Exam 4; Aspirin and NSAIDs

Question 1

What are the four major effects NSAIDs

Answer 1

analgesic
anti-pyretic
anti-inflammatory
anti-platelet (decrease in clotting

Question 2

What is the clinical use for aspirin and NSAIDs at low doses

Answer 2

aches and pains

inhibition of clotting

Question 3

What is the clinical use for aspirin and NSAIDs at high doses

Answer 3

pain/arthritis

Question 4

What is the chemistry behind aspirin

Answer 4

salicylic acid + acetyl group → acetylsalicylic acid

Question 5

What is the pharmacokinetics behind acetylsalicylic acid

Answer 5

its a weak acid that is more readily absorbed in a weak acid like the stomach)

Question 6

acetylsalicylic acid is dissociated in the plasma to what, which can have what effects

Answer 6

into salicylic acid which strongly binds to plasma proteins which then can displace other proteins and drugs

Question 7

What is the mechanism behind aspirin

Answer 7

it inhibits prostaglandin metabolism by inhibiting the enzyme cyclooxygenase

Question 8

What are the two different types of cyclooxygenase that aspirin effects

Answer 8

COX1; all cells have this and it regulates prostaglandin synthesis
COX2; inflammatory cells have it which is responsible for the inflammation process

Question 9

How does aspirin affect temperature

Answer 9

it lowers the temperature of a fever, but only in those with fever
may act in the CNS to counteract pyrogens

Question 10

How does aspirin affect peripheral vasculature

Answer 10

may cause mild peripheral vasodilation

Question 11

The use of aspirin to treat this is potentially very dangerous

Answer 11

viral infection in children; could cause Reye’s syndrome

Question 12

What is the mechanism behind the analgesic effect of aspirin

Answer 12

decrease PG production (which are neuromodullary and may regulate pain)
has both central and peripheral effects

Question 13

What is the mechanism being the anti-inflammatory effect of aspirin

Answer 13

PGs serve as vital signs for inflammation, so decreasing them decreases the signs and may also decrease immune cell migration and activity

Question 14

What is the mechanism behind the anti-clotting effects of aspirin

Answer 14

ASA causes irreversible inhibition of platelet COX preventing the synthesis of thromboxane

Question 15

What is the lethal dose of aspirin in children

Answer 15

4gram or 12 regular aspirin

Question 16

What is the lethal dose of aspirin in adults

Answer 16

20 grams or 50-60 regular aspirin

Question 17

What results in death from an overdose of aspirin

Answer 17

severe pulmonary edema

Question 18

Which side effects are the most common when taking aspirin

Answer 18

GI effects; salicylic acid is a direct irritant

Question 19

What is the mechanism behind GI upset involving aspirin

Answer 19

decreased mucosal production in GI

decreased bicarbonate in the GI; no longer a counter mechanism of stomach acid

Question 20

What are two CNS effects of aspirin

Answer 20

tinnitus

increase respiration rate

Question 21

In which patients is aspirin contraindicated

Answer 21

in patients with clotting deficiencies

Question 22

Aspirin has a direct effect on which part of the eye

Answer 22

the iris, it reduces mitosis that occurs during and after eye surgery

Question 23

How does aspirin affect the kidney

Answer 23

decreased kidney perfusion

Question 24

True or False

Aspirin does not cause hypersensitivity reactions

Answer 24

False, it does

Question 25

Aspirin causes this in pregnant women

Answer 25

inhibits labor, prolonging gestation

Question 26

Aspirin can cause this, especially with patients with nasal polyps

Answer 26

bronchospasms

Question 27

Which drug is not a NSAID because it has no anti-inflammatory or anti-platelet effects

Answer 27

acetaminophen

Question 28

An OD of acetaminophen (20-30) tablets can cause what

Answer 28

irreversible liver damage

Question 29

What is the mechanism behind acetaminophoen affecting the liver

Answer 29

most common cause of acute liver failure reduces glutathione in the liver will confound with an already damaged liver (like in alcoholics)

Question 30

Which drug family are the NSAIDs

Answer 30

``` propionic acid derivatives; ibuprofen and the other "pro's" naproxyn fenoprofen ketoprofen flurbiprofen oxaprozin suprofen ```

Question 31

What are the three NSAIDs that are acetic acid derivatives

Answer 31

Indomethacin tolmetin sulindac

Question 32

What is the mechanism behind Indomethacin

Answer 32

very potent COX inhibitor

Question 33

What are the side effects of indomethacin

Answer 33

thrombocytopenia corneal opacities plastic edema

Question 34

What are side other NSAIDs

Answer 34

``` pyroxicam disclofenac bromfenac nepafenac etodolac nabumeone ```

Question 35

This is a selective COX2 inhibitor

Answer 35

celecoxib

Question 36

What is celecoxib used to help prevent

Answer 36

helps prevent the GI upset that aspirin usually cause

Question 37

2 similar drugs to celecoxib have been pulled from the market, why?

Answer 37

may cause in increase in MI and stroke

Question 38

All NSAIDs at high enough doses may have what

Answer 38

similar effects