Pain: Pharm - NSAIDS Flashcards by J H

Pain - NSAIDs

What are NSAIDs used for?

Analgesic, antipyretic, anti‐inflammatory
Used for mild – moderate pain (≤ 4‐6/10)
Have been shown to be more effective that
acetaminophen at full doses
No clinically significant difference in efficacy
Initial choice: empiric with consideration of patient
factors

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Pain - NSAIDs

What is the MOA of NSAIDs?

Cyclooxygenase inhibitors → block PG synthesis

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Pain - NSAIDs

Slide 43: MOA of NSAIDs

Look at slide 43 picture - MOA of NSAIDs

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Pain - NSAIDs

Does all NSAIDs have similar pharmacokinetics (PK)?

Yes

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Pain - NSAIDs

What are the pharmacokinetics (PK) similarities in all NSAIDs?

◦ Rapid & extensive absorption

◦ Highly protein bound

◦ Metabolized by the liver – variable half life

◦ Excreted in urine or bile

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Pain - NSAIDs

Does all NSAIDs have similar efficacy?

Yes: At equivalent doses

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Pain - NSAIDs

What are the 3 common groups of NSAIDs OTC?

ASA (Aspirin, Coated Aspirin, Entrophen, generics)
Ibuprofen (Advil, Advil Liqui‐Gels, Motrin, generics)
Naproxen (Aleve, generics)

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Pain - NSAIDs

Dosing for ASA?

◦ 325‐650mg q4h

◦ 500mg‐1g q6h

◦ Pediatric ‐ avoid

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Pain - NSAIDs

Dosing for Ibuprofen?

◦ 200–400 mg q4–6h PRN PO

◦ Maximum dose for self‐care: 1200 mg/day

◦ Maximum dose: 2400 mg/day

◦ Pediatric – 10mg/kg/dose

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Pain - NSAIDs

Dosing for Naproxen?

◦ 220–440 mg Q8–12H PRN PO

◦ Maximum dose for self‐care: 440 mg/day

◦ Use in children 12 years and older

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Pain - NSAIDs

What are the adverse Effects in the CNS system?

Headaches, tinnitus, and dizziness

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Pain - NSAIDs

What are the adverse Effects in the CVS system?

Fluid retention, hypertension, edema and rarely, myocardial infarction and congestive heart failure

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Pain - NSAIDs

What are the adverse Effects in the GI system?

Abdominal pain, dyspepsia, nausea, vomiting & ulcers/bleeding

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Pain - NSAIDs

What are the adverse Effects in the Heme system?

Rare thrombocytopenia, neutropenia, or even aplastic anemia.

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Pain - NSAIDs

What are the adverse Effects in the Hepatic system?

Abnormal LFT & rarely liver failure

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Pain - NSAIDs

What are the adverse Effects in the Pulm system?

Bronchospasm

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Pain - NSAIDs

What are the adverse Effects in the Skin system?

Rashes & puritus (includes anaphylactoid reactions, SJS & TEN)

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Pain - NSAIDs

What are the adverse Effects in the Renel system?

Renal insufficiency, renal failure, hyperkalemia, and proteinuria

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Pain - NSAIDs

Risk Factors for Serious Adverse Events

Slide 48 - table

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Look at table on slide 48

Pain - NSAIDs

Caution:

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◦ Renal dysfunction, solitary kidney CVD/CHF, HTN, 
   asthma, history of Peptic Ulcer Disease (PUD) or 
   Gastrointestinal bleeding (GIB)

◦ Avoid in severe hepatic failure – hepatorenal
syndrome

◦ Pregnancy – 1st trimester  miscarriage & 3rd trimester
premature closure of ductus arteriosus

Pain - NSAIDs

Contraindications:

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◦ ASA sensitive Asthma or hypersensitivity to
NSAID/ASA (bronchospasm, rhinitis, urticaria)

◦ Peri‐op pain post CABG

coronary artery bypass grafting - improved blood flow to heart

Pain - NSAIDs

PK - clearance of renally eliminated drugs (Lithium,
digoxin, aminoglycosides, vancomycin)

increase or decrease?

