NSAIDs

Question 1

COX-1

Answer 1

Enzyme that produce prostaglandins that are important for general housekeeping function of gastric protection and hemostasis

Question 2

COX-2

Answer 2

Inducible form of the enzyme

Prostaglandins that mediate pain, inflammation, fever and carcinogenesis

Question 3

Key mediator of both peripheral and central pain sensitization

Answer 3

PG-E2

Question 4

Effect of PG

Answer 4

Increase release of Sub. P and glutamate (1ON)
Increase sensitivity of 2ON
Decrease NT from descending pain modulating pathways

Question 5

NSAID general MoA

Answer 5

Competitive inhibitor of COX

Question 6

Duration of NSAID relates directly to

Answer 6

Metabolism of the drug

Question 7

Hyperalgesia

Answer 7

Exaggerated pain response to normally painful stimulus

Question 8

Allodynia

Answer 8

Painful response to a typically non-painful stimulus

Question 9

Areas where COX-2 is constitutively expressed

Answer 9

Kidney
Bone
Brain
Reproductive organ

Question 10

Side effect of NSAIDs

Answer 10

Platelet dysfunction
GI ulceration
Risk of nephrotoxicity
Hypertension

Question 11

Contraindications of NSAIDs and COX-2 selective inhibitor

Answer 11

Hypersensitivity

Triad of Asthma, aspirin and nasal polyposis

Question 12

Contraindications for COX-2 inhibitors

Answer 12

Allergy to sulfonamides

Question 13

NSAID with no/little anti inflammatory and anti platelets effect

Answer 13

Paracetamol

Question 14

MoA of Paracetamol

Answer 14

Inhibition of central COX-3 in CNS
Modulation of descending inhibitory serotonergic pathway
Act on opioid and NMDA receptor

Question 15

Effect of Salicylates on Respiration

Answer 15

Increase O2 consumption
Increase CO2 production
Increase respiration

Question 16

MDD of Paracetamol

Answer 16

4gm

Question 17

DOA of Paracetamol

Answer 17

2 hours

Question 18

Dosage of Paracetamol

Answer 18

0.5-1 gm/4-6 hrs

Question 19

Dosage of Salicylate

Answer 19

0.5-1 gm/4-6 hrs

Question 20

DOA of Salicylates

Answer 20

15-20 min

Question 21

MDD of Salicylates

Answer 21

3gm

Question 22

Effect of Salicylates on CVS

Answer 22

Cardioprotective effect <100mg

Salt and water retention&raquo_space; increased CO

Question 23

Contraindications of Salicylates against bleeding time

Answer 23

Hypoprothrombinemia
Severe hepatic damage
Vit K deficiency
Haemophilia

Question 24

Contraindications of Salicylates in third trimester because

Answer 24

Prolonged gestation
Complicated deliveries
Premature closure of ductus arteriosus

Question 25

Excretion of Salicylates

Answer 25

Free salicylates 10% | Metabolites 90%

Question 26

Urine pH dependecy of Salicylates excretion

Answer 26

Alkaline urine - 30% | Acidic urine - 2%

Question 27

Toxicity of Salicylates

Answer 27

Hearing impairment Blurred vision Light-headedness

Question 28

Use of Ketrolac

Answer 28

Short-term pain management | Immediate postop period

Question 29

Ketorolac (Vs Morphine)

Answer 29

Less dosage Similar onset to morphine Longer DOA

Question 30

Use of Ketorolac

Answer 30

Patient at high risk for postoperative respiratory depression or emesis

Question 31

Pre-admission of Ketorolac

Answer 31

Hypovolemia should be corrected

Question 32

Effect of Ketorolac on CNS

Answer 32

Minimal effect | Does not cross BBB to significant degree

Question 33

Side effect of Ketorolac

Answer 33

Inhibit platelet aggregation Prolong bleeding Long term use may lead to renal toxicity

Question 34

Contraindication of Ketorolac

Answer 34

Aspirin or NSAID allergy | Triad (AAP)

Question 35

Most commonly used NSAID in Europe

Answer 35

Diclofenac

Question 36

DOA of Diclofenac

Answer 36

8hrs

Question 37

Property of Diclofenac

Answer 37

Preferentially COX-2 inhibitor High first pass effect Accumulate in synovial fluid

Question 38

Use of Diclofenac

Answer 38

Long-term symptomatic treatment of RA and OA Short-term treatment of acute musculoskeletal pain, post-op pain, dysmenorrhea Cataract Extraction

Question 39

Side effect of Diclofenac

Answer 39

Modest, reversible elevation of hepatic transaminase

Question 40

Property of Indomethacin

Answer 40

More potent inhibitor of COX than aspirin Central and peripheral anti-inflammatory action Excellent oral bioavailability

Question 41

Use of Indomethacin

Answer 41

Acute gouty arthritis RA OA Closure of PDA

Question 42

Side effect of Indomethacin

Answer 42

Diarrhea PUD Acute pancreatitis Hepatitis

Question 43

Which NSAID has inhibitory effect on leukocyte function

Answer 43

Ibuprofen