T3-Analgesics: NSAIDS-MJ Flashcards
Is acetaminophen technically a NSAID?
No
What do both NSAIDs and acetaminophen do?
Both inhibit cox
When there is tissue injury, arachidonic acid is going to be released, and two cox will be released from the arachidonic. What are the two cox?
COX-1
COX-2
Which is the “good cox” and what does it do?
COX-1
Gastric protection, platelet activation
What is the “bad cox” and what does it do?
COX-2
Pain, inflammation
What do NSAIDs do?
Block COX-1 and COX-2
Is there selectivity in regards to how much COX and which COX is being inhibited?
Yes, some NSAIDs block a little more COX-1, some may block a little more of COX-2
What drugs are more selective for COX-1?
Aspirin
Naproxen
Ibuprofen
What drugs are more selective for COX-2?
Meloxicam
Celecoxib
Diclofenac
NSAIDS cause an ____ in Na and ____ in renal blood flow
Increase in Na
Decrease in renal blood flow
Some of the adverse effects with NSAIDS deal with the blocking of pathways that can cause issues in the kidneys. What are some of those related issues?
Hypertension
Edema (may worsen heart failure)
Acute kidney injury
NSAIDS are also highly associated with __ issues.
GI
What are the two main GI issues that NSAIDs cause?
GI ulcerations
GI bleeding
If you are taking NSAID meds for 3-6 months, what is your risk for GI issues? Is this a good percentage?
1%; it sounds good but in reality it isn’t since these NSAIDs are such common meds that the large population takes
If you are taking NSAID meds for 12 months or so, what is your risk for GI issues?
2-4%
Is there a black box warning for NSAIDs?
Yes
The black box warning for NSAIDs is controversial. Why?
The warning came because there was an increase in stroke and MI with people taking COX-2 NSAID drugs. It is controversial because what about COX-1? There is no real evidence supporting COX-1 inhibiting NSAIDs do the same
What is the ONE NSAID that is the exception to the black box warning? Why?
Aspirin; it PROTECTS against MI and stroke
If someone is about to have surgery, is aspirin a suitable drug to give them?
No-bleeding risk
What does aspirin do in the body that makes it so dangerous to take before surgery?
Aspirin binds to the platelets irreversibly! You can’t just stop taking aspirin one day before a surgery. It has to be a week or so because when aspirin binds to a platelet irreversibly you have to wait for your body to make NEW platelets before having a surgery. It may take the body a week or so to make the new platelets
Can children take aspirin?
No
Why can’t children take aspirin?
Increase risk for Reye’s Syndrome
Is it okay to take aspirin during pregnancy?
No
Why is it not good to take aspiring during pregnancy?
Increase risk for bleeding
Can we give a patient acetaminophen before a surgery?
Yes
What are some of the characteristics of acetaminophen? (four)
- No anti-inflammatory effect
- No platelet effect
- No GI ulceration
- No renal impairment
Does acetaminophen work well for patients with arthritis?
No
T or F: Acetaminophen is lipid soluble.
TRUE
Where all does acetaminophen inhibit COX?
ONLY in the CNS
Why is acetaminophen a good drug to give for patients with fever?
Fever is controlled centrally by the hypothalamus, which is why it’s a good drug to take with fever
What is acetaminophen’s effect?
Reduces fever
Analgesia
Should we only ever give acetaminophen or do we need to alternate?
Alternate
What is acetaminophen toxic to?
Liver
What is Ibuprofen toxic to?
Kidney and GI
For example, why should we alternate giving a patient acetaminophen and Ibuprofen?
Since acetaminophen is toxic to the liver and ibuprofen is toxic to the kidney and GI, it is good to alternate giving these drugs so that it reduces stress on the organs those drugs are acting on
What is the leading cause of liver failure?
Acetaminophen overdose
What is the antidote for acetaminophen overdose?
Acetycysteine
Giving acetyclysteins 8-10 hours within the time of overdose will ___% reverse the problems of liver failure.
100%
What groups of people are most at risk for tylenol overdose?
Undernourished
Heavy drinkers
Liver disease
What should a total daily tylenol dose be for patients with liver disease?
Undernourished?
Heavy drinkers?
ASK PRESCRIBER!;
Undernourished= less than 3000 mg
Heavy drinkers= less than 2000 mg
