Chapter 42: Eicosanoids

Question 1

Which NSAID works in an irreversible manner to block COX 1 and COX 2?

Answer 1

aspirin

Question 2

What NSAID would you AVOID using in children with chickenpox or flu symptoms? Why?

Answer 2

Aspirin - risk of Reye’s disease

Question 3

A daily, low dose of which NSAID is used for its antithrombogenic properties?

Answer 3

Aspirin –> shifts the PGI/TXA balance toward prostacyclin and away from thromboxane formation

Question 4

Should you use aspirin for asthmatics?

Answer 4

Not really…aspirin induced airway hyperreactivity is a potential problem

Question 5

What NSAID would you use to CLOSE a patent ductus arteriosus?

Answer 5

Indomethacin

Question 6

Adverse side effects of NSAIDs?

Answer 6

GI issues

Stevens Johnson syndrome (life threatening skin condition, really nasty)

Question 7

Naproxen

Answer 7

NSAID that has a longer half life, it 20 times more potent, and has less GI issues than aspirin

winner!

Question 8

Ketorolac

Answer 8

NSAID used for analgeisa for post surgical pts

Do not use for more than 3-5 days

Question 9

What NSAID has the greatest selectivity for COX2 ? (NSAID, not another type..)

Answer 9

Nabumetone

Question 10

Fenamates

Answer 10

NSAIDs that aren’t really used at all
why not?
they are more toxic and worse at antiinflammatory crap than aspiriin

why use inmates (fenamates) when you can use aspirin? AND..inmates bleed a lot…
fenamates can be used to treat primary dysmennorrhea

Question 11

Which NSAID has a long enough half life that once-daily dosing is used?

Answer 11

Piroxicam

“cam” - take a picture and it lasts all day

Question 12

Typical uses for NSAIDs?

Answer 12

Period crap
Mild/moderate pain
fever
Osteoarthritis
gout

Question 13

Which NSAID would you use to prevent strokes and MIs? why?

Answer 13

aspirin - antiplatelet effects

Question 14

Acetaminophen MOA?

Answer 14

COX 3 inhibitor - supposedly

thus does NOT have anti inflammatory effects

Question 15

What is the serious adverse effect of acetaminophen use?

Answer 15

hepatotoxicity - leading cause of liver failure is acetaminophen OD

Question 16

Which is tolerated better by patients: ibuprofen or indomethacin?

Answer 16

ibuprofen

Question 17

Kids at risk for Reye’s disease with aspirin use can be treated with what instead?

Answer 17

acetaminophen

Question 18

Celecoxib

Answer 18

MOA: COX 2 inhibitor
No anti platelet effect
Less GI disturbance
TX: arthritis and POLYPOSIS

watch out for MI or stroke…YIIIIIIKESSSSSS

Question 19

So when would you actually use a “coxib”?

Answer 19

Patient needs chronic anti inflamm therapy but also is at risk for gastropathy

then can use celecoxib with an NSAID!

Question 20

Etanercept

- mab(s)

Answer 20

TNF alpha inhibitor to stop inflamm response
TX of rheumatoid arthritis (halt joint destruction, etc.)

BUT - high increased risk of infection was found , so pts must be continuously tested for Tb

Question 21

Anakinra

Answer 21

IL-1 antagonist to stop inflammatory response

e.coli derived -ewwwwww

Question 22

What drug maintains a patent ductus arteriosis?

Answer 22

Alprostadil - PDE1 analogue
(prostaglandin EEE keeeeeps the PDA open)
(PROSTA - it’s IN the name idiot)

Question 23

Misoprostol

Answer 23

MOA: PGE1 analogue
TX: Protective effect against gastric ulcers in long term NSAID use

protectively coats the stomach like miso soup

Question 24

Carboprost

Answer 24

MOA: PGF2a analogue
TX: abortion in 2nd semester
postpartium hemorrhage

carb-loving prostitutes probably need an abortion

Question 25

What prostanoids would you use to treat ocular hypertension or open-angle glaucoma? Eye craps.

Answer 25

Latanoprost
Bimatoprost
Travoprost
(Prost sounds like provost…provosts wear glasses….eye crap)

Question 26

Thromboxane antagonists - what are 3 and why not use ‘em?

Answer 26

Dazoxiben
Pirmagrel
Rodigrel

no advantages over aspirin and they are way more expensive $$$$$$$

Question 27

Zileuton

Answer 27

MOA: inhibits 5-lipooxygenase
TX: asthma

Question 28

MonteLUKAST

ZafirLUKAST

Answer 28

leukotriene receptor antagonists
TX: Not ACute asthma and rhinitis
Both are excreted in breast milk!

Question 29

What is the function of PGD2?

Answer 29

Bronchoconstriction (asthma)
Sleep control fxns
Alzheimer’s?

pgD2 –> R2D2 –> darthvader heavy breathing –> asthma

Question 30

What is the function of PGE2?

Answer 30

PGE2 is the housekeeping prostaglandin; vasodilation, bronchoconstriction, fever, mucus production, cytoprotective to the gastric mucosa by modulating acid secretion, mucus, and blood flow

Question 31

What is the function of PGF2a?

Answer 31

Vascular tone/ smooth mm contraction
Bronchoconstriction
Abortion

pgF - Fuck - Abortion

Question 32

Thromboxane, TXA2, is produced by ____

Answer 32

platelets

Question 33

Prostacyclin, PGI2, is produced by _____

Answer 33

vascular endothelial cells

Question 34

Which functions as a vasodilator, venodilator, and inhibitor of platelet aggregation, PGI2 or TXA2?

Answer 34

PGI2 duh

Question 35

Explain why certain populations that consume more EPA and DHA have a decreased incidence of heart disease, stroke, and thromboembolisms?

Answer 35

EPA and DHA (commonly found in cold water fish) lead to more formation of TXA3 over TXA2. TXA3 is less effective at stimulating platelet aggregation and vasoconstriction than TXA2

Question 36

What are the primary functions of lipoxins?

Answer 36

Stop neutrophil chemotaxis, adhesion, and migration through endothelium

Help resolve inflammation - bc they remove neutrophils blah blah

Question 37

Which NSAID can be used to treat familial adenomatous polyposis? Hint: selective COX-2 inhibitor

Answer 37

Celecoxib

Question 38

Misoprostol is aborticaient with what drug?

Answer 38

mifepristone