NSAIDS Flashcards
The principal cyclooxygenase product
arichidonic acid in platelets
What act as a stimulus for platelet aggregation and vasoconstriction?
Thromboxane
Ibuprofen should be stopped about
2 weeks
Enzyme is by low doses of aspirin
Irreversibly inhibited
NSAIDS enzyme is
reversibly inhibited
Prostacyclin is the most potent
Endogenous inhibitor of platelet aggregation, a potent vasodilator
Increase thromboxane would result in
decrease blood flow
Increase prostacyclin can lead to ?
bleeding
There has to be a normal ration of
Thromboxane to prostacyclin
Once patient has suffered from a heart attack
Low dose ASA is safe
Once patient has suffered from a heart attack
Low dose ASA is safe but before not really
Major site of prostaglandin synthesis
Lungs
ASA can lead to an increase in production of
leukotrienes
When you inhibit the other pathway
Leukotrienes become elevated
ASA block this pathway?
block arachidonic acid production
Because of increase leukotrienes, it
Can lead to Asthma
NSAIDs in asthma can exacerbate
Bronchoconstriction
Intrarenal release of prostaglandins by kidney
Modulate renal blood flow
inhibition of cyclooxygenase may lead to risk of acute renal injury.
Prostaglandins MOA
A
Intrarenal release of prostaglandins by kidney
Modulate renal blood flow
inhibition of cyclooxygenase may lead to risk of acute renal injury because it interferes with the renal prostaglandin protective
Cr greater than 1.3
Do not administer Toradol
Epoprosterenol use for
Treatment of primary pulmonary HTN
Illoprost route of administration
Inhaled
Illoprost is a derivative of
Prostacyclin
Uniprost is administered
Administered subcutaneously portable pump
Unapproved use
Pulmonary HTN with ARDS, Neonatal pulmonary HTN, CPB
MOA of Epoprosternol
aka Prostacyclin and PGID2
STRONG VASODILATOR of ALL VASCULAR BEDS
Epoprosterenol should be given by
Continuous transfusion
Half life of Epoprosterenol
2-9 minutes
Never do this with EPOPROSTERENOL
Never interrupt infusion
Initial rate of EPO
2ng/kg/min
Steady state levels are reached in
15 minutes
EPO can be diagnostic also for
Pulmonary HTN
Metabolism of EPO
rapidly hydrolyzed at neutral pH in blood , subject to enzymatic degradation
Alprostadil aka
PGE1, Prostaglandins
Use of Alprostadil
maintenance of ductus arteriosus in neonates with CHD
Alprostadil use for
Hypotension while maintaining local CBF
Also use for ED
Alprostadil
Prostaglandins analogues mainly
Vasodilation and inhibition of platelet aggregation
If you think you’re pregnant
Stay out of room where prolan is being administered
MOA Alprostadil
Vasodilation
Inhibition of platelet aggreggation
Dinoprostone uaw
Use to promote cervical ripening prior to labor induction
Suppositories of Dinoprostone
Use to terminate pregnancy in week 12-28
Dinoprostone caution
Use cuation in bronchospasm, asthmatic , seizure
Carboprost (hemobate)
Produces uterine contractions
Use of Carboprosts
Termination of pregnancy , tx of refractory postpartum uterine bleeding
Misoprostil (Cytotec) use
Used to prevent NSAIDS-induced gastric ulcers, replace prostaglandins, and inhibits secretion of gastric acid
Misoprostil Side effects include
Severe N/V, Diarrhea
Abdominal pain
Flolan major side effects include
Abdominal issues
Comparison:Thromboxane
Thomboxane Increse SVR< Airway resistance , Platelet aggr
Protacylcin PGIe
SVR down
Airway res up
Platelet agg down
Illoprosts decrease
SVR, airway resistance, platelet aggregation
Epoprosterenol new drugs Treprostinil (remodulin)
Longer half life
Can interrupts therapy
Trepostinil is a
Subcutaneous pump.
