NSAIDs

Question 1

In single doses non-steroidal anti-inflammatory drugs (NSAIDs) have analgesic activity comparable to that of _______________, but _______________ is preferred, particularly in the elderly.

Answer 1

paracetamol

paracetamol

Question 2

In regular full dosage NSAIDs have both a lasting ________________ and a(n) ______________ effect which makes them particularly useful for the treatment of continuous or regular pain associated with inflammation.

Answer 2

analgesic

anti-inflammatory

Question 3

Although paracetamol often gives adequate pain control in ______________, NSAIDs are more appropriate than paracetamol or the opioid analgesics in the ________________________ and in some cases of advanced _____________ due to their anti-inflammatory properties

Answer 3

osteoarthritis

inflammatory arthritides (e.g. rheumatoid arthritis)

osteoarthritis

Question 4

NSAIDs can also be of benefit in the less well defined conditions of _____________ and ______________.

Answer 4

back pain

soft-tissue disorders

Question 5

Differences in _____________ activity between NSAIDs are small, but there is considerable variation in _____________ and _____________ to these drugs.

Answer 5

anti-inflammatory

individual response

tolerance

Question 6

About _______% of patients will respond to any NSAID; of the others, those who do not respond to one may well respond to another.

Answer 6

60

Question 7

Pain relief starts ___________ after taking the first dose and a full analgesic effect should normally be obtained within ____________, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to _____________. If appropriate responses are not obtained within these times, another NSAID should be tried.

Answer 7

soon

a week

3 weeks

Question 8

NSAIDs reduce the production of _______________ by inhibiting the enzyme _______________.

Answer 8

prostaglandins

cyclo-oxygenase

Question 9

NSAIDs vary in their selectivity for inhibiting different types of cyclo-oxygenase; selective inhibition of cyclo-oxygenase-2 (COX-2) is associated with less _____________.

Answer 9

gastro-intestinal intolerance

Question 10

Ibuprofen is a propionic acid derivative with __________, ____________, and ____________ properties. It has fewer side-effects than other non-selective NSAIDs but its anti-inflammatory properties are weaker

Answer 10

anti-inflammatory

analgesic

antipyretic

Question 11

Ibuprofen is a propionic acid derivative with anti-inflammatory, analgesic, and antipyretic properties. It has ____________ (greater/fewer) side-effects than other non-selective NSAIDs but its anti-inflammatory properties are ___________ (stronger/weaker)

Answer 11

Fewer

Weaker

Question 12

Is ibuprofen suitable for conditions in which inflammation is prominent?

Answer 12

No; due to its weak anti-inflammatory properties compared to other non-selective NSAIDs

Question 13

______________ is the active enantiomer of ibuprofen. It has similar properties to ibuprofen and is licensed for the relief of mild to moderate pain and inflammation.

Answer 13

Dexibuprofen

Question 14

____________ is one of the first choices of NSAIDs because it combines good efficacy with a low incidence of side-effects (but more than ibuprofen).

Answer 14

Naproxen

Question 15

_____________ may be slightly more effective than naproxen, and is associated with slightly more gastro-intestinal side-effects than ibuprofen.

Answer 15

Flurbiprofen

Question 16

Ketoprofen has anti-inflammatory properties similar to ibuprofen and has ___________ (more/fewer) side-effects

Answer 16

More

Question 17

Tiaprofenic acid is as effective as naproxen; it has ___________ (more/fewer) side-effects than ibuprofen.

Answer 17

More

Question 18

Which NSAIDs are propionic acid derivatives? (5)

Answer 18

Naproxen
Flurbiprofen
Ketoprofen and dexketoprofen
Tioprofenic acid

Question 19

Diclofenac sodium and aceclofenac are similar in efficacy to _____________.

Answer 19

naproxen

Question 20

__________ is comparable in efficacy to naproxen; it is licensed for symptomatic relief of osteoarthritis and rheumatoid arthritis

Answer 20

Etodolac

Question 21

Indometacin has an action equal to or superior to that of naproxen, but with a high incidence of side-effects including…? (3)

Answer 21

1. headache
2. dizziness
3. gastro-intestinal disturbances

Question 22

Indometacin has an action equal to or superior to that of ____________, but with a high incidence of side-effects including headache, dizziness, and gastro-intestinal disturbances

Answer 22

naproxen

Question 23

_______________ has an action equal to or superior to that of naproxen, but with a high incidence of side-effects including headache, dizziness, and gastro-intestinal disturbances

Answer 23

Indometacin

Question 24

_______________ has minor anti-inflammatory properties. It has occasionally been associated with diarrhoea and haemolytic anaemia which require discontinuation of treatment

Answer 24

Mefenamic acid

Question 25

Mefenamic acid has minor anti-inflammatory properties. It has occasionally been associated with ______________ and ___________ which require discontinuation of treatment

Answer 25

diarrhea haemolytic anaemia

Question 26

Mefenamic acid has ____________ (major/minor) anti-inflammatory properties. It has occasionally been associated with diarrhoea and haemolytic anaemia which require discontinuation of treatment

Answer 26

Minor

Question 27

Meloxicam is licensed for the short-term relief of pain in ____________ and for long-term treatment of _____________ and _______________.

