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PHARM 2 SUMMER > NSAIDS and non narctoics > Flashcards

NSAIDS and non narctoics Flashcards

1
Q

3 functions of Anti- Inflamatories NSAIDs

A

1) analgesic
2) anti-inflamatory
3) Antipyretic

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2
Q

Pharmacokinetics of NSAIDs, where are they metabolized, how are they excreted

A
  • food doesn’t change availability
  • get in synoviral fluid good for arthritis
  • metabolized by liver
  • excreted renaly
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3
Q

MOA of NSAIDS

A

they inhibit the cyclooxygenase enzyme (COX).

COX needed to make prostaglandins (PG)

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4
Q

What does COX make and why is this product needed?

A

1) makes PG- needed for maintinance of body

PG protect mucosal layer of stomach, regulate blood flow to the kidney & allow platelets to function

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5
Q

What activates COX 2?

A

-inflamtion

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6
Q

Do COX 2 inhibitors specificly only inhibit COX 2

A

no only a little more

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7
Q

What is the only COX 2 inhibitor ?

A

Celebrex

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8
Q

Most ADRs of NSAIDs are related to inhibiting which cox?

A

Cox 1

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9
Q

GI side effects of NSAID

A

1) increased gastric acid bc PGs is GI mucosa protective
2) Dyspepsia
3) Gastro Duodenal Ulcer

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10
Q

During what time period of treatment dose hepatotoxicity from NSAIDs occur?

A

first 6 weeks

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11
Q

What to monitor and how often when pt. is on NSAIDs

A

-serum transaminases measured every 2 weeks for long term treatment

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12
Q

Black Box warning on NSAIDs is for what?

A
  • cardiovascular thrombotic events
  • myocardial infarctions
  • stroke
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13
Q

What do NSAIds cause you retain?

A

salt and fluid

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14
Q

How many points do NSAIDs raise ur BP?

A

8-10 pts

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15
Q

Angioedema

A

an unstable complement system which is activated by inhibition of prostaglandins

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16
Q

who do you avoid using NSAIDs in?

A

asthmatic pts w/ polyps

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17
Q

ASA Aspirin

A

-irreversibly inhibits COX enzymes, platelet effect last 10 days

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18
Q

nonacetylated salicylates

A

dont have any effect on platelets

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19
Q

Do NSAIDs increase or decrease serum creatinine?

A

increase bc decrease blood flow to kidney

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20
Q

when is there an absolute contraindication to NSAIDs?

A

Abnormal kidney function

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21
Q

CNS effects of NSAIDs

A

HA

aseptic meningitis

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22
Q

which NSAIDs are the ones known for causing HAs?

A
  • indomethacin

- tolmetin

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23
Q

which NSAIDs are the ones known for causing aseptic meningitis?

A

ibprofin

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24
Q

Which drugs to NSAIDs decrease the effectivness of?

A

Diuretics
ACEI
ARBS
- can lead to hyperkalemia

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25
Q

PUD with SSRI and NSAIDs?

A

SSRI may lead to depletion of serotonin in platelets, which is thought to play an important role in hemostasis

26
Q

Which drugs increase PUD bleeding with NSAIDs

A

clopidogrel
warfarin
hepatins
DONT DO IT

27
Q

Aspirin and Nonacetylated Salicylates

A 
Acetyl salicylic acid
Magnesium & choline salicylate ( Trilisate)
Magnesium salicylate ( Doan’s Pills)
Choline salicylate (Arthropan)
Sodium salicylate 
Salicylsalicylate (Disalcid)
28
Q

ASA

A
  • rapidly absorbed

- 0 order

29
Q

ASA dosage for mild pain

A

325-600

30
Q

ASA dose for arthritis

A

650

31
Q

ASA dosage for antiplatelet effect, angina, MI, CABG

A

81

32
Q

How much blood loss in lost every day if ASA routinely used?

A

teaspoon in stool

33
Q

Hyperpnea with ASA

A

high respiratory rate -> resp. aslk

antidote: stomach irrigation, IV fluids, sodium bicarb

34
Q

Nonacetylated salicylates

A

less effective than ASA

dont use for antiplatelet effect

35
Q

COX 2 selective NSAIDS

A

Celecoxib (Celebrex)

Meloxicam (Mobic)

36
Q

COX 2 selectives

A
  • the idea there would be more anti-inflammatory effect and less effect on stomach
  • more CVS events (MI, stroke). This is because they inhibit COX-2 mediated prostacyclin synthesis in vascular endothelium

not protective of kidney blood flow but seem to cause fewer GI problems & less bleeding

37
Q

What theraputic effect do COX 2s have?

A

1) antipyretic
2) antiinflamatory
3) analgesic

38
Q

Celecoxib (CELEBREX)

A
  • Sulfa: can get a rash if allergic to sulfa
  • Long-term use of celecoxib may cause an increased risk of serious adverse cardiovascular thrombotic events, MI, and stroke, which can be fatal.
39
Q

3 main Nonselective NSAIDs and their dosages

A
  • Diclofenac (Voltaren)- 50 mg and 75 mg twice a day
  • Ibuprofen (Motrin, Advil) 800 3 day
  • Naproxen (Naprosyn, Aleve) 550 twice a day
40
Q

IM NSAID is called…

A

Ketorolac

41
Q

Ketorolac-

A
  • IM loading dose, then oral max 40 mg/day
  • use 5 days or less
  • dont use for inflamation
42
Q

3 NSAIDs with long 1/2 life – ONCE DAILY DOSING

A

Oxaprozin (Daypro)
Piroxicam (Feldene)
Nabumetone (Relafen)

43
Q

tolmentin

A

not effective for gout

44
Q

how long do you give an NSAID before you switch?

A

2 weeks

45
Q

cases where you should avoid using NSAIDs

A

have CHF, renal failure, active peptic ulcer disease, uncontrolled HTN

46
Q

Is it okay to combine 2 NSAIDs?

A

NO

47
Q

NSAID in pts with hx of high BP

A

check BP before starting and every two weeks

if high stop or give more HTN meds

48
Q

What do you use if PUD and over 70?

A

Celebrex w/ PPI, and Misoprostol

49
Q

Aceominphen APAP

A

-oral or rectal
-onset in 30-60 min
less than 3 grams/day
metabolized by liver and is toxic

50
Q

APAP annecdote

A

mucomyst

51
Q

What are the theraputic properties of APA?

A

-analgesic and antipyretic

NOT ANTI INFLAMTORy

52
Q

Adverse effects of APAP

A

dizziness, excitment, disorientation

53
Q

APAP antidote is…

A

N-acetylcysteine

54
Q

can you add APAP to NSAIDs?

A

yes

55
Q

Neuropathic Pain Relievers

A

Gabapentin (Neurontin)
Pregabalin (Lyrica)
amitryptyline- migraine and diabetic neuropathy

56
Q

Two topical Pain Relievers

A
  • Methyl slicylate (wintergreen oil)
  • Capsacin

lidocainpatch patch

lidocaine/Prilocaine EMLA cream

57
Q

MOA capsacin

A

release substance P, continuously stimulates nerve (hurts at first), continuous nervestimulation deplets substance P, works best for neuropathic pain

58
Q

lidocaine patch

A

you can cut it

59
Q

mild pain

A

acetominophin

60
Q

moderate pain

A

NSAID

61
Q

visceral pain?

A

narcotics, start with schedule 4- tramadol

PHARM 2 SUMMER (3 decks)

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