Pharm2 7 Pain pt2

Question 1

Ibuprofen and Others NSAIDs
Therapeutic effects (2)
How does it effect COX?

Answer 1

Analgesic
Antiinflammatory
Reversible inhibitors of COX - Inhibition only lasts for life of the DRUG.

Question 2

Ibuprofen and Others NSAIDs can have adverse effects. why?

Answer 2

Nonselective inhibitor of COX (adverse effects)

Analgesic ceiling

Question 3

Non-steroidals: Steve Nissen discovered they do what? With which drug specifically?

Answer 3

increase the risk of heart attack. This was first recognized as a possibility with Vioxx (Rofecoxib)

Question 4

Of all the non-steoridals that are NOT selective, what has the highest risk of cv events?

Answer 4

Meloxicam. Despite this being very dangerous, it still continues to be written.

Question 5

Every nonsteroidal increases cv risks, including aspirin! Why is it used then?

What’s the #2 least likely non-steroidal to lead to cv risks?
Which drug has an increased risk of CHF?

Answer 5

But aspirin’s BENEFITS greatly exceed risks.

Ibuprofen

Naproxium sodium

Question 6

Which NSAIDs for Young & healthy patients (2)

Answer 6

ibuprofen (3 or 4x day) or naproxium sodium (BID) – naproxium is more freq written b/c it’s easier to take

Question 7

Which NSAID for patient at higher cv risk.

Answer 7

naproxium sodium as a first choice, unless there is any hx of CHF – then use ibuprofen

Question 8

Which NSAID for if family hx of CVA or poorly controlled BP to put them at risk of CVA

Answer 8

back away from naproxium and use ibuprofen.

Question 9

Ibuprofen adult regiment

Answer 9

100mg per hour. 800 mg every 8 hours, 600 mg tablet every 6 hours, etc. 2 200 tablets every 4 hours.
Cheapest formulation to buy it in: 200 mg. and you buy a big giant jar OTC and costco or cvs.

Question 10

Ibuprofen’s 3 effects. When is each?

Answer 10

Has analgesic, antipyretic, and antiinflammatory effects – BUT NOT AT THE SAME TIME!
analgesic & antipyretic – after the first dose.

Question 11

Ibuprofen only has antiinflammatory effects when?

Ex: 400mg every 4 hours? how long will it take?

Answer 11

After 5 doses, aka when you reach steady state level.

20 hours.

Question 12

Ibuprofen plan for a general injury.

Answer 12

600mg Motrin with food (substantial food or it’ll be irritating) after first dose you have a degree of analgesia and pain control.
What’s more important is icing and elevating your injury. That’ll have a bigger effect.
Tomorrow when you take your 5th dose you’ll start getting the antiinflammatory properties. So stress to the patient they need to ice and elevate until then.

Question 13

___ is a “phenomenally good pain med, one of the best.”

Answer 13

Ibuprofen

Question 14

if patient says they tried ibuprofen otc and it doesn’t work for them, but Aleve does…are they most likely telling the truth or not?

Answer 14

Yes, It makes sense b/c they go through 2 diff substrates of your CYP450 pathway.
So if someone says one or the other doesn’t work for them, switch pain meds. “I do that all the time.”

Question 15

Celecoxib
What is this?
When would this be used?

Answer 15

COX-2 selective NSAID.

If they’ve been on a PPI for the last 5 years to prevent ulcers & never had a medication reconciliation
. It does not eliminate GI bleeding. It reduces it by 8%.

Question 16

Most NSAIDS are COX 1> COX-2

Name 2 drugs that are = for both
Name 3 drugs that are cox 2>cox 1

Answer 16

Nabumetone and Etodolac: COX-1 = COX-2

Celecoxib, Rofecoxib, Valdecoxib: COX-2 > COX-1

Question 17

When would COX 2 > COX 1 be used?
(Celecoxib, Rofecoxib, Valdecoxib)

Name 3 drugs that fall under this

Answer 17

GI problems. If they’ve been on a PPI for the last 5 years to prevent ulcers & never had a medication reconciliation
You choose cox-2 b/c a pt has a GI problem. It does not eliminate GI bleeding. It reduces it by 8%..

Question 18

Selective COX-2 inhibitors

2 therapeutic effects

Answer 18

Analgesic, Antiinflammatory.

Question 19

Celecoxib (Celebrex)
Half life
Where’s it metabolized?
CI

Answer 19

Half life ~ 12 hours
Metabolized in liver
Relative CI with sulfa allergies (contains a sulfur atom)