Answer 27

osteoarthritis rheumatoid arthritis ankylosing spondylitis

Question 28

_____________ is licensed for the short-term relief of pain in osteoarthritis and for long-term treatment of rheumatoid arthritis and ankylosing spondylitis.

Answer 28

Meloxicam

Question 29

Nabumetone is comparable in effect to ____________.

Answer 29

naproxen

Question 30

Phenylbutazone is licensed for _____________, but is not recommended because it is associated with serious side-effects, in particular haematological reactions; it should be used only by a specialist in severe cases where other treatments have been found unsuitable.

Answer 30

ankylosing spondylitis

Question 31

________________ is licensed for ankylosing spondylitis, but is not recommended because it is associated with serious side-effects, in particular haematological reactions; it should be used only by a specialist in severe cases where other treatments have been found unsuitable.

Answer 31

Phenylbutazone

Question 32

Phenylbutazone is licensed for ankylosing spondylitis, but is not recommended because it is associated with serious side-effects, in particular ________________; it should be used only by a specialist in severe cases where other treatments have been found unsuitable.

Answer 32

haematological reactions

Question 33

Piroxicam is as effective as naproxen and has a _____________ (short/long) duration of action which permits ______________

Answer 33

Long once-daily administration

Question 34

______________ has more gastro-intestinal side-effects than most other NSAIDs, and is associated with more frequent serious skin reactions

Answer 34

Piroxicam

Question 35

Piroxicam has more gastro-intestinal side-effects than most other NSAIDs, and is associated with more frequent ______________

Answer 35

serious skin reactions

Question 36

Sulindac is similar in tolerance to _____________.

Answer 36

naproxen

Question 37

Tenoxicam is similar in activity and tolerance to ____________. Its long duration of action allows once-daily administration.

Answer 37

naproxen

Question 38

Tolfenamic acid is licensed for the treatment of __________.

Answer 38

migraine

Question 39

Ketorolac trometamol and the selective inhibitor of cyclo-oxygenase-2, parecoxib, are licensed for the short-term management of _________________

Answer 39

postoperative pain

Question 40

The selective inhibitors of COX-2, ___________ and ____________, are as effective as non-selective NSAIDs such as diclofenac sodium and naproxen.

Answer 40

etoricoxib celecoxib

Question 41

Although selective COX-2 inhibitors can cause serious gastro-intestinal events, available evidence appears to indicate that the risk of serious upper gastro-intestinal events is lower with selective inhibitors compared to non-selective NSAIDs; this advantage may be lost in patients who require concomitant _______________.

Answer 41

low-dose aspirin

Question 42

Available evidence appears to indicate that the risk of serious ________________ is lower with selective COX-2 inhibitors compared to non-selective NSAIDs; this advantage may be lost in patients who require concomitant low-dose aspirin.

Answer 42

upper gastro-intestinal events

Question 43

Celecoxib and etoricoxib are licensed for the relief of pain in _______________, ______________, and _______________; etoricoxib is also licensed for the relief of pain from _____________.

Answer 43

osteoarthritis rheumatoid arthritis ankylosing spondylitis acute gout

Question 44

______________ and ______________ are licensed for the relief of pain in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; _____________ is also licensed for the relief of pain from acute gout.

Answer 44

Celecoxib etoricoxib etoricoxib

Question 45

Aspirin has been used in high doses to treat ______________, but other NSAIDs are now preferred

Answer 45

rheumatoid arthritis

Question 46

Most mild to moderate dental pain and inflammation is effectively relieved by ____________

Answer 46

NSAIDs

Question 47

Which NSAIDs are used in the management of mild to moderate dental and orofacial pain? (3)

Answer 47

1. Ibuprofen 2. Diclofenac sodium 3. Diclofenac potassium

Question 48

The use of NSAIDs in the elderly is potentially inappropriate if co-prescribed with a ____________, _____________, or ______________

Answer 48

Vit K antagonist Direct thrombin inhibitor Factor Xa inhibitor (Due to increased risk of major GI bleed)

Question 49

The use of NSAIDs in elderly patients is potentially inappropriate if prescribed with concurrent ______________ without PPI prophylaxis

Answer 49

Antiplatelet agent(s) | Due to increased risk of PUD

Question 50

The use of NSAIDs in elderly patients is potentially inappropriate in a history of PUD or GI bleeding UNLESS concurrent __________ or ___________ are prescribed

Answer 50

PPIs H2-receptor antagonists (Due to risk of peptic ulcer relapse; COX-2 selective NSAIDs are not included)

