- gastric cytoprotection - platelet aggregation - renal sodium/water balance

NSAIDs Flashcards by Suraya Dhalla

t/f: NSAIDs are used in the treatment of neuropathic pain

false. NSAIDs are used in the tx of nociceptive pain

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t/f: NSAIDs target the ascending sensory pathway

true

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t/f: stimulus from ascending sensory pathway go to the cerebral cortex

true

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t/f: only the C fibers are non-myelinated

true. only C fibers are non myelinated, making them very slow

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t/f: the fastest nerve fibers are the A-delta fibers

false. the fastest are the A-alpha fibers

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describe the mechanism of fever

antigen => leukocytes => pyrogen CK => hypothalamic thermoreg center => brain stem thermoreg center => PG => peripheral vasoconstriction

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t/f: NSAIDs are analgesic, antipyretic, anti-inflammatory drugs

true

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t/f: the main thermostat of the body is the brain stem

true

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COX -1 functions

gastric cytoprotection
platelet aggregation
renal sodium/water balance

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t/f: inhibition of COX-1 will cause gastric bleeding, decrease blood clotting, increase Na+/water (increase swelling)

true

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t/f: COX-1 receptors are always expressed, while COX-2 receptors are inducible, rapidly regulated, and only expressed during inflammation

true

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activation of COX-2 results in __ in prostaglandins that mediate pain and inflammation

increase

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t/f: adverse effects from inhibiting COX receptors occurs when COX-1 is also inhibited

true. AEs can be reversed by selective inhibition of COX-2

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where are COX-3 receptors found

in the brain

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t/f: COX-3 receptors are constitutively expressed in the brain and are responsible for central regulation of fever and pain

true

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the benefit of NSAIDs over steroids is that they don’t cause ___

endocrine problems and many AEs

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t/f: ASA is a non-selective COX inhibitor

true

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t/f: ibuprofen is a selective COX-2 inhibitor

false. it is a non-selective COX inhibitor

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t/f: naproxen sodium is a selective COX-2 inhibitor

false. it is a non-selective COX inhibitor

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3 main non-selective COX inhibitors

ASA
ibuprofen
naproxen sodium

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2 main selective COX-2 inhibitors

celecoxib

2. meloxicam

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t/f: all NSAIDs are COX inhibitors

true

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t/f: ibuprofen and naproxen are both propionic acid derivatives and mixed COX1/COX2 inhibitors

true

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t/f: ASA causes reversible acetylation of COX1/COX2

false. it causes IRREVERSIBLE acetylation of COX1/COX2

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ASA will cause decrease in ___

1. decrease cytoprotection (increase GI bleeding) 2. decrease thromboxin synthesis (decrease platelet aggregation) 3. decrease PG synthesis (decrease infl response)

t/f: low dose of ASA can be used in the prevention of CVD

true (due to decreased platelet aggregation)

t/f: AEs of ASA include: hypersensitivity, tinnitus, headaches, N/V, renal failure, and higher bleeding time

true

t/f: new platelets will have to be restored to reverse platelet effects of ASA

true (because it's irreversible)

t/f: local hemostatic measures are sufficient to control bleeding in pts on ASA

true

t/f: ASA can be administered during last trimester of pregnancy

false.

pts on ASA who have GI bleeding, ulcers, and perforation should take which drugs for cytoprotection?

- proton pump inhibitors (PPI) | - misoprostol

t/f: ASA in high doses can lead to increased thyroid activity

false. DECREASE thyroid activity

t/f: ASA can be given to asthmatic patients

false. should avoid (can develop bronchoconstriction)

t/f: ASA can be given to someone with hypertension

false. ASA can cause edema which increases BP

t/f: ASA can be given to someone with renal failure

false. ASA causes decrease GFR

name all drug interactions for NSAIDs

- antihypertensives (ACE inhibitors, beta blockers) - diuretics - corticosteroids - cyclosporine

interaction between NSAIDs and corticosteroids leads to ___

GI bleeding

t/f: giving NSAIDs to a pt on ACE inhibitors will cause decreased BP

false. it will cause increase BP

t/f: celecoxib is a selective cox-2 inhibitor

true

t/f: meloxicam is a selective cox-2 inhibitor

true

t/f: NSAIDs can be given to pts with asthma

false. can cause bronchoconstriction

t/f: NSAIDs can be given to pts with hypertension or heart failure

false.

can you give NSAIDs with ASA

no! NSAIDs block ASA's inhibition of platelet aggregation (thus more clotting)

t/f: NSAIDs enhance the cardioprotective effect of ASA

false. NSAIDs BLOCK the cardioprotective effect of ASA

what does NSAIDs/ASA drug interaction increase the risk of?

thromboembolism

what is the dose direction for giving NSAIDs with ASA?

ibuprofen (non-selective COX NSAID) 30-120 min AFTER ASA

t/f: acetaminophen has a higher affinity for COX-1

false. higher affinity for COX-3

t/f: acetaminophen irreversibly inhibits COX-3

false. it reversibly inhibits COX-3

t/f: acetaminophen has anti-inflammatory properties

false.

t/f: acetaminophen is an NSAID

false. it does not have anti-inflammatory properties

acetaminophen gets metabolized by CYP2E1 to form ___

NAPQI

max allowed daily dose of acetaminophen

4000 mg/day

t/f: a lower dose of acetaminophen should be taken if its not taken with a meal

true. not taken with food means overwhelming liver which can cause liver toxicity

t/f: allopurinol is a co-analgesic used in the tx of gout

true

t/f: ergots and triptans are co-analgesics used in the tx of headache

false. co-analgesics used in the tx of migraine

t/f: adalimumab (humira) is a co-analgesic used to tx rheumatoid arthritis

true

t/f: Gabapentin/ pregabalin are considered anticonvulsants and analgesics

false. they are anticonvulsants and CO-analgesics

t/f: Lidocaine is considered an anticonvulsant and co-analgesics

true

name 2 tricyclic anti-depressants that are co-analgesics

- amitryptiline | - venlafaxine

t/f: acetaminophen is an analgesic and antipyretic

true

tx for mild/moderate pain

acetaminophen

tx for moderate to severe pain

NSAIDs

tx for moderate to severe pain for someone with AEs/DI to NSAIDs

- celecoxib - acetaminophen +codeine - acetaminophen + oxy/tramadol

tx for severe pain

- acetaminophen +codeine | - acetaminophen + oxy/tramadol

t/f: acetaminophen is an NSAID and COX inhibitor

false. it is NOT an NSAID but it is a COX inhibitor

t/f: odontogenic oral pain is associated with infection and involves pulp or periodontium

true

t/f: tx of odontogenic oral pain includes dental procedure + NSAIDs+ABX

true

tx of odontogenic oral pain after extraction is __

NSAIDs +/- ABX

differential dx for odontogenic oral pain is

elimination of pain by local anesthesia

t/f: non-odontogenic tooth pain is caused by referred pain

true

t/f: pain due to non-odontogenic causes is eliminated by LA

false. non-odontogenic pain is NOT eliminated by LA