NSAIDs II

Question 1

Mild Pain

Answer 1

Aspirin-like Drugs: 200-400mg ibuprofen or 650mg aspirin

Non Aspirin-like Drugs: 650-1000mg acetaminophen

Question 2

Moderate Pain

Answer 2

Aspirin-like Drugs: 600-800mg ibuprofen
400mg ibuprofen plus non-narcotic/narcotic combination analgesic equivalent to 60mg codeine
Non Aspirin-like Drugs: 600-1000mg acetaminophen and narcotic equivalent to 60mg codeine

Question 3

Severe Pain

Answer 3

Apirin-like Drugs: 600-800mg ibuprofen plus non-narcotic/narcotic combination analgesic equivalent to 10mg oxycodone
Non Aspirin-like Drugs: 1000mg acetaminophen and narcotic equivalent to 10mg oxycodone

Question 4

Time Horizons of Tooth Surgery, Endodontic Therapy and Periodontal Graft Surgery

Answer 4

Tooth Extraction: 1-3days
Endodontic Therapy: 1-7days
Periodontal Graft Surgery: 7+ days

Question 5

PGE1

Answer 5

Gastroprotective, Maintains patency of ductus arteriosus

Question 6

PGE2, F2a

Answer 6

Smooth muscle contraction, Nociceptor sensitization (NSAID targets)

Question 7

PGI2

Answer 7

Prostacyclin; Antiaggregatory on platelet, Vasodilator

Question 8

TXA2

Answer 8

Thromboxane; Platelet aggregation

Question 9

Therapeutic Actions of NSAIDs

Answer 9

Analgesic, Anti-inflammatory, Anti-pyretic, Anti-platelet (reversible); No sedative actions, No addictive potential; Few if any subjective effects

Question 10

Adverse Effects of NSAIDs

Answer 10

CNS: Headaches, Tinnitus, Dizziness
CVS: Fluid retention, Hypertension, Edema, Rarely MI and CHF
GI: Pain, Dysplasia, Nausea, Vomiting, Bleeding, Ulceration (long term use)
Hepatic: Abnormal liver function tests, Rare liver fail
Pulmonary: Asthma
Skin: Rashes, Pruritus
Renal: Renal insufficiency, Failure, Hyperkalema, Proteinuria

Question 11

Shorter Half-Life NSAID

Answer 11

4-6hrs
Aspirin
Ibuprofen
Diclofenac
Ketoprofen
Tolmetin

Question 12

Longer Half-Life NSAID

Answer 12

8hrs or longer
Celecoxib
Diflunisal
Nabumetone
Naproxen
Oxaprozin
Sulindac

Question 13

Ketoprofen

Answer 13

Effective at dosage of 100-300mg/d equivalent to other NSAIDs

Question 14

Nabumetone

Answer 14

Only non-acid NSAID in current use

Question 15

Naproxen

Answer 15

Only NSAID market as single enantionmer

Question 16

NNT

Answer 16

1/ARR

Question 17

NNT Ideal Results

Answer 17

Ibuprofen/200-400mg + Acetaminophen/500-1000mg: 1.5-1.6
Long duration (>8hrs): Difunisal/500mg, Acetaminophen/650mg + Oxycodone/10mg, Ibuprofen/400mg + APAP/1000mg

Question 18

COX 2 Inhibitors

Answer 18

Synthesized PGs are pro-inflammatory early, may reduce inflammation and promote healing later; Cardiovascular side effects - Salt and water retention

Question 19

Patients with Renal Insufficiency

Answer 19

Non-acetylated salicylates

Question 20

Risk of GI bleeding

Answer 20

COX2 inhibitors but higher risk of CV toxicity