Flashcards in Exam 4 - Non-opioid analgesics and anti-inflammatories Deck (22):
Which non-opioid inhibits cyclooxygenase so prostaglandins cannot be formed and is sensitize to pain receptors to substances such as bradykinin. Also it is more effective if given before painful stimuli.
Aspirin - ASA - acetylsalicylic acid
Which non-opioid works on COX 3 in the CNS?
What 5 things does acetaminophen NOT do?
1. Not anti-inflammatory
2. Inhibit platelet aggregation (not an anticoagulant)
3. Irritate the GI tract
4. Cause bronchoconstriction
5. No effect on uric acid
NSAIDs inhibit what 3 things?
1. Inhibit prostaglandin synthesis
2. Inhibit cyclooxygenase so that prostaglandins are not formed
3. Inhibits cytoprotective PG as well as PG associated with inflammation
What are the selective/non-selective enzymes affected in NSAIDs?
Non-selective: COX-1 / COX-2
What 3 things are an indication of use for Aspirin?
2. salicylate for analgesia
3. throbbing pain (due to inflammation)
Acetaminophen and aspirin are equally ______ and ______, but acetaminophen is less useful clinically bc it is not ____________. Acetaminophen also has no effect on ___ acid and no ______ effects
3 dental uses for NSAIDs and 5 medical uses for NSAIDs
Dental: pain(analgesic), fever(antipyretic), inflammation (anti-inflammatory)
Medical: osteoarthritis, RA, gouty arthritis, fever, dysmenorrhea, pain
5 clinical effects of Aspirin
1. Analgesic (mild to mod.)
2. Antipyretic (fever reduction- vasodilation and sweating)
3. Anti-inflammatory -decreased erythema and swelling (ALL DENTAL PAIN)
5. Antiplatelet - irreversible for life of platelet (7-10days)
How does high/low doses of Aspirin affect uric acid?
High doses (3+g/day) = excretion of uric acid in urine (tx for gout)
Low doses (<1g/day) = uric acid retention (take probenecid to excrete uric acid/aspirin antagonizes)
At what dose does aspirin reduce the risk for clots?
What are 6 general adverse side effects of aspirin?
1. GI problems
3. Reye's syndrome (with viral infections)
4. Salicylism (6-10 g in adults)
5. Hypersensitivity/allergic reactions
6. Aspirin burn
What happens in Aspirin poisoning or salicylism?
confusion, tinnitus, dizziness, nausea, vomiting, headache, dimness of vision, hyperthermia, hyperventilation, respiratory alkalosis, renal loss of bicarb -> respiratory and metabolic acidosis -> death
How does aspirin affect bleeding?
Causes irreversible effect on platelets by reducing platelet adhesiveness/aggregation interfering with ADP which inhibits production of prothrombin causing hypoprothrombinemia
What are the 2 major adverse side effects of acetaminophen?
2. Increased bleeding (INR)
What 4 groups of people is acetaminophen contraindicated in?
1. liver disease or dysfunction
2. patients treated with drugs that are dependent of liver function
4. patients on warfarin
What are 10 general side effects of NSAIDs?
1. Reversible effect on blood platelets
2. Increased risk of MI/stroke
4. Compromised rental function
5. GI complications (bleeding/perforation)
6. CNS complications
7. Skin reactions
8. Respiratory complications (do not use if asthmatic)
10. Kidney damage
How do NSAIDs affect the kidney?
inhibiting prostaglandins shuts down renal blood flow -> renal necrosis. (short term ok)
Whats the dose of NSAIDs that gives anti-inflammatory effects?
3500 mg - for pain and arthritis. (Difficult bc chronically will lead to GI ulceration/bleeding)
Whats the optimal analgesia dose of ibuprofen to relieve dental pain?
Whats the optimal analgesia dose of ibuprofen to chronic inflammatory pain?
400-800 mg 4x/day NOT exceeding 3200 mg - takes days/weeks to reach anti-inflammatory effects