Pharm Flashcards
NSAIDS
- what are the classes?
- what do you do if one class isnt working for a pt?
- what is the function of COX-1 and COX -2
Classes:
- salicylate (acetylated)
- salicylate (nonacetylated)
- proprionic acids
- acetic acids
- oxicams
- fenamates
- nonacidic
- selective cox-2 inhibitors
It is reasonable to substitute with a different class of failure of one drug. **Trial of 2 weeks at max anti-inflammatory dose before failure is considered.
COX-1: gastric cytoprotection, vascular homeostasis, platelet aggregation, kidney function)
COX-2: inhibits inflammation
NSAIDS:
- general MOA
- does IV administration of NSAIDS affect the gut?
- adverse effects?
General MOA:
-inhibits COX1 and COX 2 which impairs the tranformation of arachadonic acid to prostaglandins and thromboxanes.
Yes, I NSAIDS still have an effect on the gastric stuff, high incidence of gastritis
Adverse Effects:
- GI
- Renal
- CV
- Liver
- Pulmonary
- Hematologic
- Malignancy
- Dermatologic
- Healing of MSK injuries
Describe the effects of NSAIDS on:
- renal
- hepatic
- pulmonary
- heme
- CNS
- skin
- fx healing
Renal:
-acute renal failure, hypertension, hyperkalemia, edema, renal vasoconstriction
Hepatic:
-elevation of liver transaminases
Pulmonary:
- bronchospasm
- pulmonary infiltrates with eosinophilia
Heme:
- neutropenia
- antiplatelet effects d/t inhibition of COX-1
- -interaction with warfarin (may increase INR)
- -higher risk of bleeding with anticoagulant use.
CNS:
- aseptic meningitis
- tinnitus (usually w/ salicylates but can occur with all NSAIDS)
- psychosis & Cognitive impairment (MC with indomethacin)
Skin:
- drug rash or pseudopophyria (blister with sun exposure)
- blistering skin lesions that may be life threatening (TENS. SJS)
Fx healing:
- may cause non-union
- AVOID NSAIDS 90 post fx
NSAIDS:
-CI
CI:
- NSAID:
- -Nursing or pregnancy
- -Serious bleeding
- -Allergy/asthma/angioedema
- -impaired renal function
- -Drug (anticoagulants)
NSAID; SALICYLATE:
- drug name in this class
- special MOA features from other NSAIDS
- use
Drug name: Aspirin
MOA:
-different from other classes by irreversible platelet inhibition for the life of the platelet.
Use:
-use for CV protective effects, dont use for pain.
NSAID: Proprionic Acids:
-Drugs in this class
Drugs:
- Naproxen*
- -aleve
- -naprosyn
- Ibuprofen*
- -advil
- -motrin
Proprionic Acid: NAPROXEN
- does this have a CV risk?
- maximum daily dose?
- indications
YES, all NSAIDS have CV risk, but this one has the lowest.
Maximum daily dose: 1250mg daily dose day 1. 1000mg subsequent daily doses.
Indications:
good choice for tx of acute or chronic pain if an NSAID is indicated.
Proprionic Acid: IBUPROFEN:
- max dose
- usual analgesic dose?
Max dose: 2400mg/day with loading dose of up to 1600mg.
analgesic dose: 400mg q 4-6hrs
NSAIDS: Acetic acids:
-medications
Meds:
- IV ketorolac (toradol)
- Indomethacin (Indocin)
Acetic Acid: TORADOL
- indications
- route of admin
Indications:
- tx of moderate to severe post op pain
- not for chronic pain/inflammation
Route: NOT for oral
Acetic Acid: INDOMETHACIN:
- max dose
- indications
- SE
Max dose: 150mg/day
Indications:
-acute gout and pericarditis
SE:
-aplastic anemia
NSAID: Oxicams:
-drugs in this class
Drugs:
- meloxicam (Mobic)
- Prioxicam (Feldene)
Oxicams: MELOXICAM
-dosing
Oxicams: PIROXICAM:
- indications
- dosing
Dosing: once daily dosing.
PIROXICAM:
- indications: chronic pain that is unresponsive to other NSAIDS
- once daily dosing.
NSAIDS: Selective Cox-2 inhibitor:
- drug
- no effect on what?
Drugs:
-celecoxib (Celebrex)
No effects on platelet function
Fracture:
- tx
- who require narcotics?
Tx:
-usually treated with APAP or NSAID, occasionally narcotics
Requirements for narcotics:
- significant soft tissue swelling, echymosis suggests significant injury.
- pain at rest
- night pain
- pain uncontrolled with NSAIDS or APAP
- anyone who had surgery
