NSAIDS

Question 1

aspirin chemical name

Answer 1

Acetyl-salicylic acid

Question 2

NSAID target

Answer 2

Prostaglandin synthesis

Question 3

Rate limiting step of prostaglandin synthesis

Answer 3

COX activity

Question 4

COX-1 Functions

Answer 4

Fever
Pain
Protect mucosal lining of stomach
Increase platelet aggregation
Regulate kidney function

Question 5

Prototype COX-1 inhibitor

Answer 5

Aspirin

Question 6

COX-2 Functions

Answer 6

Pain
Protect mucosal lining of stomach
Decrease platelet aggregation in endothelial cells
Wound healing
Inflammation

Question 7

Prototype COX-2 inhibitor

Answer 7

Celecoxib

Question 8

Aspirin dose

Answer 8

325 mg

Question 9

Aspirin is hydrolyzed to:

Answer 9

Salicylic acid

Question 10

Salicylate NSAID metabolism
Low dose:
High dose:

Answer 10

Low dose: conjugated in liver; first order kinetics
High dose: excreted.by kidneys unmetabolized; zero order kinetics

Question 11

Low dose aspirin uses:

Answer 11

Pain
Fever
Anticoagulation

Question 12

High dose aspirin uses:

Answer 12

Inflammation

Question 13

Aspirin mechanism of anti-coagulation

Answer 13

Salicylate Irreversibly/covalently binds to COX-1 to decrease platelet synthesis of thromboxanes

Question 14

Aspirin side effects

Answer 14

Bleeding
GI irritation
Premature closure of ductus arteriosus

Question 15

Aspirin contraindications

Answer 15

Clotting deficiencies
Children
Late pregnancy

Question 16

Aspirin drug interactions

Answer 16

Warfarin, methotrexate, sulfonamides

Question 17

Aspirin overdose treatment

Answer 17

Bowel irrigation
Activated charcoal
Volume repletion
Alkalinization of urine

Question 18

Non-aspirin NSAIDs are derivatives of:

Answer 18

Proprionic acid

Question 19

Ibuprofen brand names

Answer 19

Motrin
Advil

Question 20

Celecoxib brand name

Answer 20

Celebrex

Question 21

Naproxen brand name

Answer 21

Aleve

Question 22

Ibuprofen dose:

Answer 22

200mg for pain and fever
400mg for anti-inflammatory

Question 23

Non-aspirin NSAID adverse effects

Answer 23

GI irritation
Increased bleeding time (shorter term than aspirin; reversible)
Drug interactions (high albumin binding)
Renal toxicity

Question 24

Indomethacin is a derivative of:

Answer 24

Acetic acid

Question 25

Indomethacin is more/less potent than aspirin?

Answer 25

More potent (10-20x)

Question 26

Indomethacin main use

Answer 26

Severe inflammation Not used for pain or.fever due to severe side effects

Question 27

Celecoxib mechanism of action

Answer 27

Selective COX-2 inhibitor

Question 28

Celecoxib uses

Answer 28

Decrease inflammation and pain with less side effects than COX-1 inhibitors

Question 29

Celecoxib adverse effects

Answer 29

Edema GI upset Increase risk of MI

Question 30

Acetaminophen chemical name

Answer 30

Acetyl para-amino phenol (APAP)

Question 31

Acetaminophen MOA

Answer 31

Unknown Probably COX and prostaglandin inhibition

Question 32

Acetaminophen dose

Answer 32

325mg

Question 33

Acetaminophen uses

Answer 33

Pain Fever NOT inflammation

Question 34

Maximum daily dose of acetaminophen

Answer 34

4g

Question 35

Acetaminophen adverse effects

Answer 35

Hepatic damage Skin rash Mucosal lesions Nephrotoxicity

Question 36

Acetaminophen overdose symptoms

Answer 36

GI distress Hepatotoxicity

Question 37

Acetaminophen overdose treatment

Answer 37

Supportive care Activated charcoal N-acetyl-cysteine (Acetadote)

Question 38

Which of the following drugs is specifically approved for and frequently advertised for treating menstrual cramps and pain? A. Indomethacin B. Naproxen C. Celecoxib D. Aspirin E. Acetaminophen

Answer 38

B. Naproxen

Question 39

In a setting of overdose toxicity with aspirin, which of the following pairs the most serious concern with its appropriate treatment? A. hepatotoxicity, treated with sodium bicarbonate. B. hepatotoxicity, treated with N-acetyl-cysteine. C. long-lasting inhibition of coagulation, treated with N-acetyl-cysteine. D. risk of GI ulceration, treated with prostaglandin analogs, such as misoprostol. E. respiratory and metabolic acidosis, treated with sodium bicarbonate

Answer 39

E. respiratory and metabolic acidosis, treated with sodium bicarbonate

Question 40

A drug whose use is limited to specific types of severe inflammation because of its significant toxicities in other settings is A. naproxen sodium. B. indomethacin. C. celecoxib. D. prednisolone. E. acetaminophen.

Answer 40

B. indomethacin

Question 41

Aspirin is the only drug specifically recommended for decreasing the risk of myocardial infarction and stroke in middle-aged and aging persons or those with a prior incident. This is because aspirin A. is more COX-2 selective than any other NSAIDs. B. is the only NSAID that inhibits platelets significantly because of its selective uptake by platelets. C. has significantly greater COX-2 inhibition than any of the other orally effective NSAIDs. D. causes irreversible covalent acetylation of COXs in platelets. E. inhibits prostacyclin production to a greater extent than thromboxane production

Answer 41

D. causes irreversible covalent acetylation of COXs in platelets.

Question 42

GI distress and potential GI hemorrhage with prolonged use is a greater concern with A. aspirin than with other salicylates. B. ibuprofen than with aspirin. C. celecoxib than with naproxen. D. aspirin than with celecoxib. E. acetaminophen than with ibuprofen.

Answer 42

D. aspirin than with celecoxib

Question 43

A 3-year -old child is brought to the emergency room after ingesting the remaining aspirin tablets from a 50-tablets bottle about 3 hours earlier The mother estimates that 30-35 tablets were in the bottle. The child is unconscious and given sodium bicarbonate intravenously. Which of the following best describes the goal of the sodium bicarbonate? A. To alkalinize the plasma, to prevent respiratory acidosis B. To alkalinize the urine, to remove salicylate from the plasma by ion trapping. C. To neutralize the salicylic acid in the blood stream D. To prevent binding of the aspirin to plasma binding proteins that can cause indirect side effects E. To serve as a sulfhydryl group "sink" to react with the excess salicylic acid

Answer 43

B. To alkalinize the urine, to remove salicylate from the plasma by ion trapping