Exam 4 - NSAIDs

Question 1

Function of Cyclooxygenase (COX)

Answer 1

Enzyme that converts arachidonic acid into prostaglandins

Question 2

Two groups of cyclooxygenase inhibitors

Answer 2

1 - NSAIDs
2 - Acetaminophen

Question 3

Two subgroups of NSAIDs

Answer 3

1st gen NSAIDS (inhibit cox1 and cox2)
2nd gen NSAIDS (selective for inhibiting cox2)

Question 4

Examples of NSAIDs

Answer 4

Aspirin
Celecoxib
Ibuprofen
Naproxen
Advil

Question 5

Drugs without anti inflammatory properties

Answer 5

Acetaminophen

Question 6

Action of first generation NSAIDS

Answer 6

Inhibit cox1 and cox2

Question 7

What are first generation NSAIDs used for?

Answer 7

To treat inflammatory disorders
(Especially rheumatoid arthritis, osteoarthritis, bursitis)

Alleviate mild to moderate pain
Suppress fever

Question 8

Prototype NSAID

Answer 8

Aspirin

Question 9

Therapeutic uses of aspirin

Answer 9

Analgesic
Antipyretic
Anti-inflammatory
(Suppression of platelet aggregation, protects in thrombotic disorders)

Question 10

Unique characteristic about aspirin that other NSAIDs do not have

Answer 10

Protects against MI and stroke

Question 11

Adverse effects of Aspirin

Answer 11

GI effects: gastric upset, GI bleeding
Renal impairment
Salicylism (ringing in ears, N&V)
Reye’s syndrome in children
Hypersensitivity reaction

Question 12

Risks of taking Aspirin during pregnancy

Answer 12

Anemia
Postpartum hemorrhage
May prolong labor

Question 13

Drug interactions with Aspirin

Answer 13

Anticoagulants: Warfarin, Heparin
Glucocorticoids
Alcohol
Ibuprofen
ACE inhibitors and ARBs

Question 14

Principle indications for non-Aspirin first gen NSAIDs

Answer 14

Rheumatoid arthritis
Osteoarthritis

Question 15

Class of Ibuprofen

Answer 15

First generation NSAID

Question 16

Safety alert for all first generation NSAIDs

Answer 16

Associated with increased risk of GI bleeding that can lead to hospitalization or death

Question 17

Function of Second generation NSAIDs

Answer 17

Just as effective as first generation in suppressing inflammation and pain

Question 18

Side effects of second generation NSAIDs

Answer 18

Impaired renal function
HTN
Edema
*Increases risk for MI and Stroke

(Somewhat lower risk for GI side effects)

Question 19

Prototype for second generation NSAIDs

Answer 19

Celecoxib (Celebrex)

Question 20

*Uses of Celebrex

Answer 20

Osteoarthritis
Rheumatoid arthritis
Acute pain
Dysmenorrhea
Familial adenomatous polyposis

Question 21

Adverse effects of Celebrex

Answer 21

GI ulceration
Renal impairment
Sulfonamide allergy
Cardiovascular impact (stroke, MI, etc.)
*Contraindicated in pregnancy

Question 22

What is Celebrex not a great choice for long term management of pain?

Answer 22

*Because of cardiovascular risks

Question 23

Drug interactions with Celebrex

Answer 23

*Warfarin (and other anticoagulants)
May decrease diuretic effect of furosemide
May decrease antihypertensive effect of ACE inhibitors
May increase levels of lithium
Levels may increase by fluconazole

Question 24

Therapeutic uses of Acetaminophen (Tylenol)

Answer 24

Analgesic
Antipyretic
(Does not have anti inflammatory or anti rheumatic actions)

Question 25

Action of Acetaminophen

Answer 25

Inhibits prostaglandin synthesis in CNS

Question 26

Adverse effects of Tylenol

Answer 26

Very few at normal doses:
*Hepatotoxicity

Overdose: *hepatic necrosis

Question 27

S/S of hepatic necrosis

Answer 27

Early: N&V, diarrhea, sweating, abdominal pain
Late: hepatic failure, coma, death

Question 28

Treatment for Tylenol overdose

Answer 28

*Acetylcysteine (Mucomyst)

Question 29

Drug interactions with Acetaminophen

Answer 29

Alcohol
Warfarin