Anti Inflammatories Flashcards
(35 cards)
Why are NSAIDs used in Rheumatoid Conditions?
- reduce associated pain
- improve mobility
- slow or arrest tissue-damage, not curative though
**aspirin is no longer the initial drug of choice in treating articular and musculoskeletal disorders
What is the adverse result of reduction in PGE2 levels caused by NSAIDs?
-decreased gastric mucosal acid secretion
What is the adverse result of reduction in PGI2 levels caused by NSAIDs?
-decreased vasodilatory actions reducing cytoprotective properties
What is the beneficial result of reduciton in PGE2 levels caused by NSAIDs?
-decreased erythema, edema, pain, local heat, and systemic fever
What is the beneficial result of reduction in PGI2 levels caused by NSAIDs?
-Decreased erythema, pain, local heat, and systemic fever
What is erythema?
-redness of the skin or mucosa
Why is inhibition of COX-1 bad?
- it results in most of the unwanted side effects of NSAIDs
- particularly gastric ulcers
Why is inhibition of COX-2 good?
Inhibition of COX-2 is thought to mediate,at least in part, the antipyretic (antifever), analgesic and anti-inflammatory actions of NSAIDs
What are the most common GI side effects of NSAIDs? Mechanism?
- Gastric or intestinal ulceration
- Caused by inhibition of PGI2 and PGE2
What are the most common Hemostatic effects of NSAIDs? Mechanism?
- disturbances in platelet function
- Inhibition of Thromboxane A2
What kind of patient is more susceptible to Stevens-Johnson Syndrome caused by NSAIDS?
-patients with Lupus or HIV
What is Stevens-Johnson syndrome?
-A diffuse, severe, mucocutaneous eruption involving 2 or more mucosal surfaces
+/- visceral involvement
What is the most common use of Aspirin?
-inhibition of platelet aggregation
How does aspirin affect warfarin levels? Why?
- Increases plasma warfarin levels
- displaces warfarin from plasma protein binding sites
How do we manage aspirin overdose?
- Patient will be acidemic
- cardiovascular and respiratory support followed by administration of sodium bicarbonate to correct acid-base abnormalities
Is acetaminophen a NSAID?
- maybe
- it is an effective alternative to aspirin, used as an analgesic-antipyretic, but lacks the anti-inflammatory and anti platelet effects
- It is a weak inhibitor of peripheral COX
What is the antidote for acetaminophen overdose?
- activated charcoal
- N-acetyl-cysteine (Mucomyst), a replacement for glutathione
- consider liver transplant for pts with fulminant hepatic failure
What is Indomethacin used for?
- NSAID
- Anti-inflammatory in treatment of gouty arthritis and ankylosing spondylitis
- Also promotes closure of patent ductus arteriosus in newborns
**not for simple analgesia
Ketorolac is a potent analgesic, when is it used?
- One of the few NSAIDs approved for parenteral administration
- Use for post-op pain when pt cannot swallow, and you don’t want to give a narcotic
What are COXIBs?
-NSAIDs that have been designed to selectively target COX-2 over COX-1 to minimize stomach ulcer risk
Do NSAIDS affect leukotriene synthesis?
-no
Why don’t we give aspirin to children? What can we give instead?
- there is an epidemiological association of Reye’s Syndrome in children (ages 2 to 16) with administration of aspirin for the treatment of febrile viral illnessess (influenza B > A) -> FUO
- can give acetaminophen
What does Reye’s syndrome involve?
-swelling of the liver and edema of the brain
What should Grammy do if she decides to take aspirin/NSAIDs while taking warfarin?
-Have her prothrombin time checked
