NSAIDs

Question 1

Hilton’s law

Answer 1

The nerve supplying a joint also supplies the muscles that move the joint, the skin over the joint, and the insertion of the muscles

Question 2

Characteristics of somatic pain

Answer 2

Aching
Often constant
Dull or sharp
Worse with movement
Well localised unless deep

Question 3

4 steps on the WHO analgesic ladder

Answer 3

Nonopioids
Weak opioids
Strong opioids
Nerve block/epidural/PCA pump/spinal stimulators

Question 4

Which type of pain goes up the WHO analgesics ladder and which type goes down

Answer 4

Acute goes down
Chronic and cancer goes up

Question 5

NSAID MOA

Answer 5

Inhibition of COX enzymes preventing prostaglandin formation

Question 6

Which NSAIDS inhibit COX1 and COX2

Answer 6

Aspirin
Ibuprofen
Diclofenac
Ketoprofen

Question 7

Which NSAIDS are selective COX2 inhibitors

Answer 7

Rofecoxib
Celecoxib
Etoricoxib
Meloxicam
MERC

Question 8

How does the MOA of aspirin differ from those of ibuprofen diclofenac and ketoprofen

Answer 8

All inhibit COX 1+2
Ibuprofen, diclofenac, and ketoprofen also have additional mechanisms

Question 9

Effects of aspirin

Answer 9

Analgesic
Antipyretic
Anti inflammatory

Question 10

Effects of ibuprofen diclofenac and ketoprofen

Answer 10

Analgesic
Anti inflammatory

Question 11

Most prescribed NSAID in UK

Answer 11

Naproxen

Question 12

Function of COX enzymes

Answer 12

Catalyse formation of prostaglandins from Arachidonic acid

Question 13

3 classes of prostaglandins

Answer 13

Prostaglandins D E and F
Prostacyclin
Thromboxane A

Question 14

What type of molecule are prostaglandins

Answer 14

Tissue hormones

Question 15

How far do prostaglandins travel from site of production to site of action

Answer 15

Work on cells within tissue that produced them
Don’t diffuse far

Question 16

PGE2 actions

Answer 16

Vasodilation of renal art
Suppress lymphocytes
Sensitises peripheral nerve endings
Inhibits gastric acid secretion
Fever
Uterine relaxation

Question 17

PGD2 actions

Answer 17

Vasodilation
Bronchoconstriction

Question 18

PGI2 action

Answer 18

Vasodilation of renal artery
Inhibits platelet aggregation
Bronchodilation
Inhibit gastric secretion
Sensitise afferent nerve endings to pain

Question 19

PGF alpha actions

Answer 19

Vasoconstriction + dilation
Bronchoconstriction
Uterine contraction

Question 20

TXA2 actions

Answer 20

Vasoconstriction
Induce platelet aggregation
Bronchoconstriction
Uterine contraction

Question 21

How many types of prostaglandin receptor are there and what receptor type are they

Answer 21

9
G protein coupled receptor

Question 22

Which COX enzyme is physiologic and which is inducible

Answer 22

COX1 physiologic
COX2 inducible

Question 23

What enzyme catalyses the conversion of cell membrane phospholipids to arachadonic acid

Answer 23

Phospholipase A2

Question 24

What conditions increase COX2 in joints

Answer 24

OA
RA

Question 25

What molecules cause COX2 increase in joints effected by OA and RA

Answer 25

IL1, TNF, IL17 -> stim iNOS -> induces COX2

Question 26

Production of Which prostaglandin in joints can be directly activated by mechanical stress

Answer 26

PGE2

Question 27

Which COX isoforms is predominant in the stomach

Answer 27

COX1

Question 28

Where is COX1 and COX2 found in the stomach

Answer 28

1 - in crypts 2 - superficial mucosa

Question 29

How is COX1 beneficial in the stomach

Answer 29

Produces PGE2 which protects gastric mucosa

Question 30

Why are long term NSAIDs harmful to the stomach

Answer 30

Long term COX1 inhibition blocks PGE2 production leading to gastritis and gastric ulcers

Question 31

Why are NSAIDs given as GI preparations

Answer 31

Decrease risk of gastric ulcers

Question 32

Effects of PGE2 on gastric mucosa

Answer 32

Incr mucus secretion Incr cell regeneration Incr HCO3 release Incr blood flow Decr H+ secretion

Question 33

Effects of PGI2/prostacyclin and thromboxane A2 on the cardiovascular system

Answer 33

PGI2 vasodilation, prevents platelet aggregation Thromboxane A2 vasoconstriction, promotes platelet aggregation

Question 34

Where is COX1 and COX2 found in the cardiovascular system

Answer 34

COX1 - platelets COX2 - endothelium

Question 35

What type of spinal cord transmission is COX2 important in

Answer 35

Nocioceptive

Question 36

What increases COX2 in the kidney

Answer 36

Salt deprivation

Question 37

Protective effects of PGE2 and PGI2 in the kidney

Answer 37

PGE2 regulates Na reabsorption PGI2 incr K secretion by stimulating renin Vasodilation

Question 38

Which COX enzyme is more harmful

Answer 38

COX2

Question 39

What drug type has the suffix -coxib

Answer 39

Selective COX2 inhibitor

Question 40

What adverse effect is associated with rofecoxib diclofenac celecoxib and high dose ibuprofen

Answer 40

Increased cardiovascular risk

Question 41

Is GI risk higher in selective COX2 inhibitors or non selective NSAIDs

Answer 41

Non Selective NSAIDs

Question 42

How many COX enzymes do humans have

Answer 42

COX1 COX2 COX3 - non functional