Question 51

The use of NSAIDs in elderly patients is potentially inappropriate if prescribed with concurrent ______________ without PPI prophylaxis

Answer 51

Corticosteroids | *also antiplatelets Increased risk of PUD

Question 52

The use of NSAIDs in elderly patients is potentially inappropriate in patients with an eGFR less than _______________

Answer 52

50 mL/min/1.73 m2 | Risk of deterioration in renal function

Question 53

The use of NSAIDs in elderly patients is potentially inappropriate if prescribed in patients with ____________ or _______________

Answer 53

Severe HTN Severe HF (Risk of exacerbation)

Question 54

The use of NSAIDs in elderly patients is potentially inappropriate if prescribed for ___________ symptom relief of osteoarthritis where ____________ has not been tried

Answer 54

long-term (longer than 3 mo) paracetamol

Question 55

The use of NSAIDs in elderly patients is potentially inappropriate (STOPP criteria) if prescribed for chronic treatment of __________ where there is no contraindication to a(n) _____________

Answer 55

Gout Xanthine-oxidase inhibitor

Question 56

The use of NSAIDs in elderly patients is potentially inappropriate (STOPP criteria) if a _____________ is prescribed in patients with concurrent _______________

Answer 56

COX-2 selective NSAID CVD (Increased risk of MI and stroke)

Question 57

Any degree of worsening of ____________ may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.

Answer 57

asthma

Question 58

Any degree of worsening of asthma may be related to the ingestion of ___________, either prescribed or (in the case of ___________ and others) purchased over the counter.

Answer 58

NSAIDs ibuprofen

Question 59

All NSAID use (including COX-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of ______________ (e.g. __________ and __________)

Answer 59

thrombotic events myocardial infarction stroke * independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term

Question 60

The greatest risk of thrombotic events in patients taking NSAIDs may be in those receiving ____________________

Answer 60

High doses long term

Question 61

Which 3 NSAIDs are associated with an increased risk of thrombotic events?

Answer 61

COX-2 selective inhibitors (eg. etoricoxib, celecoxib) diclofenac (150 mg daily) and aceclofenac ibuprofen (2.4 g daily)

Question 62

Although there are limited data regarding the thrombotic effects of ___________, treatment advice has been updated in line with diclofenac, based on ___________'s structural similarity to diclofenac and its metabolism to diclofenac

Answer 62

aceclofenac aceclofenac

Question 63

Which NSAIDs are considered to have the lowest thrombotic risk? (2)

Answer 63

1. Naproxen | 2. Low dose ibuprofen (1.2 g daily or less)

Question 64

____________ (1 g daily) is associated with a lower thrombotic risk, and low doses of _____________ (1.2 g daily or less) have not been associated with an increased risk of myocardial infarction

Answer 64

Naproxen ibuprofen

Question 65

The ______________ of NSAID should be prescribed for the ______________ to control symptoms and the need for long-term treatment should be ________________.

Answer 65

lowest effective dose shortest period of time reviewed periodically

Question 66

All NSAIDs are associated with serious ________________; the risk is higher in ___________.

Answer 66

gastro-intestinal toxicity the elderly

Question 67

Which NSAIDs are associated with the highest risk of serious upper GI side effects? (3)

Answer 67

1. Piroxicam 2. Ketoprofen 3. Ketorolac

Question 68

Which NSAIDs are associated with moderate risk of serious upper GI side effects? (3)

Answer 68

1. Indomethacin 2. Diclofenac 3. Naproxen

Question 69

Which non-selective NSAID is associated with the lowest risk of serious upper GI side effets?

Answer 69

Ibuprofen (although high doses have been associated with intermediate risk)

Question 70

Selective inhibitors of COX-2 are associated with a lower risk of ________________ side-effects than non-selective NSAIDs.

Answer 70

serious upper gastro-intestinal

Question 71

Recommendations are that NSAIDs associated with a low risk of serious upper GI side effects e.g. ______________ are generally preferred, to start at the _________________ and not to use more than __________ oral NSAID at a time

Answer 71

ibuprofen lowest recommended dose one

Question 72

What consideration should be taken regarding NSAIDs and alcohol?

Answer 72

Alcohol increases the risk of gastro-intestinal haemorrhage associated with NSAIDs.

Question 73

Alcohol increases the risk of _______________ associated with NSAIDs.

Answer 73

gastro-intestinal haemorrhage

Question 74

Specialist sources recommend that concurrent use of NSAIDs need not be avoided with ___________ alcohol intake, but greater caution is warranted in those who drink more than ____________.

Answer 74

moderate the recommended daily limits

Question 75

Some cases of _______________ have been attributed to use of NSAIDs and acute excessive alcohol consumption

Answer 75

acute kidney injury

Question 76

Some cases of acute kidney injury have been attributed to use of NSAIDs and ________________

Answer 76

acute excessive alcohol consumption