Pharm: NSAIDs and Non-Narcotic Analgesics Flashcards
Explain the relationship between inflammation and AA, COX-1, and PGE2?
- Inflammation stimulates AA release
- COX-1 converts AA –> PGE2
- PGE2 causes sx’s –> erythema, edema, and pain
What is the role of COX-2 in relation to the inflammatory resposne?
- Inflammation also induces COX-2 expression
- COX-2 also converts AA –> PGE2 which amplifies sx’s of COX-1 activation
- Worse erythema, edema, and pain
How does the location and action of COX-1 vs. COX-2 differ?
- COX-1 expressed in ‘all’ tissues, ‘all’ the time –> prominent role = responding to physiological stimuli
- COX-2 induced in ‘some’ tissues, ‘some’ times: has physiologic role in kidney, complements COX-1 and prominent role in response to any pathologic stimuli that release AA from cells (i.e., inflammation)
What are the 4 major beneficial actions of Aspirin?
- Suppression of inflammation (due to COX-1 and COX-2 inhibition)
- Relief of mild to moderate pain (due to COX-1 and COX-2 inhibition)
- Reduction of fever (due to COX-1 and COX-2 inhibition)
- Prevention of MI and stroke due to inhibition of COX-1 in platelets, suppresses platelet aggregation
Because Aspirin inhibits COX-1 and COX-2, it may lead to what 3 complications?
- Gastric ulceration
- Bleeding
- Renal impairment
What is the nature of the interaction between cyclooxygenase and aspirin, but not other NSAIDs?
Irreversible
What is the effect of aspirin on cyclooxygenase and why is this significant?
- Irreversible inhibition of cyclooxygenase –> effects persist until cells make more COX because platelets cannot synthesize new COX
- Anti-platelets effects last for life of platelet (~8 days)
What are 2 ways to minimize risk of aspirin-induced ulcers?
- Test for/eliminate H. pylori before starting therapy
- Give a proton pump inhibitor
What are the effects of ibuprofen, naproxen, and other non-aspirin NSAIDs on the antiplatelet actions of aspirin?
Antagonize the antiplatelet actions
Pt’s on which drugs are at a higher risk of bleeding when taking aspirin?
Those on warfarin, heparin, and other anti-coagulants
Long-term aspirin use may lead to what serious kidney dysfunction?
Renal papillary necrosis
Aspirin can impair renal function, causing Na+ and H2O retention, edema and HTN, adverse outcomes are more likely in people with what conditions?
- Advanced age
- Pre-existing renal dysf.
- HYPOvolemia
- HTN
- Hepatic cirrhosis
- Heart failure
Aspirin can cause hypersensitivity rxns, especially in those with what underlying conditions; treated how?
- Asthma, rhinitis, and nasal polpys
- Tx w/ epinephrine
Explain the 5 stages of progression in aspirin/salicylate toxicity?
- Salicylates uncouple mitochondrial OxPhos in the CNS
- Respiratory center senses ↓ ATP as hypoxemia, responds w/ hyperventilation
- ↓ CO2 –> respiratory alkalosis - eventually prompts kidney to deplete HCO3
- Organic acids accumulate because ATP is no longer generated via Krebs cycle
- Metabolic acidosis becomes life-threatening
Although the MOA is similar to aspirin, what are some important difference with non-aspirin NSAIDs?
- Are reversible, so effects decline as blood levels decline
- Suppress platelet aggregation, but use acutally ↑ risk of MI and stroke
- Therefore, should use lowest effective dosage for shortest possible time
Which NSAID causes less gastric ulceration and is indicated for patients with chronic pain/inflammation whom suffer from GI problems (i.e., ulcers)?
Celecoxib –> selectively blocks COX-2
What are the AE’s of the 2nd gen. NSAID, Celecoxib?
- Does NOT inhibit platelet aggregation –> risk of bleeding
- ↑ risk of MI and stroke