NSAIDs and Acetaminophen

Question 1

MOA of NSAIDs?

Answer 1

ameliorate pain and inflammation through reversible (Except aspirin) inhibition of cyclooxygenase enzyme (COX)

Question 2

How are most NSAIDs metabolized?

Answer 2

hepatically with the exception of ketorolac, which is 58% unchanged in urine

Question 3

Which leads to platelet inhibition: Inhibition of COX1 or COX2?

Answer 3

COX1 inhibition causes platelet inhibition and increaesd bleeding time. GI toxicity as well.

Question 4

Which NSAID has shortest half-life?

Answer 4

diclofenac (tiny dick)

Question 5

Which NSAID has longest half-life?

Answer 5

piroxicam (peer off into the distance)

Question 6

Which NSAID has lowest risk of GI toxicity?

Answer 6

ibuprofen

Question 7

Which NSAID has highest risk of GI toxicity?

Answer 7

ketorolac

Question 8

What factors contribute to an NSAIDs GI toxicity?

Answer 8

half-life and COX selectivity (more COX1 inhibition=more GI toxicity)

Question 9

What can be given with NSAIDs to reduce GI toxicity?

Answer 9

H2 receptor antagonists, misoprostol, or proton pump inhibitors (PPIs). PPIs are most effective because they better suppress acid.

Question 10

How do NSAIDs cause cardiovascular events?

Answer 10

NSAIDs inhibit platelets but only for a short duration, whereas aspirin inhibits permanently (7-10 days). NSAIDs will compete with aspirin and result in decreased protection, thus more thrombotic events and CV damage in patients who need the inhibition

Question 11

Which NSAID is seemingly cardioprotective and has no interaction with aspirin?

Answer 11

na interactions so naproxen protects

Question 12

What can a combo of aspirin and ibuprofen cause?

Answer 12

increased CV risk

Question 13

What effects do NSAIDs have on BP?

Answer 13

they increase BP

Question 14

Which BP drugs can have adverse effects with NSAIDS?

Answer 14

ACEI’s and ARB’s

Question 15

How do NSAIDs cause acute renal toxicity?

Answer 15

they inhibit PGI2 and E2, which help maintain renal bloodflow and GFR

Question 16

Is aspirin a good choice for achieving inflammation reduction?

Answer 16

no. even though it is just as effective at high enough doses, It has more GI toxicity than other NSAIDs.

Question 17

What can salicylate poisoning cause?

Answer 17

disturbs acid/base balance and causes respiratory alkalosis. Eventually respiratory depression and CV collapse can occur.

Question 18

What is MOA of acetaminophen?

Answer 18

produces analgesia and antipyretic actions by inhibiting COX1 and 2. Has NO peripheral action and NO anti-inflammatory action.

Question 19

What is most common/serious adverse effect of acetaminophen?

Answer 19

acute hepatic failure