Exam 4: NSAIDs/Non-Opioids yo-Part 2 NSAIDs & Tylenol Flashcards Preview

Pharmacology > Exam 4: NSAIDs/Non-Opioids yo-Part 2 NSAIDs & Tylenol > Flashcards

Flashcards in Exam 4: NSAIDs/Non-Opioids yo-Part 2 NSAIDs & Tylenol Deck (85):
1

Inhibiting cyclooxygenase reduces formation of _________ precursors and ____________ from arachidonic acid

prostaglandin.... thromboxanes

2

What are the 2 categories of NSAIDs?

Non-selecitve (COX-1 & COX-2 inhibitors) & Selective (COX-2 inhibitors)

3

Pharmacokinetics of NSAIDs.....Peak in ___-___ hours, metabolized by the ______, excreted by the _______.

1-2...liver..kidney

4

Pharmacokinetics of NSAIDs.....what is the half life?

IT VARIES by product

5

What are the 3 actions of NSAIDs?

1.Anti-Inflammatory 2.Analgesic 3.Antipyretic

6

Actions of NSAIDs.....________ effects on blood platelets

REVERSIBLE (opposite of aspirin!!!)

7

Actions of NSAIDs......their effect lasts only as long as _________.

the drug is in the bloodstream

8

If there is a need to DISCONTINUE NSAIDs before surgery, time is based on _______.....ibuprofen = ___ day(s) naproxen = __ day(s)....

HALF LIFE.....1 day....4 days

9

If you need to discontinue NSAIDs COUNT BACK ____ to ____ half lives!

4 to 5

10

_________ can interfere with the antiplatelet effect of low-dose aspirin (81 mg), potentially rendering aspirin less effective when used for cardioprotection and stroke prevention

ibuprofen

11

FDA recommends for patients who use immediate release aspirin (not enteric coated) and take a single dose or chronic doses of ibuprofen 400 mg, dose the ibuprofen at least 30 minutes or longer ______ aspirin ingestion or MORE than 8 hours ______ aspirin ingestion to avoid attenuation of aspirin’s effect....so like when?

AFTER...BEFORE.....before bed time (when MI/stroke most commonly occur)

12

Occasional use of ibuprofen or other NSAIDS pose _____ risk for attenuation of anti-platelet effects of low-dose aspirin

little

13

What are our 2 examples of NSAIDs?

1.ibuprofen 2.Naproxen

14

What are the 4 brand names for ibuprofen? Which one is the Rx name?

1.Advil 2.Midol 3.Motrin (Rx) 4.Ultraprin

15

What are the 3 brand names for naproxen? What are the 2 Rx?

1. Aleve 2.Anaprox (Rx) 3.Naprosyn (Rx)

16

What is the NSAID with the MOST drug interactions?

IN-DO-METH-A-CIN

17

Which organ is most susceptible to NSAID use?

KIDNEYS (no not liver dawg)

18

Adverse Events with NSAIDs!!! Increased risk of ____, stroke

MI

19

Adverse Events with NSAIDs!!! New onset or worsening of ________.

hypertension

20

Adverse Events with NSAIDs!!! Compromised _____ function...Excessive or chronic use = ________.....Contraindicated in patients with advanced ______ disease... Age group more susceptible to this damage _______.

renal...nephrotoxicity...renal...elderly

21

Adverse Events with NSAIDs!!! _________ ulceration, irritation, bleeding and perforation...Consuming more then ___ alcoholic drinks per day increases risk for GI bleeding... and this age group is most susceptible to bleeding.

Gastrointestinal..3...Elderly

22

T/F NSAIDs have CNS effects.

TRUE! Dose-dependent effects...Sedation, dizziness, confusion, mental depression, headache, vertigo, convulsions...Blurred vision, TINNITUS...Caution operating heavy machinery, driving...No addiction, no tolerance, no withdrawal

23

Skin reactions are also associated with ______ adverse events.

NSAID

24

Avoid NSAIDs in pts with an _____ allergy and if they have decreased _____ function too.

aspirin...liver

25

What is STEVEN-JOHNSON syndrome and what is it a sign of?

sloughing off of skin on palms and soles....hypersensitivity to NSAIDs

26

Target organ for NSAIDS is ______!!! (not liver)

KIDNEY

27

NSAIDs: Inhibiting prostaglandins shuts down ______ blood flow...which can result in _______, especially beyond use for ___ days with high doses.

renal...renal necrosis...5 days

28

Short-term use of NSAIDs: _____ to _____ risk if normal kidney function...Slight increased risk for ____, cystitis

little to no..UTI (i wonder why!?)

