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Ortho > Pharmacology Review > Flashcards

Pharmacology Review Flashcards

1
Q

Differently Classes of NSAIDs

A 
Salicylate (acetylated)
Salicylate (non-acetylated)
Popionic acids (phenyl-propionic acid)
Acetic acids
Oxicams
Fenamates
Nonacidic
Selective COX-2 inhibitors
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2
Q

When is NSAID therapy considered a failure?

A

2 weeks at max anti-inflammatory dose

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3
Q

MOA of NSAIDs

A

Inhibit cyclooxyrgenase which impairs the transformation of arachidonic acid to prostaglandins to prostacyclin and thromboxanes

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4
Q

What do COX-1 enzymes regualte?

A

Normal cellular processes such as gastric cytoprotection, vascular homeostasis, platelet aggregation, kidney function

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5
Q

SE of NSAIDs

A 
GI
Renal
CV
Liver
Pulmonary
Hematologic
Malignancy
Dermatologic
Healing of musculoskeletal injuries
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6
Q

Renal SE of NSAIDs

A 
Renal vasoconstriction
Acute renal failure
Hypertension
Hyperkalemia
Hyponatremia
Edema
Increased risk of renal cell cancer
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7
Q

Hepatic SE of NSAIDs

A

Elevation of liver transaminases
NSAID associated liver injury
More common in SLE and RA

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8
Q

Pulmonary SE of NSAIDs

A

SE more related to nonselective COX 1/2 inhibitors (less with COX2 selective)
Bronchospasm
Pulmonary infiltrates with eosinophilia

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9
Q

Hematologic SE of NSAIDs

A

Neutropenia

Anti platelet effects due to COX-1 inhibition

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10
Q

Anti-platelet Activity with NSAIDs

A

Need to continue ASA for cardioprotection
Interaction with warfarin (increase INR)
Higher risk of bleeding with anticoagulant use

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11
Q

CNS SE with NSAIDs

A

Aseptic meningitis
Tinnitus (usually salicylates)
Psychosis and cognitive impairment (indomethacin, elderly)

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12
Q

Dermatologic SE with NSAIDs

A

Drug rash
Pseudoporphyria
Blistering skin lesions (TENS, SJS)

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13
Q

Fracture Healing Effects with NSAIDs

A

Non-union

Avoid NSAIDs up to 90 days post fracture

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14
Q

Contraindications for NSAIDs

A 
N: nursing or pregnancy
S: serious bleeding
A: allergy, asthma, angioedema
I: impaired renal function
D: drug (anticoagulants)
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15
Q

Acetylated Salicylate Medication

A

Aspirin

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16
Q

How is the acetylated salicylate class different from the other classes?

A

Irreversible platelet inhibition for the life of the platelet

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17
Q

Medications in the Propionic Acids Class

A

Naproxen

Ibuprofen

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18
Q

Naproxen

A

Less CV risk

Naproxen base or naproxen sodium

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19
Q

Ibuprofen

A

Advil or Motrin
Short duration of effect
Alternative to naproxen

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20
Q

Medications in the Acetic Acids Class

A 
IV Ketorolac (Toradol)
Indomethacin (Indocin)
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21
Q

Ketorolac (Toradol)

A

Adjust dose based on age and weight
Moderate to severe post-op pain
Risk of gastropathy >5 days
Not for chronic pain or inflammation

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22
Q

Indomethacin (Indocin)

A

Immediate release and extended release formulations
Treats acute gout and pericarditis
Not for chronic use
May be associated with aplastic anemia

23
Q

Medications in the Oxicams Class

A

Meloxicam (Mobic)

Prioxicam (Feldene)

24
Q

Meloxicam (Mobic)

A

Long duration
Slow onset
Low doses: COX-2 selective

25
Q

Piroxicam (Feldene)

A

Treatment of chronic pain and inflammation poorly responsive to other NSAIDs
>20 mg QD = serious GI complications

