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Pharm 2024 > NSAIDs and Non-opioid Analgesics > Flashcards

NSAIDs and Non-opioid Analgesics Flashcards

Exam 4

1
Q

What are the 5 types of autocoids?

A
  • Histamine
  • Serotonin
  • Bradykinin
  • Prostaglandins
  • Leukotrienes
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2
Q

What are the 2 pathways of arachidonic acid?

A
  1. Cyclooxygenase pathway - Arachidonic acid (AA) converted to prostaglandin by COX
  2. Lipoxygenase pathway - AA converted to leukotrienes by lipoxygenase
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3
Q

Differentiate between COX1 and COX2

A

COX1 - constitutive, wide distribution, homeostatic functions (platelets, GI, renal)
COX2 - expression is stimulus-dependent, facilitates inflammatory response

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4
Q

What are the 3 types of anti-inflammatory drugs?

A
  1. NSAIDs
  2. Glucocorticoids
  3. Slow-acting anti-rheumatic drugs (DMARDs)
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5
Q

What is the original NSAID?

A

Aspirin

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6
Q

Which NSAIDs are reversible vs irreversible?

A

Aspirin - Irreversible block of cyclooxygenase
Other NSAIDs - Reversible block

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7
Q

What is the toxicity of NSAIDs?

A
  • All are gastric irritants
  • All can cause nephrotoxicity and hepatotoxicity
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8
Q

Which NSAIDs inhibit COX and lipoxygenase?

A

Indomethacin and Diclofenac

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9
Q

Which NSAID inhibits COX1 > COX2?

A

Aspirin

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10
Q

Which 2 NSAIDs inhibit COX1 = COX2?

A

Ibuprofen and Ketorolac

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11
Q

Which 2 NSAIDs inhibit COX1 < COX2?

A

Celecoxib and Meloxicam

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12
Q

Acetaminophen is used when ___________ effect of NSAIDs isn’t required

A

anti-inflammatory

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13
Q

What are the 3 biologic DMARDs?

A

Abatacept
Rituximab
Adalimumab

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14
Q

What are the 5 mediators released during chronic inflammation?

A
  • Interleukins
  • GM-CSF
  • TNF
  • Interferons
  • PDGF
    All increase WBCs
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15
Q

Acute inflammation is mediated by ______

A

autocoids

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16
Q

Describe how aspirin is an irreversible inhibitor

A

Aspirin acetylates serine group, obstructing AA access → Irreversible block of cyclooxygenase → prevents platelet activation by TXA2
- lasts as long as platelets do (8-10 days)

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17
Q

What medication can cause Reye syndrome?

A

Aspirin - when given to kids after a viral illness

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18
Q

Aspirin can cause ________ poisoning

A

salicylate

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19
Q

Why should NSAIDs be avoided in pregnancy? What medication is the alternative?

A
  • Fetal kidney development, decreased amniotic fluid
  • Acetaminophen
20
Q

What is the treatment for aspirin OD?

A

activated charcoal, IV fluids, dialysis

21
Q

Patients with _______ allergies can’t take celecoxib

A

sulfonamide

22
Q

NSAIDs that are COX-2 selective have fewer _______ effects

A

GI

23
Q

What is the black box warning for celecoxib?

A

Increased risk of serious adverse CV events - Inhibition of prostacyclin (PGI2) production

24
Q

What medication can be taken with diclofenac that can decrease adverse effects?

A

misoprostol

25
Q

What are the indications for indomethacin?

A
  • Rheumatism
  • Gout
  • Patent ductus arteriosus
26
Q

What keeps a PDA open after birth?

A

prostaglandins

27
Q

What NSAID can be used in conjunction with opioids to decrease pain?

A

Ketorolac

28
Q

Why isn’t acetaminophen considered an NSAID?

A

No anti-inflammatory effect, just pain

29
Q

Acetaminophen is COX-__ selective

A

2

30
Q

Aspirin has a vaso_____ effect in peripheral tissues, but a vaso_____ effect in the CNS

A

dilation, constriction

31
Q

Differentiate between acute and chronic effects of glucocorticoid use

A

acute - suppresses inflammation, salt and water retention, improved cognitive function, mobilizes energy stores

chronic - immunosuppression, diabetes, depression, HTN

32
Q

Glucocorticoids inhibit immune response by blocking ______

A

transcription/translation

33
Q

What are the 3 options for glucocorticoids?

A
  • Hydrocortisone
  • Prednisone
  • Dexamethasone (longer acting)
34
Q

What are the indications for glucocorticoid use?

A
  • Suppression of inflammation
  • Addison’s Disease
  • Post-adrenalectomy (Cushing’s disease)
  • Fetal lung maturation
35
Q

DMARDs clinical uses

A
  • Reduced Inflammation
  • Joint disorders - decreased damage to bones and joints
36
Q

Biologic DMARD that blocks T-cell activation

A

Abatacept

37
Q

Biologic DMARD that depletes B-lymphocytes

A

Rituximab

38
Q

Biologic DMARD that is anti-TNF-α

A

Adalimumab

39
Q

Chronic exposure to inflammatory mediators leads to increased:

A
  • Cell proliferation
  • Mutatgenesis
  • Oncogene activation
  • Angiogenesis
40
Q

Describe tumor-promoting inflammation

A

Initiation: Inflammatory response increases mutational rates
- Inflammatory cells emigrate to tumor cells
- ROS accumulation
Promotion: Cytokines activate transcription factors (NF-kB / STAT3) in premalignant cells

41
Q

What are the 5 pharmacokinetic properties of NSAIDs?

A
  • Weak acids
  • Well absorbed
  • Highly metabolized
  • Renal and biliary excretion
  • Highly protein-bound
42
Q

Define the MOA for GI upset with all NSAIDs.

A
  • Buffering may decrease (especially with COX1 inhibitors)
    Cause:
  • Irritation of gastric mucosa
  • Inhibition of GI protective prostaglandin
  • Increase incidence of gastric ulcers
43
Q

Define the MOA of glucocorticoids.

A

Glucocorticoids inhibit the conversion of phospholipids to AA by inhibiting phospholipase; this inhibits all of the AA products, decreasing inflammation and suppressing immune function

44
Q

Explain the selection criteria for NSAIDs.

A
  • Cost
  • Toxicity
  • Personal factors
45
Q

Determine toxicity of aspirin from nomogram.

A

Pharm 2024 (32 decks)

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