29

ibuprofen (MOTRIN): Available both OTC and prescription strength...OTC dose = _____ mg tablets....Prescription dose = ____ – _____ mg

200 mg....Rx-400 - 800 mg

30

ibuprofen (MOTRIN): _______ onset of analgesia (30-60 minutes)

RAPID

31

ibuprofen (MOTRIN): ______ duration of action (4-6 hours)

Short

32

ibuprofen (MOTRIN): ______ half-life (2-4 hours) = must take frequently

Short

33

ibuprofen (MOTRIN): Dental dosing (analgesic/fever reduction) Children: __-__ mg/kg/dose every __-__ hours...Use of ______ to select dose is preferred!!

4-10 mg/kg/dose every 6-8 hours..WEIGHT

34

ibuprofen (MOTRIN): Adults: 200-400 mg/dose every 4-6 hours for a maximum daily dose of _____ mg...WHAT is the upper dose of ibuprofen for arthritic pain?

1200 mg...3200 mg for arthritis

35

Please compare the limit for daily ibuprofen vs aspirin...

1.2 g for ibuprofen vs 4 g for aspirin

36

PRACTICAL APPLICATION-----ibuprofen (MOTRIN): Preoperative use of ibuprofen at a dose of ____-____ mg every __ hours for ____ hours before the appointment decreases postoperative edema and hastens healing time!!!!! ANTICIPATORY

400-600 mg....4 hours... 24 hours

37

Ibuprofen is unique, it has a “______” effect for dental pain where the optimal analgesia occurs at ____ mg dose

"ceiling"...400 mg

38

NSAIDs and Arthritis-Takes ____ to _____ to reach anti-inflammatory effects, from gradual reduction in prostaglandin synthesis

days to weeks

39

In our Rx example of ibuprofen, what was the daily limit?

3200 mg (directed by a physician)

40

naproxen: ______ onset of analgesia (1 hour)

quick

41

naproxen: _____ half life (12-17 hours)

long

42

naproxen: Duration of action (analgesia: < 7 hours; anti- inflammatory: < ____ hours; peaks after ___ weeks)

12...2 weeks

43

naproxen: Dental dosing = adults: ____ mg initially, then 250 mg every 6-8 hours; maximum: _____ mg /day...this is called a "_____" dose

500 mg...1250 mg..."loading" dose

44

________ (Feldene) = **longest acting of all NSAIDS *...10 mg 2 times per day...Long half life = ___-___ hours

PRI-OXI-CAM...45-50 hours

45

What are the 3 "other important NSAIDs in Dentistry?

1.Pir-oxi-cam 2.flur-bi-profen 3.keto-ro-Lac

46

_______ (Toradol)* = used for up to 5 days for severe acute pain requiring analgesia at opioid level; taken primarily by injection; causes renal damage

Keto-RO-Lac

47

______=“super aspirin” = No greater efficacy than
aspirin...____ half life- ___ to ___ hours.

di-flu-nis-al...8-12 hours

48

What are the two ways to Rx for pain? Why do we do this?

1. As needed for pain 2.every 6 hours....keep the [ ] in blood at therapeutic level

49

Sometimes its useful to think about ________ considerations:...A prescription drug gives more relief to a
patient than an OTC drug....More relief with expensive drug vs. cheap drug...More relief from colored pills vs. white pills

psychological considerations

50

WHAT IS THE ONLY COX-2 INHIBITOR AVAILABLE? What is it indicated for?

cel-e-cox-ib (Celebrex)...arthritis

51

_____ inhibitors have better adverse events profile

COX-2 (then why aren't there more of them???)

52

Interesting...Celebrex has been shown to reduce risk for _______ of the colon...also improvements in ____ cancer, and possibly ____ cancer

adenocarcinoma...lung...oral

53

Freaking wonder drug- Celebrex shown to delay onset and degree of severity of _________ too!!

Alzheimer’s disease

54

Celebrex can be used for acute DENTAL pain!! Initial ____ mg "losing" dose, followed by an additional ____ mg dose if needed on day 1.

