NSAIDs (COX selective/Non-selective)

Question 1

Naproxen selectivity

Answer 1

Non-selective (Favor COX-1)

Question 2

Naproxen indications

Answer 2

1) Juvenile arthritis (JA)
2) Rheumatoid arthritis (RA)
3) Menstrual migraine → Naproxen alone
4) Migraine attacks → Treximet (Naproxen + Sumatriptan)

Question 3

Ketorolac selectivity and RoA

Answer 3

Non-selective (Favor COX-1)
Given as eyedrop

Question 4

Ketorolac indications

Answer 4

1) Prevent intraoperative miosis
2) Relieve ocular itching and inflammation related to: (Seasonal allergy rhinitis, After cataracts surgery)

Question 5

Meloxicam (Vivlodex) indications

Answer 5

Osteoarthritis pain management

Question 6

Flurbiprofen (Ocufen) indications

Answer 6

1) Prevent intraoperative miosis
2) Maintain pupil dilation for better visibility during cataracts surgery
3) Relieve: (discomfort, inflammation, photophobia) after surgery

Question 7

Meloxicam (Vivlodex) selectivity

Answer 7

Non-selective (Favor COX-1)

Question 8

Flurbiprofen (Ocufen) selectivity and RoA

Answer 8

Non-selective (Favor COX-1)
Given as eyedrop

Question 9

Diclofenac sodium (Voltaren) selectivity and RoA

Answer 9

Non-selective (Favor COX-2)
Given as: Oral, IV, SC, Suppository, Topical gel, ED (Epidural)

Question 10

Diclofenac sodium (Voltaren) side effects

Answer 10

Diclofenac has the least GI irritation, but has the highest hepatotoxicity

Question 11

Diclofenac sodium (Voltaren) indications

Answer 11

Joints pain, it achieves high concentration in synovial fluid

Question 12

Ibuprofen selectivity and RoA

Answer 12

Non-selective (Favor COX-2)
Given orally

Question 13

Ibuprofen indications

Answer 13

Patent Ductus Arteriosus (PDA) → we use ibuprofen when the ductus arteriosus has not closed properly after birth

Question 14

What does the suffix (-coxib) indicate in medications?

Answer 14

COX-2 selective

Question 15

All COX-2 selective NSAIDs and their properties

Answer 15

→ Celecoxib
→ Etorocoxib
→ Lumeracoxib
→ Parecoxib (the only FDA approved IV COX-2 inhibitor)
→ Rofecoxib (banned because of CVS mortality)
→ Valdecoxib (banned because of CVS mortality)
* All given orally except Parecoxib
(VR CLEP)

Question 16

Celecoxib half life and properties as COX-2 selective inhibitor

Answer 16

• Long half-life (11 hours → given once/twice daily)
• Celecoxib can be used as analgesic, antipyretic, and anti-inflammatory without inducing peptic ulcer → safe except in 2 cases:
• patients who are at risk; who already have peptic ulcer
• patients who use low-dose aspirin (COX-1 inhibitor)

Question 17

Celecoxib indications

Answer 17

1) Rheumatoid arthritis (RA)
2) Osteoarthritis

Question 18

Celecoxib contraindications

Answer 18

1) Avoided in patients with hepatic or renal diseases
2) Sulfonamides allergy patients

Question 19

Celecoxib side effects

Answer 19

→ NS: Headache
→ GI distress: Dyspepsia, Diarrhea, Abdominal pain
→ CVS: HTN, Thrombosis, Heart failure “Black-Box”