NSAIDS and Gout

Question 1

NSAIDs-function characteristics

Answer 1

Analgesia
Antipyretic
Anti-inflammatory

Question 2

NSAID primary target

Answer 2

COX-1 and COX-2 inhibitor=>stop prostaglandin production

Question 3

NSAIDS clinical uses

Answer 3

Mild/moderate pain
Fever
Inflammation
Antithrombotic 
Miscellaneous=>menstrual cramps, closure of patent ductus arteriousos, MI/stroke, others.

Question 4

Aspirin pharmacokinetics

Answer 4

Absorbed into GI tract, hydrolyzed into salicylic acid

Bound to plasma proteins, so potential for drug interactions

Question 5

Low dose aspirin

Answer 5

analgesic and antipyretic

Question 6

High dose aspirin

Answer 6

Anti-inflammatory

Question 7

Aspirin anti-pyretic effects

Answer 7

Blocks prostaglandins in CNS=> resets temperature control in the hypothalamus
Fall of temp is caused by dilation of superficial blood vessels

Question 8

Aspirin Anti-coagulant effects

Answer 8

Prolongs bleeding time=>inhibition of Thromboxane (TX)

Question 9

Aspirin Adverse

Answer 9

GI Tract upset=>cox-1 inhibition, dyspepsia, epigastric pain, nausea, vomiting, cramping
GI irritation due to inhibition of cytoprotective PGs (PGE2 and PGI2)
Platelet Inhibition
Decreased kidney function

Question 10

Main differences between other NSAIDs and aspirin

Answer 10

Duration of action and potency

Question 11

Non-Selective COX inhibitors

Answer 11

Aspirin
Ibuprofen
Idomethacin=> gout
Ketorolac
Naproxen
Oxaprozin
Piroxicam
Sulindac

Question 12

Cox-2 selective inhibitors

Answer 12

Have analgesic, antipyretic, and anti-inflammatory effects w/ less GI adverse effects
No impact on platelet aggregation=>higher incidence of CV thrombotic events

Question 13

COX-2 selective inhibitor approved for rheumatoid arthritis and osteoarthritis

Answer 13

Celecoxib

Question 14

Acetaminophen actions/uses

Answer 14

Pain reliever and fever reducer, but no anti-inflammatory properties
NOT an NSAID
-Used in children and elderly

Question 15

Acetaminophen safety/adverse

Answer 15

Hepatotoxicity at high doses=>narrow therapeutic index
150mg/kg=>liver necrosis
350mg/kg=:>liver failure

Question 16

Capsaicin Preparations

Answer 16

Used topically for the relief of RA, osteoarthritis, and neuralgia

Question 17

Capsaicin MOA

Answer 17

Prolonged activation of TRPV1 receptors depletes and prevents re-accumulation of Substance P

Question 18

NSAID interactions

Answer 18

Displacement of protein binding
Reduces diuretic effectiveness (increase in Na+ reabsorption)
Anticoagulants
GI effects

Question 19

Choice of NSAIDs

Answer 19

Takes into account multiple factors, no best NSAID for everyone

Question 20

Gout

Answer 20

Form of acute arthritis with accumulation of uric acid crystals in joings/ cartilage
Associated with hyperuricemia

Question 21

Gout therapeutic goals

Answer 21

TErminate acute attack

Provide control of pain and inflammation

Question 22

Gout first line treatment

Answer 22

NSAIDs=> Indomethacin
other: ibuprofen, naproxen, sulindac
do NOT use aspirin

Question 23

Colchicine

Answer 23

Used to be primary tx for gout, use declined now

Question 24

Xanthine Oxidase Inhibitors

Answer 24

Allopurinol

Febuxostat

Question 25

Allopurinol MOA

Answer 25

• Blocks conversion of xanthine to uric acid

- Standard for periods between acute gout attacks

Question 26

Febuxostat

Answer 26

-More selective than allopurinol, used for people with allopurinol intolerance

Question 27

Uricosuric Drugs

Answer 27

Probenecid

Sulfinpyrazone

Question 28

Probenecid/Sulfinpyrazone MOA

Answer 28

• Increase renal clearance of uric acid by inhibiting tubular absorption
• Not effective in acute gout