NSAIDs Flashcards
What is the MOA of NSAIDs?
cyclooxygenase (COX) inhibitors
prevent binding of arachidonic acid to cox enzyme
inhibits the biosynthesis of prostaglandins (pain
causing)
What are some common effects of NSAIDs?
common analgesic, anti-inflammatory, and antipyretic effects
Which drugs most likely work on 1st order neuron?
NSAIDs
How do NSAIDs affect COX inhibitors?
they are either non-selective or Cox-2 selective (viox)
Cox 1 isoenzymes are involved in physiologic functions
maintenance of renal function
mucosal protection of the GI tract (more prone to developing ulcers)
production of thromboxane A2 (released by platelets to attract other platelets)
Cox 2 isoenzymes are
expression induced by inflammatory mediators
role in: mediation of pain, inflammation, & fever
Cox 2 isoenzymes are things we
want to block
What is a drug we can give that is Cox 2 selective?
celebrix but this comes with its own cardiac issues
non-selective nsaids are rarely used in the periop setting b/c of
GI toxicity and platelet dysfunction
What is a consideration of NSAIDs with bone healing?
bone healing is delayed with NSAIDs but safe in the setting of primary bone healing
What is the dose of toradol (ketorolac) and what is a consideration to not giving it?
15 mg IV or IM Q6h
do not give in patients with reduced renal function
What are some considerations with Celebrex?
have less GI toxicity since it is a Cox 2 selective inhibitor but does have cardiovascular risks
What is the dosing of celebrex and when might we give it?
part of ERAS surgery
400 mg PO preop
200 mg BID x 5 days postop
NSAIDs are acids or bases?
weak acids (like propofol and barbiturates)
What kind of distribution to NSAIDs have?
low Vd (.1-.3 L/kg)
Additional important pharmacokinetics of NSAIDs?
plasma half-life is variable
increased protein binding
GI absorption occurs rapidly
How are NSAIDs metabolized and excreted?
liver metabolizes most NSAIDs
eliminated primarily by renal and biliary excretion
How do NSAIDs affect platelet function?
primarily through Cox-1
What are risk factors for increased GI complications?
elderly, hx of previous ulcer, H. pylori infection, concomitant use of aspirin, anticoagulants, or corticosteroids
Aspirin is a derivative of
salicylic acid
How is aspirin metabolizied?
plasma esterases, erythrocytes, and liver
What is aspirin used for?
general analgesic & “irreversible” platelet inhibitor