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Flashcards in NSAIDS Deck (34)
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1

What is the mechanism of action of NSAIDS?

Inhibit cyclooxygenase- reduces formation of prostaglandin precursors and thromboxanes from arachidonic acid

2

What are the 2 different categories of NSAIDS?

  1. Selective - COX2 inhibitors
  2. Non-selective - COX1 & COX2 inhibitors 

3

When's the peak of NSAIDS and what are their half-life?

Peaks in 1-2 hours, half life varies by product

4

What are the actions of NSAIDS?

  • Analgesic
  • Anti-inflammatory
  • Antipyretic 

5

What is the action of NSAIDS on platelets?

Reversible - effect lasts only as long as the drug is in the bloodstream

6

Do you discontinue NSAIDS before surgery?

Yes - based on it's half-life - if needed for dental surgery, count back 4 to 5 half lives

  • ibuprofen - 1 day
  • naproxen - 4 days

7

What can happen when you take aspirin (chronic) and NSAIDS together?

ibuprofen can interfere with the antiplatelet effect of low-dose aspirin (81mg) potentially rendering aspirin less effective when used for cardioprotection and stroke prevention

8

What does the FDA recommend for patients on aspirin therapy and taking NSAIDS to avoid attenuation of aspirin's effect?

  • Dose ibuprofen at least 30 minutes or longer after aspirin ingestion ... or ....
  • More than 8 hours before aspirin ingestion

9

Is occasional use of ibuprofen or other NSAIDS while taking aspiring harmful?

No- poses little risk because the effects of aspirin on the patelets are permanent

10

What are the indications for NSAIDS?

  • Dental
    • Pain, fever, inflammation
  • Medical
    • Osteoarthritis, rheumatoid arthritis, gouty arthritis, fever, dysmenorrhea, pain

11

What are some examples of non-selective NSAIDS?

  • ibuprofen - Advil, Midol, Motrin (prescription), Ultraprin
  • naproxen - Aleve, (Anaprox, Naprosyn - prescription)

12

Which NSAID is a red flag in that it causes the most drug interactions?

indomethacin - Indocin

13

What are some common adverse events with NSAIDS?

  • Increased risk of MI, stroke
  • Hypertension
  • Comprised renal function
  • Gastrointestinal ulceration, irritation, bleeding and perforation (elderly especially)
  • CNS effects
  • Skin reactions

14

What does excessive or chronic use of NSAIDS lead to?

Nephotoxicity, elderly more susceptible to kidney damage

15

When are NSAIDS contraindicated?

  • In patients with advanced renal disease
  • (avoid) - patients with aspirin allergy 

16

What happens in patients that become hypersensitive to NSAIDS?

  • Hives, ithcing, angioneurotic edema, chills, fever, Steven-Johnson syndrome, bronchospasm, anaphylaxis 

17

What is the target organ for NSAIDS to effect?

Kidney - inhibiting prostaglandins shuts down renal blood flow --> renal necrosis

18

For ibuprofen, what is the OTC and prescription dose, rate of onset of anaglesia, and half-life?

  • OTC - 200 mg tablets
  • Rx - 400 - 800 mg tablets
  • Rapid onset of analgesia (30-60 min)
  • Short half-life (2-4 hours)

19

What is the dental dosing (analgesic/fever reduction) for ibuprofen (Motrin)?

  • Children: 4-10 mg/kg per dose every 6-8 hours
  • Adults: 200-400 mg/ dose every 4-6 hours for a max daily dose of 1200mg 

20

What is the preoperative dose of ibuprofen (Motrin) and why take a preoperative dose?

  • 400-600 mg every 6 hours for 24 hours before appointment
  • Decreases postoperative edema and hastens healing time

21

What is the ceiling effect of ibuprofen (Motrin)?

Optimal analgesia occurs at 400mg dose

beyond this dose = very little additional analgesia, mainly for inflammation

22

What is the rate of onset, half-life and duration of action for naproxen?

  • Rate of onset: 1 hour
  • Long half-life: 12-17 hours
  • Duration: analgesia < 7 hours, anti-inflammatory < 12 hours, peaks after 2 weeks

23

What is the dental dosing for naproxen?

  • Adults: 500 mg initially, then 250 mg every 6-8 hours (amp up above steady state) 
  • Max: 1250 mg/day

24

What is the longest active of all NSAIDS?

piroxicam (Feldene)

45-50 hour half-life

25

What are the 4 other important NSAIDS used in dentistry?

  • piroxicam (Feldene)
  • flurbiprofen (ANSAID)
  • ketorolac (Toradol)
  • diflunisal (Dolobid)

26

Which NSAID is known as "super aspirin"?

difunisal (Dolobid) 

no greater efficacy than aspirin

27

What are the 2 ways to write a prescription for pain?

  1. As needed for pain "prn"
  2. Every 6 hours

So that blood level never falls below therapeutic blood level

28

What are some psychological considerations when prescribing medications?

  • Prescription drug gives more relief than an OTC
  • More relief with expensive drug vs cheap
  • More relief from colored pills vs white pills

29

What is the only selective NSAID (COX2 inhibitor) available?

celecoxib (Celebrex)

30

How do selective NSAIDS spare the GI?

COX2 inhibitors inhibit prostaglandins associated with inflammation

Not expressed by GI tract, platelets or kidneys