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Pharmacology (Dale Turley) > Tx of Bone and Joint disorders > Flashcards

Tx of Bone and Joint disorders Flashcards

1
Q

Acetylsalicylic Acid (Aspirin) facts ?

A

Aspirin was first introduced by the drug and dye firm Bayer in 1899

Classified among the nonsteroidal anti-inflammatory drugs (NSAIDs)

Inhibits prostaglandin and thromboxane synthesis

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2
Q

Acetylsalicylic Acid (Aspirin) what is required for effective anti-inflammatory action ?

A

Higher dose

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3
Q

Acetylsalicylic Acid (Aspirin) low doses ?

A

typically 75 to 81 mg/day

inhibits platelet generation resulting in an antithrombotic effect.

anti platelet effect

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4
Q

Acetylsalicylic Acid (Aspirin) intermediate doses ?

A

(650 mg to 4 g/day)

inhibit COX-1 and COX-2, blocking prostaglandin (PG) production, analgesic and antipyretic effects.

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5
Q

Aspirin anti platelet effect ?

A

Measurable prolongation of bleeding time (PTT)

Inhibitory effect on platelet aggregation lasts for up to 8 days

Significantly reduces the incidence of stroke and myocardial infarction in patients at risk

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6
Q

Common in patients who self-medicate ?

A

Watch for salicylism (salicylate poisoning) pg. 47

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7
Q

Salicylism ?

A

Mild chronic salicylate intoxication after repeated administration of high doses

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8
Q

Aspirin, pharmacokinetics change at ?

A

higer doses

Severe form requires immediate treatment (within 1 to 2 hours)

  • *watch people with liver disease you can send them into an OD
  • *
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9
Q

Salicylism sxs ?

A

headache,

dizziness,

tinnitus,

hearing loss,

mental disturbances,

sweating,

thirst,

hyperventilation,

nausea,

vomiting,

and sometimes diarrhea

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10
Q

Salicylism tx ?

A

Immediate treatment needed

Gastric lavage (NG tubes)

Activated charcoal to adsorb drug left in the stomach / dialysis

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11
Q

An association between aspirin use and induction of ___________ exists in children

A

Reye’s syndrome

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12
Q

FDA recommends NO ASA to those under the age of __ ?

A

16

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13
Q

what is Reyes syndrome ?

A

Reye’s syndrome is a rapidly progressive encephalopathy which usually begins shortly after recovery from an acute viral illness, especially influenza and varicella (chickenpox).

liver encephalopathy

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14
Q

The exact cause is unknown and, while it has been associated with aspirin consumption by children with viral illness ?

A

Reyes syndrome

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15
Q

Reye’s syndrome elevates blood _____ levels , lowers blood _____ .

A

ammonia

sugar

ammonia level to see if they are truly encephalopathic

hepatic encephalopathy

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16
Q

Reye’s syndrome results in

A

Fatty liver with minimal inflammation and cerebral edema

Effects many organs, especially the brain and liver

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17
Q

Reye’s syndrome classic features ?

A

rash, vomiting, and liver damage

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18
Q

ASA dose ?

A

325 mg

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19
Q

ASA complication and precautions ?

A

GI bleeding

coagulation disorder

G6PD deficiency

influenza, varicella, or febrile viral infection (pts <20 yo)

caution in pts 80 yo and older

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20
Q

Theenzyme ____________________ responsible for the formation of prostanoids

A

cyclooxygenase (COX)

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21
Q

Precursor to formation of three main groups ?

A

Prostanoids

Prostacyclins

Thromboxanes

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22
Q

Cyclooxygenase-1 (COX-1) is known to be present in most ______

A

tissues

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23
Q

In the gastrointestinal tract, COX-1 maintains the ______________.

A

normal lining of the stomach

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24
Q

COX-1 also involved in ?

A

kidney and platelet function

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25
Q

Cyclooxygenase-2 (COX-2) is primarily present at sites of ___________ ?

A

inflammation

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26
Q

Traditional NSAIDs are considered “nonselective” because they inhibit both ?

