Anti-inflammatory Drugs: NSAIDs

Question 1

Arachidonic acid is the precursor molecule for

Answer 1

prostanoids and leukotrienes

Question 2

Phospholipase A2 (PLA2) hydrolyzes arachidonic acid from the

Answer 2

cell membrane

Question 3

Phospholipase A2 (PLA2) hydrolyzes

Answer 3

arachidonic acid from the cell membrane

Question 4

Cyclooxygenase-1 (COX-1) is _________ expressed

Answer 4

constitutively expressed

Question 5

Cyclooxygenase-2 (COX-2) expression is induced by

Answer 5

inflammation

Question 6

Thromboxane A2 (TXA2) is synthesized by

Answer 6

COX-1

Question 7

TXA2 (synthesized by COX-1) causes

Answer 7

vasoconstriction

Question 8

COX-1 synthesizes

Answer 8

gastric cytoprotective prostaglandin

Question 9

COX-2 is expressed in

Answer 9

vascular endothelial and smooth muscle cells

Question 10

Prostacyclin (PGI2) is synthesized by

Answer 10

COX-2

Question 11

PGI2 causes

Answer 11

vasodilation

Question 12

PGI2 inhibits

Answer 12

platelet aggregation

Question 13

COX-1 and COX-2 synthesize prostaglandins that

Answer 13

dilate the afferent arteriole

Question 14

COX-2 synthesizes prostaglandins that

Answer 14

1. Increase vascular permeability
2. Increase pain sensitivity
3. Induce fever

Question 15

NSAIDs reversible inhibit

Answer 15

both COX-1 and COX-2

Question 16

NSAIDs include

Answer 16

1. Diclofenac
2. Ketorolac
3. Indomethacin
4. Meolxicam
5. Piroxicam
6. Naproxen

Question 17

Inhibition of COX-1 by NSAIDs can

Answer 17

1. Prolong bleeding time
2. Cause GI bleeding
3. Cause gastric inflammation, erosions, and ulceration

Question 18

NSAIDs can increase blood pressure due to

Answer 18

COX inhibition in the kidney, decreasing sodium excretion

Question 19

NSAIDs can cause

Answer 19

1. Acute interstitial nephritis
2. Renal papillary necrosis (sloughing of renal papillae)
3. Aplastic anemia
4. Hypoaldosteronism (decreased mineralocorticoids)

Question 20

NSAIDs cause afferent arteriole vasoconstriction, decreasing

Answer 20

GFR

Question 21

NSAIDs cause _____ _______ vasoconstriction decreasing GFR

Answer 21

afferent arteriole

Question 22

NSAIDs cause afferent arteriole ________ decreasing GFR

Answer 22

vasoconstriction

Question 23

NSAIDs can increase serum _____ concentrations

Answer 23

lithium

Question 24

NSAIDs (indomethacin most commonly) can cause

Answer 24

Aplastic anemia

Question 25

NSAID induced hypoaldosteronism can cause

Answer 25

hyperkalemia

Question 26

Aspirin irreversibly inhibits

Answer 26

COX- 1 and COX-2

Question 27

Aspirin acetylates COX-1 and COX-2 resulting in

Answer 27

irreversible inhibition

Question 28

Aspirin is useful in treating what childhood disease

Answer 28

Kawasaki disease

Question 29

Kawasaki disease is the most common

Answer 29

vasculitis syndrome of childhood

Question 30

Aspirin use in children can lead to development of

Answer 30

Reye's syndrome

Question 31

Reye's syndrome

Answer 31

rapidly progressive encephalopathy with hepatic dysfunction

Question 32

Reye's syndrome occurs when

Answer 32

a child is given aspirin in the setting of a viral illness

Question 33

Reye's syndrome encephalopathy

Answer 33

1. Confusion 2. Seizure 3. Coma

Question 34

Reye's syndrome hepatic dysfunction

Answer 34

hepatic steatosis and hepatomegaly

Question 35

Aspirin toxicity causes what metabolic disturbance

Answer 35

1. anion gap metabolic acidosis | 2. respiratory alkalosis

Question 36

Aspirin can cause

Answer 36

1. anion gap metabolic acidosis 2. respiratory alkalosis 3. Reye's Syndrome 4. Tinnitus

Question 37

______ ______ can be used to absorb aspirin in setting of acute toxicity

Answer 37

Activated charcoal

Question 38

Alkalinization of the serum and urine with a basic solution (e.g. sodium bicarbonate) increases the renal excretion of

Answer 38

aspirin

Question 39

Minimize NSAID use in patients at risk for

Answer 39

acute kidney injury

Question 40

Avoid NSAIDs in which trimester of pregnancy

Answer 40

3rd trimester

Question 41

Avoid NSAIDs in 3rd trimester due to

Answer 41

risk of premature closure of ductus arteriosus

Question 42

Which NSAIDs have the highest risk of premature closure of ductus arteriosus in the 3rd trimester of pregnancy

Answer 42

1. Indomethacin | 2. Ibuprofen

Question 43

Celecoxib is a

Answer 43

1. Selective COX-2 inhibitor | 2. Sulfa drug

Question 44

Celecoxib has a reduced ulcer and bleeding risk by avoiding

Answer 44

COX-1 inhibition

Question 45

Celecoxib may increase the risk of

Answer 45

ischemic cardiovascular disease

Question 46

Celecoxib decreases the risk of

Answer 46

ulcer and bleeding

Question 47

Acetaminophen inhibits

Answer 47

COX-2

Question 48

Acetaminophen inhibits COX-2, acting as an

Answer 48

antipyretic and analgesic (not anti-inflammatory)

Question 49

Toxic levels of acetaminophen

Answer 49

deplete glutathione in the liver (inactivates the toxic metabolite: NAPQI)

Question 50

Acetaminophen can cause

Answer 50

hepatotoxicity

Question 51

Acetaminophen causes hepatotoxicity via the

Answer 51

toxic metabolite: NAPQI

Question 52

______ ________ can be used to absorb acetaminophen in setting of acute toxicity

Answer 52

activated charcoal

Question 53

_________ restores hepatic glutathione stores to treat acetaminophen hepatotoxicity

Answer 53

n-acetylcysteine