NSAIDs

Question 1

What three symptoms do NSAIDs primarily treat? What diseases are they often used with?

Answer 1

Fever, pain, inflammation

Rheumatoid arthritis and osteoarthritis

Question 2

What is the mechanism of NSAIDs?

Answer 2

Inhibition of prostaglandin synthesis by targeting COX 1 and COX 2

Question 3

Which prostaglandin modulates gastric mucosal acid secretion, mucus levels, and blood flow?

Answer 3

PGE2

Question 4

Which prostaglandin has vasodilatory properties?

Answer 4

PGI2

Question 5

Which prostaglandins cause systemic fever, local heat, and pain?

Answer 5

PGE2 and PGI2

Question 6

What do all of the prostaglandins cause?

Answer 6

Erythema

Question 7

Which COX is constitutive and protective?

Answer 7

COX-1

Question 8

Which COX is inducible and inflammatory?

Answer 8

COX-2

Question 9

What does PUBS stand for?

Answer 9

Perforations, symptomatic ulcers, GI bleeds

Question 10

What are the most common and frequently encountered side FX of NSAIDs?

Answer 10

Gastric or intestinal ulceration (inh of PGI2 and PGE2), disturbances in platelet function (inh of TxA2)

Question 11

What is Stevens-Johnson syndrome?

Answer 11

Diffuse, severe, mucocutaneous eruption involving 2 or more mucosal surfaces w/ or w/o visceral involvement

Question 12

What is the most popular reason people use aspirin?

Answer 12

Heart disease

Question 13

What is mechanism of salicylates?

Answer 13

Nonselective inhibition of COX-1 and COX-2

Question 14

Acetylsalicylic acid (Aspirin)

Answer 14

Covalently, irreversibly inhibits COX-1 and COX-2 and platelet aggregation

Inflammation, pain, fever, prophylaxis for thromboembolic conditions (prevents clot formation)

Question 15

What toxicities are associated with aspirin?

Answer 15

CNS - highs and lows, respiratory alkalosis, respiratory acidosis, Reye’s syndrome (swelling of liver and brain)

Question 16

Should children take aspirin?

Answer 16

NO

Question 17

Acetaminophen (Tylenol)

Answer 17

Weak peripheral COX-1 and COX-2 antagonist

Decreases prostaglandins synthesis

Pain, fever

Question 18

What are toxicities associated with acetaminophen?

Answer 18

Hepatic damage

Question 19

Tylenol is toxic at ____ the therapeutic dose and fatal at ____ the therapeutic dose.

Answer 19

10x

20x

Question 20

What do you administer for tylenol overdose?

Answer 20

N-acetyl-cysteine (Mucomyst) to replace hepatic glutathione and activated charcoal to decrease further absorption

Question 21

What do you administer for aspirin overdose?

Answer 21

Sodium bicarb

Question 22

Should alcoholics take acetaminophen?

Answer 22

NO - their liver function is impaired

Question 23

Ibuprofen (Advil/Motrin) and Naproxen (Aleve)

Answer 23

Proprionic acid derivative that reversibly inhibits COX-1 and COX-2

Decreases prostaglandin synthesis

Pain - acute and chronic RA and osteoarthritis, reduce fever, anti-inflammatory

Question 24

Indomethacin (Indocin)

Answer 24

Acetic acid derivative; reversibly inhibits COX-1 and COX-2, less prostaglandins made

Acute gouty arthritis, ankylosing spondylitis, promotes closure of patent ductus arteriosus in newborns, reduces fever, anti-inflammatory

Question 25

Diclofenac (Cambia)

Answer 25

NSAID

Decreases arachidonic acid levels

Question 26

Ketorolac (Toradol)

Answer 26

NSAID

Potent analgesic useful for post-op pain if trying to avoid narcotics and approved for parenteral administration

Question 27

***coxib - Celecoxib (Celebrex)

Answer 27

***coxib - COX-2 specific inhibitor (minimizes risk of stomach ulcers)

NSAID - pain/inflammation

Increases risk of heart attack or stroke

Question 28

What should we only use aspirin for?

Answer 28

Prophylaxis against thromboembolic disorders