Pharm 22 - NSAIDs (add more here)

Question 1

indications for acetaminophen

Answer 1

analgesic (mild to mod. pain)

antipyretic

Question 2

MOA for acetaminophen

Answer 2

analgesic effect unknown

antipyretic action: direct action on hypothalamic heat regulating center

Targets/inhibits prostaglandin synthesis in CNS

Question 3

SE of acetaminophen

Answer 3

very well tolerated except in OD

Acute poisoning: N/V, drowsiness, liver toxicity, acute renal failure

Question 4

MAX dose for acetaminophen: healthy adults

Answer 4

4 grams

Question 5

MAX dose for acetaminophen: elderly/mild liver dysfunction

Answer 5

3.1 grams

Question 6

MAX dose for acetaminophen: moderate liver dysfunction or ETOH use

Answer 6

2 grams

Question 7

MAX dose for acetaminophen: liver disease patients with EtOH use OR heavy EtOH use

Answer 7

NONE

Question 8

Advantages of APAP

Answer 8

1. Inexpensive
2. No risk of dependence, addiction or diversion
3. Antipyretic as well as analgesic
4. No effect on platelets
5. Very low risk of GI bleeding
6. Very low risk of renal dysfunction unless overdosed
7. Little to no drowsiness
8. Chronic use may have benefit over occasional use in chronic pain

Question 9

Disadvantages of APAP

Answer 9

1. Mild to moderate pain
2. Risk of OD
3. Total daily dose is a limiting factor for combo products
4. Confusion about which products contain APAP

Question 10

Hypothalamus-Pituitary-Adrenal axis

Answer 10

CRH is release from the hypothalamus

CRH stimulates the pituitary gland to release ACTH

ACTH stimulates the adrenal cortex to release cortisol

Cortisol turns off the pathway –> administration of exogenous cortisol will stop the body’s own endogenous production of cortisol

Question 11

Indications for glucocorticoids

Answer 11

allergic or inflammatory conditions

autoimmune disorders

replacement of cortisol levels in adrenal insufficiency

lymphomas, some types of leukemia

respiratory distress in premature infants

Question 12

A/E of corticosteroids - short term

Answer 12

i. Stimulation/agitation (euphoria, psychosis, insomnia)
ii. Hyperglycemia
iii. Appetite changes (increases or decreases)

Question 13

A/E of corticosteroids - long term

Answer 13

• Cushingoid features
• Osteopenia/osteoporosis
• Impaired immune response
• Thinning skin

Question 14

Corticosteroid withdrawal

Answer 14

5 days use: NO withdrawal likely

7-10 days: MAY cause withdrawal/rebound

> 10 days: watch out for rebound

Question 15

triamcinolone

Answer 15

injected into joints

Question 16

dexamethasone

Answer 16

treats chemo nausea after other agents have been tried

Question 17

Hydrocortisone

Answer 17

topical and not oral

rectal foam or enema to Tx IBD

Question 18

short acting corticosteroids

Answer 18

hydrocortisone

Question 19

intermediate acting corticosteroids

Answer 19

methylprenisolone
triamcinolone
prednisone

Question 20

long acting corticosteroids

Answer 20

dexamethasone

Question 21

NSAID indications

Answer 21

mild to moderate pain
fever
inflammatory diseases (like RA)
primary dysmenorrhea
dental pain
migraines

Question 22

NSAID MOA

Answer 22

inhibit one or both of the major forms of COX

Question 23

NSAID dosing

Answer 23

lower doses treat mild-moderate pain and counteract fever

higher doses to treat arthritic disorders and injuries

Question 24

NSAID S/E GI

Answer 24

N/V/D/Constipation
Gastritis
GI bleeding
Hepatic dysfunction

Question 25

NSAID S/E CV

Answer 25

Exacerbation of CHF

Some inhibit platelet aggregation

Question 26

NSAID S/E Renal

Answer 26

Acute renal insufficiency - esp. in dehydration or preexisting renal disease