NSAIDs

Question 1

Inflammation

Answer 1

Active response of tissues to injury (beneficial or harmful)

Question 2

Processes involved in inflammation

Answer 2

Immune responses, coagulation cascade, regeneration and repair

Question 3

4 changes involved in inflammation

Answer 3

Vasodilation, edema, WBCs enter tissue, pain

Question 4

Fibrosis

Answer 4

Scarring as a result of chronic inflammation

Question 5

Inciting causes of inflammation

Answer 5

Infection, trauma, necrosis, immune-mediated disease

Question 6

Beneficial outcomes of inflammation

Answer 6

Eliminates agent, repairs + regenerates

Question 7

Harmful outcomes of inflammation

Answer 7

Loss of function, systemic effects, scar formation

Question 8

Synthesis of inflammatory mediators

Answer 8

Some synthesized in advance (histamine), some synthesized at the site (prostaglandins)

Question 9

Redundancy of inflammatory mediators

Answer 9

Many trigger the same response

Question 10

Major classes of pro-inflammatory mediators

Answer 10

Eicosanoids (prostaglandins, thromboxane, prostacyclin), leukotrienes

Question 11

Non-pharmacological treatments of inflammation

Answer 11

Rest, heat/cold, weight reduction, surgery

Question 12

Pharmacological treatments of inflammation

Answer 12

NSAIDs, glucocorticoids

Question 13

Oldest NSAID

Answer 13

Aspirin

Question 14

Mechanism of aspirin

Answer 14

Inhibits prostaglandin synthesis

Question 15

Main benefits of NSAIDs

Answer 15

Anti-inflammatory, antipyretic, analgesic

Question 16

Normal physiological roles of prostaglandins

Answer 16

Synthesized from arachidonic acid by COX enzymes

Question 17

COX1

Answer 17

Housekeeping enzyme at lowlevels in all tissues; produces thromboxane, other prostaglandins, prostacyclins

Question 18

COX2

Answer 18

Normally present at very low levels in most tissues, very important for homeostasis in some tissues

Question 19

TXA2

Answer 19

Thromboxane, important for platelet aggregation

Question 20

PGD2, PGE2

Answer 20

Prostaglandins synthesized by both cox enzymes; maintain blood flow and are involved in gastric mucosa protection

Question 21

PGI2

Answer 21

Prostacyclin; inhibit platelet aggregation, vasodilate, and protect gastric mucosa

Question 22

Prostaglandin roles during inflammation

Answer 22

COX2 is upregulated locally, causing the 5 main symptoms of inflammation

Question 23

NSAIDs mechanism

Answer 23

Inhibit usually both COX1 and COX2

Question 24

Major benefit of NSAIDs

Answer 24

Reduces blood flow to the site of injury

Question 25

Adverse effects of NSAIDs

Answer 25

Inhibit normal protective effects of gastric mucosa (ulcers and bleeding), increased bleeding tendencies, renal medullary hypoxia and papillary necrosis

Question 26

Pk of NSAIDs

Answer 26

Weak acids, bound to protein, hepatic metabolism, variable elimination

Question 27

Adverse effects of NSAIDs

Answer 27

GI ulceration, increased bleeding, inhibition of uterine motility, decreased renal perfusion, renal necrosis in dehydrated patients

Question 28

Contraindications of NSAIDs

Answer 28

Gi ulcers, renal disease, hepatic disorder. Hypoproteinemia, dehydration, cardiac disease, hypersensitivity, concurrent use

Question 29

Clinical uses of NSAIDs

Answer 29

Relief of musculoskeletal and inflammatory pain

Question 30

Mechanism of aspirin

Answer 30

Inhibits COX1 irreversibly, causing prolonged effects

Question 31

Effective uses for aspirin

Answer 31

Musculoskeletal and cutaneous pain, not visceral

Question 32

Adverse effects of aspirin

Answer 32

Bleeding, dose-dependent gastric ulceration, renal damage

Question 33

Contraindications for aspirin

Answer 33

Bleeding disorders, prone to gi ulcers

Question 34

Ibuprofen mechanism

Answer 34

Inhibits COX1 and COX2

Question 35

Effective uses for ibuprofen

Answer 35

Arthritis and musculoskeletal pain

Question 36

Adverse effects of ibuprofen

Answer 36

Gastric ulceration, myocardial infarction risk

Question 37

Celoxicib mechanism

Answer 37

Selective for COX2

Question 38

Effective uses of celecoxib

Answer 38

Osteoarthritis (not analgesia)

Question 39

Benefits of celecoxib

Answer 39

Less likely to cause GI ulceration and bleeding

Question 40

Adverse effects of celecoxib

Answer 40

Reduced renal function, increased risk of stroke and MI, concern with chronic use

Question 41

How coxibs increase risk of stroke and MI

Answer 41

They only inhibit COX2, producing less PGI2 which prevents platelet aggregation, but doesn't inhibit COX1 so thromboxane is not inhibit el

Question 42

Acetaminophen

Answer 42

Inhibits central PG synthesis in the CNS, so it is only an antipyretic and analgesic