26
Q

Selective COX-2 Inhibitor Medication

A

Celecoxib (Celebrex)

27
Q

Celecoxib (Celebrex)

A

No effect on platelets
Decreased GI toxicity
Dose related renal and CV effects (higher = more problems)

28
Q

Pain Management with Fractures

A

Acetaminophen (APAP) or NSAID

Sometimes narcotic analgesic

29
Q

Indications for Narcotics in Fractures

A 
Significant soft tissue swelling or ecchymosis
Pain at rest
Night pain
Pain uncontrolled by NSAIDs or APAP
Anyone who had surgery
May just need at night
30
Q

Narcotics for Pain Relief

A

Codeine
Hydrocodone
Oxycodone

31
Q

Codeine

A

Weak opioid
Mild to moderate pain
Schedule II/III
Metabolized to morphine

32
Q

Medications with Hydrocodone

A

Lorcet
Lortab
Norco
Vicodin

33
Q

Hydrocodone

A 
Schedule III
Moderate to severe pain
Onset: 10-20 min
Duration: 4-8 hours
Combination with acetaminophen
34
Q

Medications with Oxycodone

A

Percocet
Roxicet
Endocet

35
Q

Oxycodone

A 
Schedule II
Moderate to moderately severe pain
Onset: 10-30 minutes
Combination with acetaminophen
Avoid long acting for acute pain
36
Q

Long Acting Oxycodone Medication

A

MS Contin

37
Q

MOA of Noloxone (Narcan)

A

Reverses respiratory depression, sedation, and analgesia

38
Q

Never use Extended Release and Long Acting Opioid Analgesics in what Situations

A

Acute pain

Narcotic naive patient

39
Q

Toxicities of Opioids in General

A 
Sedation and respiratory depression
Constipation (need a bowel regimen)
Decreased effectiveness of diuretics
QT prolongation
Check for cytochrome P450 inhibitors or inducers
40
Q

Cytochrome P450 Inhibitors

A 
Bupropion
Fluoxetine
Paroxetine
Cimetidine
Acyclovir
Duloxetine
Fluoroquinolones
Ketoconazole
PPIs
Verapamil
Diltiazem
Grapefruit juice
41
Q

Cytochrome P450 Inducers

A 
Carbamazepine
Isoniazid
Tobacco
Rifampin
St. John's wort
42
Q

Extended Release and Long Acting Opioids

A 
Morphine sulfate ER: MS Contin, Kadian, Embeda, Avinza
Buprenorphine transdermal: butrans
Methadone: dolophine
Fentanyl transdermal: duragesic
Hydromorphone: exalgo
43
Q

Rules for Transdermal Administration

A

Never cut or tear a patch

Heat exposure can increase release and absorption

44
Q

Application of Transdermal Administration

A

Chest, side of waist, upper arm
Avoid hairy areas
Rotate sites
Wash site with water only

45
Q

MOA of Tramadol

A

Mu receptors

Inhibits NE and serotonin

46
Q

Tramadol

A

Effective for relief of neuropathic pain
Improved functional outcomes for fibromyalgia
May not be more effective than NSAIDs or nortriptyline for chronic pain

47
Q

Metabolism of Tramadol

A

Hepatic

48
Q

Use Caution with Tramadol in what Populations

A

Elderly

Renal insufficiency

49
Q

Skeletal Muscle Relaxants

A

Cyclobenzaprine (Flexeril)
Tizanadine (Zanaflex)
Metaxalone (Skelaxin)
Diazepam (Valium)

50
Q

Duration of Use of Muscle Relaxants

A

1-2 weeks

51
Q

SE of Muscle Relaxants

A

Sedation

Anticholinergic

52
Q

Muscle Relaxants with High Potential for Abuse

A

Diazepam (Valium)

Carisoprodol (Soma)

53
Q

Muscle Relaxants + NSAIDs

A

Synergistic effect for treatment of acute back pain

Ortho (22 decks)

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