction

A

salicylates can be associated with increased plasma concentrations of transminase enzymes, indicating hepatic damage is usually reversible

34
Q

ASA Renal Dysfunction

A

chronic use of ASA has not been shown to increase the incidence of ESRD

35
Q

ASA and metabolic alterations

A

large doses of salicylates may cause hyperglycemia and glycosuria and may deplete liver and skeletal muscle glycogen
Salicylates decrease lipogenisis by partially blocking incorporation of free fatty acids

36
Q

ASA and uterine effects

A

prolongation of labor by salicylates may reflect loss of uterotropic effects of prostaglandins
ASA use is notmally d/c’d before anticipated time of delivery to avoid the potential of postpartum hemorrhage and prolonged labor

37
Q

ASA allergic rxn

A

rare and life threatening

vasomotor rhinitis, laryngeal edema, bronchoconstriction, CV collapse

38
Q

ASA induced asthma

A

occurs in 8-20% of al asthmatic adults
-greater incidence with rhinosinitus and nasal polyps
Occurs within an hour on ingestion
-life threatening bronchospasm and hypotension
Cross sensitivity between ASA and other NSAIDS must be considered with pts with asthma
Not an allergy- response is not immunologic

39
Q

Acetaminophen

A 
alternative to ASA
-analgesic
-antipyretic
Especially in patients where salicylates are not recommended
-peptic ulcer disease
-prolongation of bleeding time
40
Q

Acetaminophen Pharmacokinetics

A

nearly complete after oral administration
-no significan binding to serum protiens
Converted by conjugation and hydroxylation in the liver to inactive metabolites
-only small amount of drug excreted unchanged

41
Q

Acetaminophen side effects

A

reduction consumption could lower incidence of ESRD 8-10%

Hepatic necrosis and death may accompany a single dose of acetaminophen of >15g

42
Q

indomethacin

A

methylated inderole derivative
-analgesic, antipyretic, an anti-inflammatory
MOST potent inhibitor of COX known
useful management of arthritis
drug of choice for treatment of ankylosing spondylitis
Single dose controls cardiac failure in neonates with PDA

43
Q

Indomethacin side effects

A

severe adverse effects limit the usefulness

  • GI upset and frontal HA
  • inhibition of platelet aggregation
  • allergic rxn and cross sensitivity with salicylates
  • LFTs may become abnormal
  • preexisting renal disease patients may experience exacerbation
  • neutropenia, thrombocytopenia, and aplastic anemia are rare
44
Q

Propionic acid derivatives

A

Ibuprofen, naproxen,
-prominent analgesic, antipyretic and anti-inflammatory agents
-useful in treating various form of arthritis
NAPROXEN has linger elimination half life

45
Q

side effects of propionic acids

A

GI and mucosal ulcerations are less than with salicylates
platelet function is altered but varies with specific drug
assume a hypersensitive to salicylates may also be allergic to propionic acids derivatives

46
Q

what propioic acid is most associated with adverse renal effects?

A

fenoprofen

47
Q

side effects with warfarin of propionic acids

A

extensive plasma protein binding to albumin, must decrease dose of warfarin

48
Q

ibuprofen problem

A

hematopoietic suppression characterized by agranulocytosis and bone marrow granulocytic aplasia associated with chronic use of ibuprofen

49
Q

Ketorolac

A

Potent analgesic but only moderate anti-inflammatory activity IM or IV

  • potentiates the anti-nocioceptive actions of opioids
  • exhibit ceiling effect with respect to post op analgesia
  • absence of ventilatory or CV depression, little or no effect on biliary tract dynamics
50
Q

Ketorolac dose

A

30mg= 10mg MSO4 or 100mg Meperidine

51
Q

Ketorolac side effects

A

inhibits platelet thromboxane production and platelet aggregation
bleeding time may be increased
increased post op blood loss must be considered and discussed
Bronchospasm may occur in patient with nasal polyps, asthma, and ASA sensitivity
Cross tolerance between ASA and olther NSAIDS occur regularly

52
Q

Gabapentin (neurontin)

A

originally for anticonvulsant purposes
actual MOA unknown, but believed to act on N type voltage gated calcium channels in the CNS
-Many uses including neuropathic pain
-Has undergone scrutiny lately for marketing it’s off label uses
-most common side effects are dizziness and drowsiness
little to no abuse potential.

53
Q

Pregabalin (Lyrica)

A

originally for anticonvulsant purposes

  • actual MOA unknown but believed to act on N type voltage gated channels in the CNS
  • many uses including neuropathic pain
  • little or no abuse potential but has been labeled V by FDA
  • most common side effects: drowsiness, dizziness

anesthesia pharm (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions