NSAIDs, analgesics, gout

Question 1

first line tx for OA

Answer 1

Tylenol + non-drug tx

Question 2

If NSAID side effects are likely in OA what should you use

Answer 2

opioids + tylenol

Question 3

How to tx acute gout? (4)

Answer 3

high-dose NSAIDs, colchicine, steroids, and/or opioids

Question 4

How to tx frequent/severe gout or tophaceous gout?

Answer 4

xanthine oxidase inhibitor or probenecid

Question 5

Up to what dose of tylenol is safe qid (4x/day)

Answer 5

1000mg qid (4000mg)

Question 6

APAP activites (3)

Answer 6

Potent antipyretic and analgesic. (weak anti-inflammatory

Question 7

WHat is APAP converted to in liver?

Answer 7

NAPQI

Question 8

Minimum toxic dose of APAP

Answer 8

= 10-12 grams or 20 pills

Question 9

Non-acetylated salicylates

Answer 9

Choline magnesium trisalicylate, salsalate

Question 10

How should NSAIDs be dosed

Answer 10

on a schedule, not prn

Question 11

NSAID MOA

Answer 11

Inhibit both COX1/2

Question 12

COX-1 regulates what processes (4)

Answer 12

cellular processes: gastric protection, vascular homeostasis, plt aggregation, kidney function

Question 13

COX-2 regulates what processes (3)

Answer 13

Mediates pain, inflammation, fever

Question 14

naproxen shows a huge drop in what activity

Answer 14

platelet aggregation (TXA2)

Question 15

Indomethacin: greater inhibtion of COX-1 or 2
Meloxicam: greater inhibtion of COX-1 or 2
APAP: greater inhibtion of COX-1 or 2

Answer 15

Indomethacin: greater inhibtion of COX-1
Meloxicam: greater inhibtion of COX-2
APAP: greater inhibtion of COX-2

Question 16

If you have a CV risk but no GI risk, what should you take

Answer 16

naproxen

Question 17

If you have a GI risk but no CV risk, what should you take (general class)

Answer 17

COX-2 inghibitor

Question 18

If you have both GI and CV risk what is tx (2)

Answer 18

PPI + NSAID

Question 19

NSAID not effective against what type of condition? why?

Answer 19

Compression neuropathies : carpal tunnel, etc

they aren’t inflammatory

Question 20

ADEs of aspirin (3)

Answer 20

tinnitus, hearing loss, and gastric intolerance .

Question 21

ASA MOA

Answer 21

COX-1 inhibitor

Question 22

What is ASA not used as?

Answer 22

anti-inflammatory

Question 23

define Tophi:

Answer 23

nodules comprised of monosodium urate crystals in a matrix of lipids, protein, and mucopolysaccharides

Question 24

Colchicine MOA

Answer 24

Prevents microtubule formation and resultatnt inflammatory cell chemotaxis

Question 25

ADE of colchicine overdose

Answer 25

diarrhea

Question 26

What should be avoided (2) and encouraged (2) to prevent gout attacks

Answer 26

Avoid: organ meats, EtOH overuse (> 2/day in male, >1/day in female)

Encourage: low-fat or non-dairy

Question 27

*******WHat is dosing reccomendation for allopurinol

Answer 27

Wait until gout flare-up is over to start allopurinol.

Question 28

What is target for allopurinol use?

Answer 28

Serum urate target < 6mg/dL

Question 29

Probenecid: MOA, Cix

Answer 29

uric acid excretion

Cix: CKD

Question 30

What is the most common pathogenesis for gout and what drug is used to tx?

Answer 30

Under-excretion is the most common type of gout (still use allopurinol regardless)

Question 31

What drug is safe in CKD and MOA

Answer 31

Febuxostat, XOI