A

COX-1 and COX-2

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27
Q

Inhibition of COX-1 is

A

undesirable

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28
Q

inhibition of COX-2 is considered ?

A

desirable

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29
Q

What are the three categories of NSAIDs ?

A

Salicylates (aspirin)

Traditional NSAIDs (non-selective)

COX-2 selective NSAIDs

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30
Q

Non-selective NSAID’s examples ?

A

Indomethacin (Indocin)

Ibuprofen (Motrin)

Naproxen (Anaprox)

Ketoralac (Toradol) - GI offensive but great in IV form in ER - works well with real stones or renal colic ( great IV NSAIDs in acute care setting)

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31
Q

NSAIDs choice is typically determined via ?

A

trial and error

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32
Q

NSAID’s facts and choice ?

A

Patient choice

Typically cause GI effects

Use with H2 blockers chronic use

Acetaminophen preferred for mild to moderate pain without inflammation

**watch GI effects with non selectives , use you pepcids with with like the H2 ’s **

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33
Q

NSAID’s Pharmacokinetics
 ?

A

Rapidly and completely absorbed GI tract

Crosses placenta

Metabolized by Liver
watch if liver disease

Excreted in Urine

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34
Q

________ enters breast milk

A

Naproxen

  • *watch special populations
  • *
35
Q

______ does not enter breast milk

A

Motrin

back pain patient in female

36
Q

NSAID’s HL: Children ?

A

(under 8 years old)

8-17 hours

on call peds: motrin every 8 hours

37
Q

NSAID’s HL: Adolescents ?

A

(8-14 years)

8-10 hours

38
Q

NSAID’s HL: Adults ?

A

(over 14 years)

10-20 hours

39
Q

NSAID’s common side effects ?

A 
Coagulation disorders (Avoid with anticoagulant therapy)
synergistic effect

Metabolic acidosis

Rash
Blurred vision, tinnitus, amblyopia (lazy eye)
GI bleed, N/V, abd pain

Headache, altered mental (ASA toxicity)

40
Q

NSAID’s Safety
” concerned prescribing ?

A

GI increased risk bleeding

Renal impairment, HTN, heart failure

Contraindicated in Third Trimester – premature closure of ductus arteriosus
(pulmonary artery to the heart)

Elderly and alcohol users

41
Q

Acetaminophen (Tylenol)
 has what properties ?

A

Analgesic and Antipyretic properties

NSAIDs dont

42
Q

Acetaminophen (Tylenol)
 class ?

A

analgesic / antipyretic

43
Q

Acetaminophen (Tylenol)
 is Ineffective as an____________________

A

anti-inflammatory agent

44
Q

Acetaminophen (Tylenol)
 is different than NSAIDs in that ?

A

Tylenol has no…

Has no COX-1 or COX-2 effects
No GI effects generally
Mediator for inhibiting prostaglandin synthesis in the CNS, brain and spinal cord (Cox-3)
you get the effect through the COX 3 pathway

45
Q

Tylenol doses up to _ grams four times a day

A

1

46
Q

Tylenol High dose greater than 2 grams daily increase risk of ?

A

Increased risk bleeding with Coumadin

Increased risk liver toxicity (liver disease, alcoholics)

47
Q

Tylenol adults dosage ?

A

325mg, 650mg, 1000mg

Extra Strength 500mg tabs

48
Q

Tylenol meds dosage ?

A

15

49
Q

Why is tylenol better than NSAIDs ?

A

Analgesic action

Antipyretic action

Significantly reduced gastric irritation

50
Q

When prescribing patients tylenol be sure to watch for ?

A

acetaminophen poisoning

51
Q

what happens in acetaminophen poisoning ?

A

Potentially fatal hepatic necrosis over 7 to 8 days

52
Q

acetaminophen poisoning

Day 1-2 sxs. ?

A

day 1: nausea, vomiting, diaphoresis

both: liver enzymes, ALT, bilirubin, and PT rise

53
Q

acetaminophen poisoning Day 3-4 sxs ?

