wk 3- NSAIDS and glucocorticoids

Question 1

what are NSAIDs

Answer 1

antipyretic
analgesic
anti inflammatory

that work within 30mins-1 hour max anti inflammatory and analgesic benefits until felt until 2 weeks

Question 2

paracetaol is

Answer 2

analgesic
antripyretic

Question 3

conditions that are contraindiaated with NSAIDS

Answer 3

heart problems
hypertension
stomach problems
bleeding disorders (haemophilia)
asthma
renal impairment
surgery/dental work
driving- ADRs
1st/3rd pregnancy/lactation
drug interactions with
prolonged use

Question 4

drugs that are contraindicated with NSAIDS

Answer 4

Warfarin (drugs that increase INR)

ACE inhibitors, diuretics, sartans (drugs that cause hyperkalaemia)

lithium/ methotreaxte (drugs that are renal excreted)

Loop diuretics (drugs with a renal MOA)

thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers (antihypertensive drugs)

Alendronate, corticosteroids (drugs that cause GI ulceration)

Question 5

what can you use with someone with GI complications

Answer 5

paracetamol with/without codeine
gastro protection NSAID AND PPI
COX2 selective

Question 6

1st and 3rd trimster pregnancy and NSAIDs

Answer 6

increase rate of miscarriage
-closure of foetal ductus arteriosus- closure before birth can lead to R heart failure

prevent ovulation

Question 7

what NSAID is safe in breast feeding

Answer 7

ibuprofen

Question 8

NSAIDS and ACE do what

Answer 8

decrease antihypertensive effects and increase risk of renal impairment

Question 9

NSAIDS and lithium

Answer 9

decrease renal excretiton of lithium resulting in toxicity

Question 10

NSAIDs and MTX

Answer 10

Decrease renal excretion and increase toxicity

Question 11

NSAIDs and loop/thiazide diuretics

Answer 11

decrease renal function and increase risk of nephrotoxicity

Question 12

warfarin and NSAIDS

Answer 12

increase risk of GI bleeding

Question 13

triple whammy what does it do

Answer 13

loop diuretics- decrease glomerular filtration pressure

ace- decrease GFP

NSAIDs- decrease prostaglandin dependent renal vasodilation

Question 14

how to minimise NSAID toxicity

Answer 14

1. topicals
2. paracetamol before NSAID
3. minimising dose
4. selectiving NSAID with lowest risk
5. only using one NSAID

Question 15

what does aspirin do

Answer 15

analgesic
antipyretic
anti inflammatory
antplatelet

Question 16

what is low doses of aspirin used for

Answer 16

anticoagulant effect to reduce risk of CV event

Question 17

what are normal doses of aspirin used for

Answer 17

analgesic or inflammation

Question 18

aspirin MOA

Answer 18

irreversibly inhibits TxA2 in platelets causing vasodilation, platelet inhibitiion and antithrombogeneisis

lasts the lifetime of the platelet (10days)

Question 19

caution with aspirin as a podiatrist

Answer 19

in children with fever or pain as its linked to reyes syndrome

Question 20

topical NSAID over oral

Answer 20

indications: OA, muscle aches/pains
helps stimualate blood but doesnt penetrate joint

-can still cause GI bleeding but less likely to cause systemic effects

Question 21

topical NSAID contraindicated in

Answer 21

GI bleeding
warfarin
MTX
open wounds/broken skin
infection

Question 22

what NSAID for lowest risk of CV event

Answer 22

naproxen

Question 23

corticosteroids / glucocorticods

Answer 23

anti inflammatory

immunosuppressive

anti mitotic

vasocontrictive

Question 24

glucocorticoid MOA

Answer 24

bind to steroid receptors, translocate into cell nuclei to exert effects on glucocorticoid responsive gene

Question 25

2 ways NSAIDs trigger soft tissue healing

Answer 25

Inflammatory response
Inflammatory mediators (neutrophils, macrophages) cause tissue repair

Local tissue damage
Phagocytosis and activation of fibroblasts and tissue regeneration

Question 26

corticosteorids are contraindicated in

Answer 26

Diabetes: Avoid extensive use as systemic absorption can increase blood glucose
concentration

Immunicompromised patients: Avoid extensive use (months-years esp. more potent) as systemic absorption can result in further immunosuppression

Ulcerative Skin/infections/rosacea/acne/imparied circulation: Skin atrophy (e.g. in elderly) can be potentiated by topical corticosteroids & can ↑ their systemic absorption

Children: ↑ systemic absorption due to higher SA– weight ratio. Hydrocortisone is adequate initial Tx for most children. Use more potent products for short periods under close supervision to regain control of disease

Pregnanacy: use lowest potency for shortest time (category A)

Question 27

topical corticosteroid indications

Answer 27

eczema
contact dermatitis
psoriasis

(inflammatory skin conditions)

Question 28

adverse effects of corticosteroids

Answer 28

loss of dermal collagen
skin atrophy
straie formation
fragility
bruising
telangiectasia
infection
dermatitis
purpura (elderly)

Question 29

using ointments, creams or lotions or sprays

Answer 29

ointments-dry scaly skin, pentrates well. may cause folliculitis

creams- dry skin, preferred for face

lotion- hairy/weeping regions

spray-without touch/hard to reach areas/painful

Question 30

if syymptoms dont improve in how long with corticosteroid do you need to assess what?

Answer 30

3-7days

1. stronger topical
2. infection
3. adherence