Exam #01d - NSAID & APAP Flashcards Preview

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Flashcards in Exam #01d - NSAID & APAP Deck (25):
1

Name the rare syndrome of liver degeneration and encephalitis in children treated with aspirin during viral infection?

Reye's syndrome

2

What is the brand name of Diclofenac?

Voltaren

3

What are the 4 major effects of NSAIDs?

1. anti-inflammatory
2. analgesic
3. antipyretic
4. antiplatelet

4

If arachidonic acid metabolism is inhibited by an NSAID inhibiting COX, what will that do to the amount of available arachidonic acid?

The amount of arachidonic acid will increase...meaning more will be available to be metabolized by other enzymes, like lipoxygenase, and form leukotrienes

5

Indicate which major NSAID effect this MOA refers to: decrease in the PG response to IL-1 (PG enhances activity of IL)?

antipyretic

6

Indicate which major NSAID effect this MOA refers to: reversible inhibition of thromboxane (platelets) synthesis? Is there an exception here?

antiplatelet

Yes, aspirin causes IRREVERSIBLE inhibition of thromboxane (platelets) synthesis

7

Indicate which major NSAID effect this MOA refers to: decrease in vasodilator PG, less vasodilation, less edema?

antiinflammatory

8

Indicate which major NSAID effect this MOA refers to: less PGs means less sensitization of nociceptive nerve endings to mediators such as bradykinin and 5-HT?

analgesic

9

Indicate the following ASA dose ranges you'd find to produce the following major NSAID effects:

1. Anti-inflammatory
2. Analgesic/Antipyretic
3. Antiplatelet

At what dose range will GI bleed occur?

1. Anti-inflammatory - 2,400-4,000 mg
2. Analgesic/Antipyretic - 300-2,400 mg
3. Anti-platelet -

10

What is the NSAID AE of GI ulceration due to? What medications (2) can be given with NSAIDs to prevent GI ulceration?

inhibition of COX1

1. Misoprostol
2. PPI

11

True or False - coating NSAID can help with preventing GI bleeds?

False

12

List the (5) symptoms of salicylism (aspirin overdose)?

1. tinnitus
2. vertigo
3. HA
4. fever
5. change in mental status

13

True or False - NSAID AE's increase with age and are greater in women?

True

14

What is the difference between COX-1 and COX-2 with regards to where they are present?

COX-1 is expressed in most tissues, whereas COX-2 is induced only in inflammatory cells

15

Which COX is constitutively (always) active and which COX is inducible?

COX-1 is always active
COX-2 is inducible

16

Which COX is necessary for cytoprotection in GI tract?

COX-1

17

Name (2) selective COX-2 inhibitors?

1. rofecoxib (Vioxx)
2. celecoxib (Celebrex)

18

Give the brand name for the following OTC NSAIDs:

1. Diflunisal
2. Etodalac
3. Fenoprofen
4. Flurbiprofen
5. Ibuprofen
6. Indomethacin
7. Ketoprofen
8. Ketorolac
9. Nabumentone
10. Naproxen
11. Oxaprozin
12. Phenylbutazone
13. Piroxicam
14. Sulindac
15. Tolmetin

1. Diflunisal - Dolobid
2. Etodalac - Lodine
3. Fenoprofen - Nalfon
4. Flurbiprofen - Ansaid
5. Ibuprofen - Nuprin
6. Indomethacin - Indocin
7. Ketoprofen - Orudis
8. Ketorolac - Toradol
9. Nabumentone - Relafen
10. Naproxen - Aleve
11. Oxaprozin - Daypro
12. Phenylbutazone - SAME
13. Piroxicam - Feldene
14. Sulindac - Clinoril
15. Tolmetin - Tolectin

19

What are the (2) major therapeutic actions of APAP?

1. analgesia
2. antipyretic

NOT clinically anti-inflammatory or antiplatelet

20

What is the major route of metabolism of APAP? How is it excreted?

Metabolism primarily hepatic glucuronidation and sulfation (phase 2) to non-toxic metabolites and excreted in urine

21

True or False - there is no GI bleeding AE associated with APAP?

True

22

What is the major AE of concern?

hepatic toxicity (potentially lethal hepatic necrosis at high doses or with excess ethanol)

23

List the (3) ways APAP could cause liver toxicity?

1. alcohol
2. OD
3. not enough glutathione (detoxifies the small amount of toxic metabolite produced during APAP metabolism)

24

What is the rate-limiting factor in glutathione synthesis?

the availability of cysteine (glutathione is synthesized from cysteine, glutamate, and glycine

25

What drug is given to treat APAP OD?

Acetylcysteine (rapidly absorbed and hydrolyzed to cysteine to form plenty of glutathione)