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BVetMed 3 Principles of Science Term 3 > Rational Use of NSAIDs > Flashcards

Rational Use of NSAIDs Flashcards

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Biology 101 flashcards
1
Q

How do NSAIDs reduce inflammation?

A

inhibit the production of prostaglandins released by damaged tissue by inhibiting cyclo-oxygenase

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2
Q

When are NSAIDs indicated?

A
  • controlling pain and inflammation in NON ALLERGIC disorders e.g. degenerative joint disease
  • Peri-operative pain management
  • Decreasing platelet aggregation e.g. heartworm disease, thromboembolism
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3
Q

What is the name of the pathway that NSAIDs act on and what are the products of these pathways?

A

Cyclooxygenase pathway
COX-1 (physiologic COX)
COX-2 (the inducible COX)

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4
Q

What is the role of COX-1?

A

Physiologic roles- mucosal protection, renal blood flow & haemostasis

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5
Q

What is the role of COX-2?

A

Inducible behaviours- inflammation, pain & fever

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6
Q

How does inhibiting COX-2 helps with tumours?

A

Tumours produce COX-2 so inhibiting can slow the growth of these tumours

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7
Q

What are the three types of NSAIDs?

A
  1. Non selective
  2. Preferential (mainly inhibit COX-2 with some COX-1 inhibition)
  3. Selective (inhibit COX-2 without inhibiting COX-1)
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8
Q

How do Corticosteroids reduce inflammation?

A

Block the production of Phospholipase from the membrane
Phospholipase is usually used to make arachnoid acid which is needed to make COX-1 / COX-2
Therefore Corticosteroids block both COX-1 and COX-2

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9
Q

Why are some NSAIDs more toxic than others?

A

Their COX-1 : COX-2 ratios differ so have different levels of safety depending on their inhibition of COX-1 (the physiological one)

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10
Q

Give two examples of non selective COX inhibitors?

A

Aspirin
Phenylbutazone
Ketoprofen
Tolfenamic acid

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11
Q

What are Preferential COX-2 inhibitors good for but what is the risk?

A

Good for analgesic and anti-inflammatory activity by blocking COX-2
BUT some COX-1 inhibition is possible at elevated doses

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12
Q

Preferential COX-2 inhibitors also includes drugs known as…..
Why?

A

Coxibs- COX-2 selective in humans but NOT in animals

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13
Q

Give two examples of Preferential inhibitors of COX-2?

A

Meloxicam / Metacam
Carprofen
Mavacoxib
Cimicoxib

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14
Q

What is the duration of action like for Mavacoxib?

A

VERY long!- can be given as an NSAID once a month

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15
Q

Give two examples of selective inhibitors of COX-2?

A

Firocoxib
Robenocoxib

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16
Q

How do non NSAID Osteoarthritis drugs work?

A

Prostaglandin (PGE2)- binds to 4 receptors- the EP4 receptor is responsible for pain and inflammation associated with osteoarthritis- inhibiting this receptor inhibits the pain

17
Q

Give an example of a non NSAID Osteoarthritis drug?

A

Grapiprant / Galliprant

18
Q

Which two NSAIDs are preferred to administer to dogs and what is their mechanism of action?

A

Carprofen (the COX-2 preferential)
Firocoxib (COX-2 selective)

19
Q

What is the risk of using Carprofen in cats?

A

Daily dosing leads to GI disaster!- think holes in the intestine

20
Q

Can we use Firocoxib in Cats?
How does its inhibition differ in cats than dogs?

A

Technically no- not licensed in cats
Acts as a COX-2 preferential in cats rather than selective

21
Q

Which NSAIDs are preferred in Horses and what is their mechanism of action?

A

Carprofen (non selective)
Firocoxib (selective)

22
Q

How/ Where are NSAIDs best absorbed?

A

from stomach & small intestine
well absorbed after subcutaneous or intramuscular injection

23
Q

How do the biological properties of NSAIDs make them effective in targeting inflamed tissue?

A

Weak acids to readily penetrate inflamed tissue
Highly protein bound so readily accumulate in protein rich inflammatory exudate

24
Q

Which route of elimination do NSAIDs follow?

A

Hepatic

25
Q

Can we give Paracetamol to companion animals?

A

Cats- NO
Dogs- Yes

26
Q

What are some potential side effects of NSAIDs?

A

GI damage
Renal toxicity
Haematological such as blood clotting

27
Q

When there is no pre existing GI injury, are NSAIDs still a risk?

A

Depends on the NSAID- Non selective ones are higher risk as COX-1 and COX-2 need to be inhibited to generate a mucosal injury in the absence of a pre existing one

28
Q

How do NSAIDs cause GI damage?

A

Disrupt the mucosal gel layer of the GI tract meaning acid is let in

29
Q

Why do COX-2 selective drugs have higher GI risks in dogs?

A

Dogs have a higher requirement for COX-2 in the duodenum (both COX have protective roles in the duodenum but COX-2 has a bigger role) so COX-2 inhibitors cause a higher degree of duodenal ulceration compared with non selective NSAIDs

30
Q

What can increase the ulcerogenic potential of an NSAID?

A

Concurrent corticosteroids
Dehydration
Hypovolaemic Shock

31
Q

How does COX-2 inhibition effect the kidney?

A

COX-2 has physiological roles in the kidney so when renal perfusion is reduced, COX-1 and COX-2 maintain renal blood flow through vasodilatory actions hence why you cannot use NSAIDs in a dehydrated animal

32
Q

Can we use Galliprant (the EP4 receptor antagonist) as an alternative to NSAIDs in patients with renal compromise?

A

NO- EP4 is expressed in the glomerulus and collecting duct & helps regulate glomerular tone and renin release

33
Q

Why do NSAIDs carry the risk of Haematopoietic side effects?

A

COX-1 inhibitors also inhibit Thromboxane which is a vasoconstrictor and activates platelet aggregation- inhibition of this can lead to increased bleeding

34
Q

Due to the risk of Nephrotoxicity with NSAIDs in patients with pre exisiting renal issues, can we use ACE inhibitors to reduce inflammation instead?

A

NO- ACE inhibitors decrease renal vascular resistance, therefore increasing blood flow which strains the renal system

35
Q

What effect does alpha2 agonists have on NSAIDs?

A

Using alpha2 agonists as premedication before administering an NSAID may enhance the analgesic and anti-inflammatory effect of NSAIDs but also improve gatstrointestinal tolerability

36
Q

Why should you avoid a high dose of Acepromazine as a pre medication before administering an NSAID?

A

Acepromazine interacts with NSAIDs- causes an increased risk of Hypertension

37
Q

What is the result of using Diuretics and NSAIDs at the same time?

A

COX-2 inhibition reduces the effect of the diuretic

BVetMed 3 Principles of Science Term 3 (12 decks)

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