Pharm 22 drugs

Question 1

List the COX-2 inhibitors (NSAIDs)

Answer 1

Celecoxib (selective)

Meloxicam (partially selective)

Question 2

MOA of COX-2 inhibitors

Answer 2

Reversibly inhibits COX-2 only (prostaglandin inhibition)

Less GI toxicity and does not inhibit platelets due to no COX-1 inhibition

Question 3

Contraindications of COX-2 selective inhibitor - Celecoxib

Answer 3

Sulfa or sulfonamide allergy

Avoid in renal insufficiency, severe heart disease, dehydration or liver failure

Question 4

COX-2 selective inhibitors may increase CV risk for what?

Answer 4

Thrombosis, MI, and stroke

Question 5

ASEs of COX-2 inhibitors?

Answer 5

Thrombosis, Diarrhea, dyspepsia, and abdominal pain

Question 6

List the non-selective COX-2 inhibitors (NSAIDs)

Answer 6

Ibuprofen

Ketorolac

Naproxen

Indomethacin

Nabumetone

Diclofenac

Question 7

MOA of non-selective COX-2 inhibitors (NSAIDs)

Answer 7

Inhibits prostaglandin synthesis by blocking COX-1 and 2

Question 8

ASEs of non-selective COX-2 inhibitors (NSAIDs)

Answer 8

GI ulcers or bleeding (especially indomethacin)

Renal toxicity

Question 9

Contraindications of non-selective COX-2 inhibitors (NSAIDs)

Answer 9

Active GI bleed

Renal insufficiency

Anticoagulant use

Aspirin allergy

Liver dysfunction

Asthma

Question 10

MOA of acetaminophen

Answer 10

Analgesia via inhibition of prostaglandin synthesis in the CNS

Blocks pain impulse generation peripherally

Antipyretic via inhibition of the hypothalamic heat-regulating center

Question 11

Max dose of acetaminophen in healthy adults?

Answer 11

4g/daily

Question 12

Where is acetaminophen metabolized and excreted?

Answer 12

Liver and urine

Question 13

ASEs of acetaminophen?

Answer 13

Hepatotoxicity or nephrotoxicity in high doses

Rash

Question 14

List salicylate drugs used for pain

Answer 14

Aspirin and transdermal salicylates

Question 15

MOA for salicylates

Answer 15

Irreversibly inhibits COX-1 and 2

Platelet aggregation

Question 16

ASEs for salicylates?

Answer 16

Reye syndrome in children with viral infections

Acute renal failure

Interstitial nephritis

Bleeding

Gastric mucosal injury

Question 17

Contraindications for salicylates?

Answer 17

Pregnancy

Surgery - d/c 1 week prior to surgery

Question 18

S/s of salicylate toxicity?

Answer 18

Vertigo

Tinnitus

Hearing loss

N/V

Diarrhea

Respiratory alkalosis

Hyperpnea

Question 19

Drug interactions with salicylates?

Answer 19

Enhances the effect of lithium, warfarin, heparin, and digoxin

ASA + antacids may slow its absorption rate,

Question 20

List salicylates for GI conditions

Answer 20

Mesalamine (IBD tx)

Sulfasalazine (tx to reduce/maintain remission of crohns)

Question 21

List nonacetylated salicylates

Answer 21

Choline magnesium trisalicylate

Salsalate (low GI risk)

Question 22

Indomethacin short term use?

Answer 22

Gout flares

Question 23

Nabumetone cause less or more direct GI effect?

Answer 23

Less direct effect, can still cause indirect interference w/ GI lining

Question 24

Which is longer acting; ibuprofen or Naproxen?

Answer 24

Naproxen - 8-12hrs vs Ibuprofen q6 hrs

Question 25

Dosing of Ketorolac?

Answer 25

Always give lower effective dose d/t it being VERY potent causing ASEs

Question 26

What is the restriction of Ketorolac for moderate to severe pain?

Answer 26

Restriction of 10 day therapy

Question 27

Medical indications for Celecoxib (COX-2 selective inhibitor)

Answer 27

Osteoarthritis

RA

Dysmenorrhea

Acute pain

(chronic conditions use lower dose compared to acute conditions)

Question 28

choice of drug for low GI and low CV risk?

Answer 28

Celecoxib or other low risk NSAID

Question 29

choice of drug for moderate GI and low CV risk?

Answer 29

Celecoxib alone

OR

NSAID + PPI, misoprostol or double dose H2 blocker

Question 30

choice of drug for high GI and low CV risk?

Answer 30

Avoid NSAIDs if possible

OR

Celecoxib + PPI or Misoprostol

Question 31

choice of drug for low GI and high CV risk?

Answer 31

Naproxen

OR

low dose celecoxib

(if on ASA: naproxen + gastroprotection)

Question 32

choice of drug for moderate GI and high CV risk?

Answer 32

Naproxen + PPI

OR

Misoprostol or double dose H2 blocker

OR

Low dose celecoxib

Question 33

choice of drug for high GI and high CV risk?

Answer 33

Avoid NSAIDS!!!

Question 34

MOA of aspirin?

Answer 34

nonspecific inhabitation of COX

Irreversibly binds to COX in platelets

Inhibits platelet aggregation for up to 14 days

Question 35

Avoid ASA in children d/t risk of?

Answer 35

Reye Syndrome

Question 36

ASA can cause hypersensitivity resulting in?

Answer 36

Fetal anaphylaxis

Question 37

MC ASE of aspirin?

Answer 37

GI irritation w/ risk of peptic ulcer

Question 38

How does nonacetylated salicylates: Salasate and Choline magnesium salicylate differ from Aspirin?

Answer 38

Lower GI risk

Reversible effect on platelet COX