NSAIDS Flashcards

1
Q

What are NSAIDs?

A

Non Steroidal Anti Inflammatory Drugs

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2
Q

What do NSAIDs do?

A

Analgesic (anti-pain), antipyretic (anti-fever), anti-inflammatory (except acetaminophen)
With a ceiling effect

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3
Q

How do NSAIDs work?

A

Stop the formation of prostaglandins by blocking the COX 1,2,3 enzymes

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4
Q

What does cyclo-oxygenase-1 do?

A

Found in many cell types. Many critical functions like maintaining stomach lining
Not involved in fever

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5
Q

What does cyclo-oxygenase 2 do?

A

This form is induced in immune cells

Responsible for pain, inflammation and fever

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6
Q

What are the 3 phases of inflammation?

A

Acute transient phases (local vasodilation, increased capillary permeability)
Delayed subacute phase (infiltration of leukocytes and phagocytes)
Chronic proliferative phase (tissue degeneration and fibrosis)

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7
Q

What do prostaglandins do?

A

Released following cell damage, cause local inflammation, increased blood flow, severe pain, increase hypothalamic set point, stimulate local pain fibres

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8
Q

What are NSAIDs most useful for?

A

Uterine cramping, joint swelling

Would be more superior than opioids but take too long to work

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9
Q

What are the other effects of prostaglandins?

A

Platelet aggregation formation, modulate stomach acidity and mucous lining, uterine contraction

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10
Q

What are the 2 mechanisms of action of ASA?

A

Irreversibly acetylates COX enzymes (unlike the other NSAIDs) with the effect lasting as long as it takes to replace the enzymes
Not dependent on clearance

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11
Q

How can caffeine be used to help NSAIDs?

A

Will increase the effect of all non-opioid analgesics to give a co-analgesic effect.
60-120 mg (cup of coffee)

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12
Q

What happens in caffeine withdrawal?

A

Sudden onset of a headache

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13
Q

What can cause salicylate overdose?

A

Pepto bismol (bismuth salicylate) and methylsalicylate (oil of wintergreen-4 ml)

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14
Q

What are some symptoms of salicylate overdose?

A

Tinntus
Increase in metabolic rate due to interference with oxidative metabolism (hyperventilation, metabolic acidosis, severe hypoglycemia)

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15
Q

What are the immediate dangers of a salicylate overdose?

A

Hyperthermia, dehydration and hypoglycemia

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16
Q

What is the treatment of salicylate overdose?

A

Parenteral fluids and glucose (always, immediately), parenteral sodium bicarbonate, acetazolamide, activated charcoal (only within 2 hours), polyelectrolyte lavage (for modified release salicylate) or hemodialysis (severe)

17
Q

What are the salycilates?

A

Methylsalicylate, bismuth salicylate, aspirin

18
Q

Which NSAIDs are in the proprionic acid class?

A

Ibuprofen (less GI effects), Naproxen (twice daily dosing)

19
Q

What is diclofenac?

A

A prescription only high potency NSAID with a higher GI bleed risk
Used for inflammatory pain (arthritis, post operative swelling, gout), sometimes endometriosis
Gel for muscular/joint pain

20
Q

What is indomethacin used for?

A

Specifically for gout pain and swelling

21
Q

Why are there GI side effects with NSAIDs?

A

Prostaglandins are made by the gastric mucosa and surpress acid production, increase gastric blood flow and increase secretion of mucin.
Non selective COX inhibitors inhibit COX-1, increasing acid production and decreasing mucous protection.

22
Q

What is misoprostol? What is it used for?

A

A prostaglandin analog (similar structure and function) that is given with ASA to supply the stomach with the prostaglandin effect lost with non-selective COX inhibitors

23
Q

What are some adverse effects from NSAIDs?

A

Reye’s Syndrome (ASA in children with viral infections and genetic predisposition)

24
Q

What are some drug interactions with NSAIDs?

A

Inhibits alcohol, warfarin and rofecoxib

25
Q

In what patients should NSAID use be cautioned?

A

Hypertension, angina, (increase in circulating volume) bleeding disorders

26
Q

What are some example of COX 2 selective inhibitors?

A

Vioxx and Bextra (pulled, heart attack risk)

Celebrex has black box warning

27
Q

How are the analgesic effects of acteaminophen different from other NSAIDs?

A

Acts centrally, thus no ceiling effect

28
Q

How does acetaminophen overdose occur?

A

A highly reactive metabolite of acetaminophen depletes GSH (antioxidant) in the liver causing damage to liver indirectly from loss of anti-oxidant and directly from highly reactive intermediate.

29
Q

What are the signs and symptoms of acetaminophen overdose?

A

Severely elevated serum transaminase levels, hepatic encephalopathy and jaundice

30
Q

What is the best way to treat a headache?

A

Highest dose of NSAID, cup of coffee and glass of cold water.