NSAIDs

Question 1

What are NSAIDs generally used for

Answer 1

To treat inflammation, pain and fever

Question 2

What causes inflammation pain and fever and how does NSAIDs stop them

Answer 2

The increase in production of prostaglandins leads to those symptoms, so NSAIDs help decrease the production of prostaglandins

Question 3

What’s the mechanism of action of NSAIDs

Answer 3

They work by inhibiting COX enzymes which produce prostaglandins from arachidonic acid, so by inhibiting COX we inhibit the production of prostaglandins

Question 4

What’s an example of an irreversible cox inhibitor

Answer 4

Aspirin

Question 5

What’s a selective COX 2 inhibitor

Answer 5

Celecoxib

Question 6

How long before a surgery should aspirin be discontinued

Answer 6

1 week earlier

Question 7

Aspirin mode of administration

Answer 7

Taken orally

Question 8

What effect does aspirin have on COX

Answer 8

It inhibits both COX 1 and 2 irreversibly

Question 9

How does aspirin inhibit both COX 1

Answer 9

In the blood stream it irreversibly inhibits COX1 in platelets by ACETYLATION decreaseing the production of thromboxane A2-> it’s a platelet activator making aspirin a useful anti platelet medication

Question 10

How does aspirin inhibit both COX 2

Answer 10

In the liver aspirin get metabolised in to salicylate which has no anti-platelet activity but has anti inflammatory activity
- salicylate works by inhibiting COX 2 -> decrease in prostaglandins production decreasing inflammation, pain and fever

Question 11

Aspirin anti inflammatory activity is achieved at which does

Answer 11

4-6g/day

Question 12

Aspirin antipyretic and analgesic activity is achieved at which does

Answer 12

2-3G/day

Question 13

Aspirin antiplatelet activity is achieved at which does

Answer 13

75mg-150mg/day

Question 14

What’s aspirins lethal dose

Answer 14

20-30g

Question 15

Aspirin indications

Answer 15

Analgesia, fever, inhibition of platelet aggregation, rheumatoid arthritis and other rheumatoid diseases

Question 16

What’s the effect of aspirin of Alzheimer’s and colon cancer

Answer 16

Decrease the incidence

Question 17

Aspirin adverse effects

Answer 17

GI system, Hepatitis, Reyes syndrome, bleeding, aspirin asthma hypersensitivity asthma

Question 18

What is salicylism

Answer 18

Acid base disturbances, tinnitus and deafness

Question 19

What’s the treatmeant of salicylism

Answer 19

Activated charcoal, alkalinity urine and electrolyte replacement

Question 20

What irreversibly inhibits Cox 1 and 2

Answer 20

Non selective COX inhibitors

Question 21

Non selective COX inhibitors derived from proprionic acid derivatives

Answer 21

Ibuprofen, naproxen

Question 22

Non selective COX inhibitors from acetic derivatives

Answer 22

Indomethacin and sulindac

Question 23

Non selective COX inhibitors from heterosexual acetic acid derivatives

Answer 23

Do life ax and ketorelac

Question 24

Why shouldn’t we give non selective Cox inhibitors with aspirin

Answer 24

They compete with aspirin on COX1 receptors decreasing the anti platelet activity since they are reversible

Question 25

What are the indications of Non selective COX inhibitors

Answer 25

Since they inhibit COX 2 they have the same indications as aspirin

Question 26

Which NSAIDs should be given to patients with information during a gout attack

Answer 26

Ibuprofen, naproxen and indomethacin

Question 27

Why is aspirin contraindicated in gout attacks

Answer 27

Because it competes with uric acid excretion in the kidney

Question 28

Ibuprofen right dosing

Answer 28

400 mg

Question 29

Which NSAID is used for tooth ache

Answer 29

Ibuprofen

Question 30

Which NSAID causes the closure of ductus arteriosus

Answer 30

Ibuprofen —> most correct | indomethacin —> can be correct

Question 31

Which NSAID is used to treat severe pain after surgery

Answer 31

Ketorolac

Question 32

Which NSAID is used for long term treatment of rheumatoid arthritis osteoarthritis and ankylosing spondylitis

Answer 32

Diclofenac

Question 33

What’s the only COX 2 selective inhibitor and what are its contraindications

Answer 33

Celecoxib and is contraindicated in people with increased risk of thrombosis and CVD

Question 34

Can celecoxib be used with aspirin and why

Answer 34

Yes as it only inhibits COX2 and won’t compete with aspirin over COX 1

Question 35

Why are there contraindications to Celecoxib

Answer 35

Since it doesn’t have an effect on COX 1 they can increase the ability of blood to clot —> increase the risk of heart attack and stroke

Question 36

How do NSAIDs cause GI symptoms

Answer 36

By inhibiting COX 1 reducing the products of cytoprotective prostaglandins leading to ulcers of gastritis

Question 37

What’s the order of severity of GI symptoms with different drugs

Answer 37

Aspirin> Non selective COX inhibitors > Celecoxib

Question 38

What is samters triad

Answer 38

People with asthma and nasal polyps are more likely to experience NSAIDs hypersensitivity reactions

Question 39

How to prevent GI upset with NSAIDs

Answer 39

Take them with food

Question 40

Why can’t aspirin be taken with antaacids

Answer 40

Reduces absorption

Question 41

Why can’t aspirin be taken with heparin

Answer 41

Can lead to haemorrhage

Question 42

What are the contraindications of aspirin

Answer 42

Hyper sensitivity to salicylate and bleeding disorders

Question 43

What is another name for paracetamol

Answer 43

Acetaminophen

Question 44

What is acetaminophen used for

Answer 44

Antipyretic and analgesic drug

Question 45

Does acetaminophen have any anti inflammatory activity

Answer 45

Little to no anti inflammatory activity

Question 46

What acetaminophen lethal does and lethal does in alcoholics

Answer 46

12 grams | 2.7 grams

Question 47

What’s the maximal single does of acetaminophen

Answer 47

650 mg

Question 48

What are the adverse effects of acetaminophen

Answer 48

Hepatotoxicity

Question 49

What’s the antidote for acetaminophen

Answer 49

N-acetylcysteine, activated charcoal and fluids

Question 50

What do we give and don’t give to febrile children

Answer 50

We don’t give aspirin to febrile children | We administer paracetamol 10-15 mg/kg or ibuprofen 7-10mg/kg

Question 51

What is the Toxic by product of acetaminophen

Answer 51

NAPQI or N acetyl p benzoquinoneamine

Question 52

Naproxine is contraindicated

Answer 52

People with CVD