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decrease

Pain - NSAIDs

PD - renal toxicity with ACE‐I & other nephrotoxic drugs
(cyclosporine, methotrexate)

increase or decrease?

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increase

Pain - NSAIDs

PD - effectiveness of antihypertensives

increase or decrease?

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decrease

Pain - NSAIDs PD - with other potassium sparing drugs (ACE‐I, spironolactone) What happen?

hyperkalemia

Pain - NSAIDs PD - antiplatelet effect of low dose ASA increase or decrease?

decrease

Pain - NSAIDs PD - risk of bleeding antiplatelet & anticoagulants increase or decrease?

increase

Pain - NSAIDs PD - risk GI AE with smoking, systemic corticosteroids, LD ASA increase or decrease?

increase

Pain - NSAIDs NSAID monitoring Slide 51 ???

``` monitor for = abdominal discomfort - hematemesis/melena - bo - renal fx and fluid retention - pain and function ```

Pain - Topical NSAIDs Can be used to treat ________ conditions.

acute musculoskeletal

Pain - Topical NSAIDs Plasma concentrations usually < __% compared to oral administration

Pain - Topical NSAIDs Not recommended to use ___ and ___ concurrently

topical | oral

Pain - Topical NSAIDs According to Cochrane review 2010: Adults use Topical NSAIDs to treat _____

acute pain from strains, sprains, sports or overuse injuries

Pain - Topical NSAIDs According to Cochrane review 2010: Most compared NSAID to _____

placebo

Pain - Topical NSAIDs According to Cochrane review 2010: NNT = _____, for for 50% pain relief over a week

4.5

Pain - Topical NSAIDs According to Cochrane review 2010: Few systemic SE or withdrawals due to SE, local SE: 6%

Slide 52, sorry don't know how to put this statement as Q/A!

Pain - Topical NSAIDs Diclofenac 1.16% or 2.32% gel, 1.5% lotion applied TID‐QID (Voltaren Emulgel®) ◦ SE: Skin irritation, hypersensitivity, GI toxicity in clinical trials

Slide 52, sorry don't know how to put this statement as Q/A!

Pain - Topical Analgesics External analgesics include ___, ___, ___, ___

methyl salicylate menthol camphor capsaicin

Pain - Topical Analgesics How often to apply Topical Analgesics?

Applied 1‐3x /day

Pain - Topical Analgesics Limited efficacy but may be useful during rehabilitation as ___ or ___ rubs or as accompaniments to massage therapy Limited evidence for ___

cooling heating arnica montana (reduce bruising?)

Pain - Topical Analgesics External analgesics should not be applied to acute injuries if there is ___ or if the ___ are open or covered by dressings, since this can further irritate the wound area.

bleeding wounds

Pain - Topical Analgesics External analgesics should not be used concurrently with ___, as burns may result

thermotherapy devices

Pain - Topical Analgesics Health Canada Feb 2017: risk of serious skin burns with OTCs containing ___

menthol

Pain - Muscle Relaxants Muscle Relaxants is intended to provide pain relief for?

when muscle spasm is a component of an acute injury - Not recommended first line due to lack of efficacy

Pain - Muscle Relaxants List 2 examples of Muscle Relaxants:

methocarbamol chlorzoxazone

Pain - Analgesic Use in Pregnancy and Breastfeeding Pregnancy recommendations: (2)

◦ Drug of Choice = acetaminophen ◦ Restrict NSAIDs to 2nd trimester (increased risk of ductus arteriosus after this)

Pain - Analgesic Use in Pregnancy and Breastfeeding Breastfeeding recommendations: (2)

◦ Both NSAIDs and acetaminophen can be used safely ◦ Codeine is CYP2D6 substrate. If mother is ultra‐rapid metabolizer, can lead to toxic levels in infant when used while breastfeeding. Avoid If possible ◦ Monitor infant for lethargy, respiratory distress, poor feeding

Pain: Pharm - NSAIDS Flashcards

(47 cards)