400 mg...200 mg

55

COX-2 inhibitors OK to use with ________.

low dose aspirin

56

COX-2 inhibitors; Monitor _______ when used with antihypertensives (reduces effectiveness)

blood pressure

57

COX-2 inhibitors- Assess ________ when used with warfarin

bleeding times

58

Celebrex contains _____ atom = some may be allergic

SULFA (or sulfer, wtf?)

59

Celebrex is _______ in pregnancy.

CONTRAINDICATED

60

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! _______ and ibuprofen/aspirin-Used for autoimmune diseases and cancer....Ibuprofen _______ the breakdown of this drug..., causing toxicity...Cannot give aspirin = displaces this drug and interferes with its ______, increasing serum concentrations and causing toxicity (bone marrow depression).

Meth-o-trex-ane...INHIBITS...clearance

61

DRUG INTERACTIONS-NSAIDs & aspirin!!!!!....________ = used for bipolar disorder (manic depression) = NSAIDS block excretion, resulting in toxicity.

Lithium

62

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! aspirin = separate dosing intervals with NSAIDS to avoid attenuation of ______ effects of aspirin.

anti- platelet

63

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! NSAIDS = taking multiple NSAIDS together can give an ______ toxic effect

ADDITIVE!!

64

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! Alcohol increases the risk for _____ bleeding associated with aspirin and NSAIDS

GI

65

DRUG INTERACTIONS-NSAIDs & aspirin!!!!! Aspirin and NSAIDS may decrease the effectiveness of many common ________ medications = monitor BP if giving NSAIDS to patients taking BP meds

antihypertensive

66

What is the abbreviated name for acetaminophen?

APAP (n-Acetyl-P-AminoPhenol)

67

Acetaminophen is categorized as a "_______" analgesic..It blocks _____.

"miscellaneous"...COX-3

68

Where does acetaminophen work most, peripherally or centrally?

centrally...CNS COX-3

69

Acetaminophen DOES NOT-inhibit _______ aggregation....irritate the ______....cause broncho_______.

platelet....GI tract...bronchoconstriction

70

Pharmacokinetics of acetaminophen- _______ and completely absorbed from GI tract

rapidly

71

Pharmacokinetics of acetaminophen- Peak plasma level occurs in __ to __ hours..Metabolized by ____

1 to 3 hours..liver

72

Pharmacokinetics of acetaminophen- Metabolite is BOTH ________ and ________.

hepatotoxic and nephrotoxic

73

Pharmacokinetics of acetaminophen- Half-life of ___ to ____ hours... Excreted by ______

1-4...kidneys

74

AWESOME SYNOPSIS- Pt has GI problems? Rx this...

Acetaminophen

75

AWESOME SYNOPSIS- Pt has decreased kidney function/ diabetes? Rx this...

Acetaminophen

76

AWESOME SYNOPSIS- Pt has compromised liver function? Rx this...

NSAID

77

Effects of Acetaminophen...it is an ________, ________, but it is NOT an __________!!!!!!

Analegesic...antipyretic...anti-inflammatory!!!!!

78

How do acetaminophen and aspirin compare in POTENCY?

EQUAL!

79

While acetaminophen is not irritating to the ______, it is toxic to the ______.

GI...liver

80

What is the maximum dose of acetaminophen? But what about Tylenol?

4 g....3 g they are toning it down a bit

81

Remember this (YOU EXCEDRIN USERS)....Acetaminophen and aspirin are: Equally ________ (reduces same degree
of pain)....Equally _____ (same dose in milligrams needed for effect)....BUT __________ is less useful clinically, because it is NOT anti-inflammatory

efficacious..potent... Acetaminophen

82

Unlike aspirin, acetaminophen has no effect on ______ acid.

uric

83

acetaminophen dosing-------Usual dental dosing....Children (

10-15.....325 mg...4000 mg...2 grams

84

Alcohol stimulates the _______ enzymes that metabolize acetaminophen to its toxic metabolite. yikes.

oxidizing

85

WARNING: An important dental drug interaction....Taking ________ with warfarin (Coumadin) causes enhanced anticoagulation..... One study showed that taking 4 325 mg tablets for one week raised the INR (bleeding time test) ______ above those NOT taking this drug; risk also occurred in patients taking 6 tablets or fewer of 325 mg this drug in one week

acetaminophen...10x