Ortho Pharm Review

Question 1

COX-1 enzymes

Answer 1

Regulates normal cellular processes (gastric cyctoprotection, vascular homeostasis, platelet aggregation, kidney function)
Block prostaglandins

Question 2

COX-2 enzymes

Answer 2

Expression of this is increased during states of inflammation
Effects of COX-2 inhibition on inflammation is not completely understood
NO GI Risk

Question 3

Some organ specific nsaid adverse reactions

Answer 3

Renal: vasoconstriction, acute renal failure, hypertension, hyperkalemia, hyponatremia, edema, increased risk of renal cell cancer
GI
CV
May delay fracture healing

Question 4

NSAID contraindications:

Answer 4

Nursing or pregnancy
Serious bleeding
Allergy/asthma/angioedema
Impaired renal function
Drug (anticoagulants)

Question 5

Max dose Ibuprofen

Answer 5

2400 mg per day (up to 3200 mg on day 1 if loading dose is used)
Usual analgesic dose is 400 mg every 4-6 hours

Question 6

Acetic acids

Answer 6

IV Ketorolac (Toradol)- Treatment of moderate to severe postoperative pain
Indomethacin (Indocin): Gout, pericarditis

Question 7

Oxicams

Answer 7

Meloxicam (Mobic): back pain, concerns about CV and HTN

Prioxicam (Feldene)

Question 8

Selective Cox-2 Inhibitor

Answer 8

Celecoxib (Celebrex): No effect on platelet function, Decreased GI toxicity, Dose related renal and CV effects

Question 9

Toxicities of all opioids in general

Answer 9

Sedation and respiratory depression
Constipation
Decreased effectiveness of diuretics
QT prolongation