APEX- NSAIDS

Question 1

All of the following are associated with Samter’s triad EXCEPT:
A. Allergic rhinitis
B. Bronchospasm
C. Nasal polyps
D. Hypertension

Answer 1

D. Hypertension

Samter’s triad is associated with Aspirin exacerbated resp disease

Question 2

Samter’s triad is associated with what

3 components

what can happen

Answer 2

Aspirin exacerbated respiratory disease

1. Asthma
2. Allergic rhinitis
3. Nasal polyps

pts can develop life-threatening bronchospasm following aspirn administration

Question 3

How do NSAIDs reduce pain

Answer 3

they inhibit cyclooxygenase enzyme and reduce the production of prostaglandins

Question 4

What is diclofenac

Answer 4

a non-selective COX inhibitor

NSAID

prevents the formation of prostaglandins by inhibiting cylooxygenase
brand names: voltaren

Question 5

What is indomethacin

Answer 5

“a non-selective COX inhibitor “
+
“prostaglandin synthase inhibitor” - used to close PDA

NSAID

preents the formation of prostaglandins by inhibiting cylooxygenase

Question 6

What is a drug with the suffix -coxib

Answer 6

selective COX-2 inhbitior

inhibits the inducible prostaglandins which produce inflammation, pain, and fever

Question 7

Describe the arachidonic acid pathway

Answer 7

when cells break down, the phospholipids in their membrane are converted to arachadonic acid by Phospholiapase A2

Arachiodnic acid is then broke ndown into Prostaglandins by 1 of 2 pathways

COX 1 (always present)- breaks it down to prostagladins needed for GI mucousa, platelet function, and renal blood flow

COX 2 (inducible)- breaks it down to prostaglandins that are needed for inflammation, pain, and fever

Question 8

Is there a ceiling effect on analgesia with NSAIDS or Opioids?

Answer 8

ceiling effect with nsaids for analgesia

no ceiling effect for analgesia with opioids

Question 9

3 downfalls of cox 1 inhibition

Answer 9

gastric irritation
impaired platelet function
reduced renal blood flow

Question 10

selective COX-2 inhibitors seem great…but why arent they

Answer 10

they increase the risk of HTN, MI, and HF moreso than COX-1

screwed either way

Question 11

How might COX inhibitors produce bronchospasm

Answer 11

decreased prostaglandins > leukotrienes > bronchospasm

Question 12

why to avoid NSAIDs in pts with renal disease

Answer 12

because blocking prostaglandins reduces renal blood flow

cox-1 prostaglinds responsible for : platelet function, gastri mucosa, and renal blood flow

Question 13

You always know there is something with nsaids and ortho that you question… what is it?

Answer 13

they decrease osteoclast and osteoblast activity and may impair bone healing

no one seems to care though lol

Question 14

Key drug interactions with NSAIDs

Answer 14

Alter highly bound protein drugs (increase their plasma concentration)
>NSAIDS displace albumin, bound drugs
»Warfarin, phenytoin, valproic acid

Question 15

30mg of Ketorolac is equivilant analgesia provided by how many mg of IV Morphine

Answer 15

10mg

i call bullshit

Question 16

Ketorolac can only be taken for how many days

Answer 16

5

Question 17

how does aspirin work

Answer 17

it irreversibly inhibits COX-1 and COX-2
platelets are inhibited for the life of the platelet

Question 18

aspirin toxicity can cause a (gap/non-anion gap) metabolic acidosis

Answer 18

gap acidosis

salacylic acid ↔ Salisil**ate **& H+

non gap = loss of bicarb (gain of chloride (hydrochloric acid) to compensate)
+gap = gain of acid (anything that results in gaine of something adding in ate

MUDPILES
Methanyl ↔ formic acid > formate
Uremia ↔ causes accumulation of sulfates and phosphates
Dka ↔ betahydroxyentric acid ↔ betahydroxybuterate
P
Ishemia/Iron : lactic acid ↔ H+ and Lactate
Ethanol/Tthylane glycol
Salicilates

HA ↔ H+ & A-
H+ proton combines with bicarb > H20 + CO2

Question 19

How is acetaminophen similar and different compared to NSAIDS

Answer 19

+analgesic and antipyretic
NOT antiinflammatory

Question 20

T/F: tylenol has antiinflammatory properties

Answer 20

false,

just antipyretic and analgesic

Question 21

What is the most common cause of acute liver failure in the US

chronic liver failure?

Answer 21

Tyelnol - max is 4g/day

alcohol abuse

Question 22

2 theories for how tylenol works

exact mechanism is unclear

Answer 22

possibily inhibits prostaglandins by a Cox-3 pathway?
may activate the descending inhibitory pain pathway in the spinal cord

Question 23

Membrane phospholipids are converted to arachadonic acid by what

what is arachadonic acid converted to?

Answer 23

Phospholiapase A2

prostaglandins

Question 24

What is phospholiapase A2 responsible for?

i

Answer 24

converting membrane phospholipids to arachodonic acid > prostaglandins needed for GI mucuosa, renal blood flow, and platelet function

Question 25

when can the administration of aspirin lead to life threatening bronchospasm?

can other nsaids cause it?

Answer 25

if the pt has Samter’s Triad:

Asthma, allergic rhinitis, nasal polyps

yes! ketorolac, ibuprofen, or naproxen