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RUSVM Pharmacology Spring 2017 > NSAIDs > Flashcards

NSAIDs Flashcards

1
Q

What parts of the pain pathway do NSAIDs act on?

A

modulation and transduction

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2
Q

What are the main effects of NSAIDs?

A

They prevent inflammation by inhibiting cyclooxygenase (COX) enzymes.

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3
Q

Aside fro analgesia, what are other uses for NSAIDs?

A

anti-pyretic and inhibit tumor growth (anti-angiogenesis)

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4
Q

T/F: NSAIDs and steroids can be used together.

A

False

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5
Q

What is the function of COX-1 and what 2 hormones does it produce?

A

Constitutive, physiologic production of prostaglandins that play an important role in normal homeostasis. Thromboxane A2 and Prostaglandin E1 (PGE1)

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6
Q

COX-2 functions in what?

A

Inducible production of prostaglandins produced during times of inflammation.

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7
Q

T/F: selective COX-2 inhibitors are over the counter.

A

False. They are RX only.

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8
Q

T/F: NSAIDs are weak acids.

A

True.

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9
Q

Which is the strongest NSAID?

A

Aspirin.

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10
Q

T/F: NSAIDs have a greater effect on chronic inflammation than acute inflammation.

A

False. greater effect on acute inflammation.

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11
Q

Are NSAIDs highly protein bound?

A

Yes, about 95-99% of them are protein bound.

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12
Q

T/F: NSAIDs can cross the BBB into the CNS

A

True

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13
Q

Where are NSAIDs metabolized and where are they excreted?

A

metabolized in the liver (both phase 1 and 2 if hepatic metabolism in the liver), and excreted in the urine.

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14
Q

T/F: biliary excretion and enterohepatic recirculation is never seen with NSAIDs

A

False. It is seen with some NSAIDs.

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15
Q

After how many half-lives are drugs nearly completely excreted?

A

5

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16
Q

What are 2 special uses of NSAIDs?

A

antithrombotic effects and antineoplastic effects.

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17
Q

What are some adverse effects NSAIDs can have?

A

GI irritation/ulceration, vomiting, anorexia, diarrhea, renal damage and decreased blood flow, as well as post-op analgesia and hypotension.

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18
Q

Does vomiting, diarrhea, and anorexia mean that there is an ulcer present?

A

No.

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19
Q

Who is at higher risk of renal damage when using NSAIDs?

A

Cats

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20
Q

When should NSAIDs be used post-op?

A

After recovery from anesthesia.

21
Q

Can hepatotoxicity occur as an adverse effect when using NSAIDs?

A

Yes, especially in cats. Acetaminophen gets metabolized into toxic intermediates by phase 1 metabolism.

22
Q

What large animal NSAID is used as an analgesic for colic and endotoxemia in horses, for visceral pain in cattle, and is not recommended for use in small animals?

A

flunixin meglumine (Banamine)

23
Q

T/F: flunixin meglumine (Banamine) can be administered PO and IV in cattle.

A

False, only IV in cattle.

24
Q

Should flunixin meglumine be used IM in horses? Why or why not?

A

No, because muscle necrosis has been reported to occur with IM administration.

25
Q

T/F: flunixin meglumine can be administered IM in pigs.

A

True

26
Q

What species should not be given flunixin meglumine?

A

Birds, causes renal toxicity.

27
Q

This drug is used commonly in horses, banned from being used in dairy cattle, and is indicated for treatment of musculoskeletal pain.

A

Phenylbutazone (bute)

28
Q

What are the routes of administration of phenylbutazone?

A

PO (most common) and IV. NOT IM/SC.

29
Q

What can happen if phenylbutazone is administered via intracarotid injection?

A

Seizures and CNS stimulation.

30
Q

What drugs are COX-2 preferentials?

A

Carprofen, meloxicam, and deracoxib

31
Q

Which 2 of the COX-2 preferentials are available as injectables (SQ)?

A

carprofen and meloxicam.

32
Q

What COX-2 preferential is approved for single use in cats?

A

Meloxicam

33
Q

What drugs fall under the COX-2 selective class?

A

Firocoxib and robenacoxib.

34
Q

Which COX-2 selective is approved for multiple doses in cats (ip to 3 days)?

A

Robenacoxib (Onsior)

35
Q

How long should the washout period be if switching from an NSAID to a steroid?

A

1-2 weeks.

36
Q

If changing from a steroid to an NSAID, what should the washout period be?

A

minimum 1 week after weaning off of the steroid.

37
Q

If you are switching from NSAID to another NSAID, should you still have a washout period?

A

Yes, based on half life or go for 1 week (conservative default).

38
Q

T/F: Acetaminophen inhibits COX

A

False.

39
Q

Should acetaminophen be used in cats?

A

No.

40
Q

What is the most important form of toxicity caused by acetaminophen? What other toxic effect can be seen?

A

methemoglobinemia. Hepatic necrosis can also be seen.

41
Q

What is grapiprant’s mode of action?

A

antagonist at prostaglandin E2 EP4 receptor.

42
Q

This drug is a neural steroid used in dogs, cats, and horses, and is mainly used to control neuropathic pain.

A

gabapentin.

43
Q

Can gabapentin be used as an adjunct treatment for laminitis in horses?

A

Yes.

44
Q

When should you be careful using gabapentin?

A

in renal insufficiency cases because it is renally excreted.

45
Q

Does amantadine inhibit cox?

A

No. It has NMDA receptor antagonist properties.

46
Q

This medication is a less common adjunctive analgesic, it is good for neuropathic or “wind up” pain, and is available as an oral medication.

A

amantadine

47
Q

What is the mode of action of Omega 3 fatty acids? What pathways produce these mediators?

A

modulation of inflammation. COX, LOX, and cytochrome P450 pathways.

48
Q

Aside from modulating inflammation, what other effects do omega 3 fatty acids have?

A

they affect immune cell response by regulating gene expression, they act as a ligand for nuclear receptors, they inhibit TLR4 by endotoxin, and produce substrates for resolvins and protectins.

RUSVM Pharmacology Spring 2017 (10 decks)

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