A

peak hepatotoxicity

54
Q

acetaminophen poisoning Day 7-8 sxs ?

A

death or recovery

unless aggressively treated

55
Q

acetaminophen poisoning tx ?

A

Treatment must be immediate

56
Q

Acetaminophen Overdose tx ?

A

Presentation similar hepatic encephalopathy

Treatment with N -acetylcysteine (NAC)

NAC is nearly 100% hepatoprotective when it is given within 8 hours after an acute acetaminophen ingestion

Activated charcoal

57
Q

Nomogram ?

A

based on time, dosage and serum levels

tracking OD

58
Q

Acetaminophen Overdose facts ?

A

More 3 glasses wine may produce hepatotoxicity – discuss alcohol use

Discuss doses with parents due to different concentrations

15mg/kg oral remember this dose!

59
Q

Cytoprotective agents ?

A

Misoprostol

60
Q

Misoprostol trade ?

A

(Arthrotec/Cytotec)

61
Q

Cytoprotective agents MOA ?

A

Increases production of mucous lining the stomach

Inhibits gastric acid secretion

62
Q

Misoprostol (Cytotec)

is a what combination ?

A

Dicloenac Sodium (NSAID) combination

63
Q

Misoprostol (Cytotec)

indications ?

A

Indicated NSAID induced ulcer or protection

64
Q

Misoprostol (Cytotec)

is used with ?

A

Used with NSAID’s / ASA

65
Q

Misoprostol (Cytotec)

o used in ?

A

Used in early pregnancy termination

66
Q

Misoprostol (Cytotec) BBW ?

A

Black Box warning with pregnancy / miscarriage

**cytotec is actually a abortion medicine - so that is BBW

67
Q

Arthrotec reduces incidence of ulcers by __% compared to Diclofenac

A

60%

arhtrotec combos are alot better as far as producing ulcers

68
Q

Ibuprofen trade ?

A

Advil, Motrin, Nuprin

69
Q

Ibuprofen is in a sub-class of ?

A

propionic acid derivative that inhibits COX

70
Q

Ibuprofen primary used because ?

A

used for its anti-inflammatory properties

71
Q

Ibuprofen is effective a relieving ?

A

mild to moderate pain

72
Q

Ibuprofen is NOT used for what ? But is does have what action ?

A

anti platelet activity

Anti-pyretic action

73
Q

Ibuprofen pharmacokinetics and HL ?

A

Metabolized by Liver

Excreted by Kidneys

Half-life 2-4 hours for the standard does but it can go up if people taking it chronically

74
Q

Ibuprofen adverse reactions ?

A

Prolonged bleeding times, Thrombocytopenia (avoid bleeding conditions)

Rash
Arrhythmias
Edema
Headache, psychosis
May inhibit antiplatelet activity of ASA
Chewable contain aspartame (caution phenylketonuria)
75
Q

COX-2 Inhibitors own notes ?

A

more specific ones used more as a target

for RA and chronic inflammatory states

76
Q

COX-2 Inhibitors are more specific to ?

A

inflammation

77
Q

COX-2 Inhibitors are free of ?

A

GI side effects

78
Q

COX-2 Inhibitors may produce what ?

A

NSAID induced nephrotoxicity (COX-2 produced in the kidney)

79
Q

COX-2 Inhibitors example ?

A

Celecoxib

80
Q

Celecoxib trade ?

A

Celebrex

81
Q

What two previous COX2-Inhibitors were removed from the market ?

A

Vioxx

Bextra

82
Q

When COX-2 Inhibitors reach therapeutic levels, there is little or no effect on ?

A

COX-1

83
Q

Celecoxib (Celebrex)

adverse reactions ?

A

edema

HTN

increased risk of MI

Rash

Renal toxicity

Fatigue, headaches, flu-like symptoms

once starting it they can get this serum sickness when they first start it : flue achy, N/V

Pharmacology (Dale Turley) (31 decks)

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