Chapter 9 anti-inflammatory and immunomodulating agents - acetaminophen and nonsteroidal anti-inflammatory agents (NSAIDs)

Question 1

acetaminophen (tylenol)

Answer 1

• weak inhibitor of prostagladin synthesis
• analgesic + antipyretic (fever) properties similar to NSAIDs but anti-inflammatory effects are much weaker
• mild-moderate pain

effects
* compared to NSAIDs – lower risk of GI upset + bleeding or platelet dysfunction

OD
* hepatic necrosis l/t to coma or death

Question 2

acetylsalicyclic acid (aspirin)

nsaid

Answer 2

• inhibis (COX) or cyclooxygenase - enzyme needed for prostagladin synthesis (prostaglandins mediate inflammation, fever + pain)

indication:
* inflammatio nand pyrogen-induced fever
* pain caused by injury or inflammation
* prevents platelet aggregation
* rheumatictoid arthritis
* reduce stroke risk

effects
* GI upset and bleeding
* allergic rxn
* increased risk of reye’s syndrome in children (usually affects children and teenagers after a viral infection, most commonly the flu or chickenpox. Symptoms such as confusion, seizures and loss of consciousness need emergency treatment // can happen when using aspirin to tx thos conditions)
* tinnitis
* inc risk of bleeding with anticoagulants

Question 3

colecoxib

nsaid

Answer 3

• COX-2 inhibitor (COX-2 inhibitors are as effective as traditional NSAIDs but cause less stomach and intestinal problems)

Question 3

diclofenac

nsaid

Answer 3

• no sig differences

Question 4

diflunisal (dolobid)

nsaid

Answer 4

less likely to cause GI bleed and tinnitis
* may cause acute interstital nephritis (spaces between kidney tubules become inflammed => AKI)

Question 5

fenoprofen (nalfon)

nsaid

Answer 5

• more potent than aspirin
• fewer GI effects, more genitourinary effects (pain on urination, hematuria, nephropathy)

Question 6

ibuprofen (advil, motrin)

nsaid

Answer 6

• better tolerated than aspirin by most paients

effects
* reduces diuretic effects of furosemide and may reduce effectiveness of several antihypertensive agents

Question 7

indomethacin (indocin)

nsaid

Answer 7

contraindication in pts w/ lesions

may worsen existing depression, epilepsy or parkinson’s disease

effects
* nephrotoxic

indication:
* indicated to close patent ductus arteriosus in newborns

Question 8

Keoprofen

nsaid

Answer 8

• IV
• more effective than aspirin for controlling pain

Question 9

ketorolac (toradol)

nsaid

Answer 9

• only parenteral nsaid for pain relief (oral, nasal spray, IV, or IM routes)
• equal to narcotic analgesics for controlling post op pain
• short term pain mgmt

Question 10

meclofenamate (meclomen)

nsaid

Answer 10

• induce diarrhea in 10-35% of pts

Question 11

naproxen (naprosyn)

nsaid

Answer 11

• better tolerated than asprin

Question 12

olasalazine (Dipentum)

nsaid

Answer 12

• prodrug => 5-aminosalicylic acid
• retained in colon => making it effective for ulcerative colitis (chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of your large intestine.)

Question 13

piroxicam (feldene)

nsaid

Answer 13

• inhibit prostaglandin synthesis
• also prevents neutrophil aggregation and release of lysosomal enzymes

Question 14

sulindac (clinoril)

nsaid

Answer 14

• fewer GI side effects than aspirin