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NSAIDS Flashcards

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1
Q

What are the clinical features of inflammation?

A

Swelling, redness, pain & heat

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2
Q

What is the enzyme that breaks down phospholipids?

A

Phospholipase

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3
Q

What is Phospholipids broken down to?

A

Arachidonic acid

  • -> Leukotriene
  • -> Prostaglandins
  • -> Thromboxane
  • -> Prostacyclin
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4
Q

What are Prostaglandins (PGE2) responsible for?

A

Uterine contraction
Vasodilation- contraction of GI smooth muscles
Inhibition of gastric acid secretion

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5
Q

What are Thromboxane responsible for?

A

Platelet aggregation

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6
Q

What are Prostacyclins (PGI2) responsible for?

A

Inhibits platelet aggregation
Vasodilation
Gastric xytoprotection

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7
Q

What are Leukotrienes responsible for?

A

Chemotaxis
Hyperalgesia (hyper sensitivity to pain)
Broncho-constricion
Edema

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8
Q

What condition would your body produce a lot of Leukotrienes for? Specifically LTC4, LTD 4, LTE4

A

Asthma

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9
Q

How to corticosteroids work?

A

Work on Cyclo-oxygenase, shutting off the Cox 1 & Cox 2 pathways

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10
Q

Is Acetominophen (tylenol) an NSAID?

A

NO!

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11
Q

Is Aspirin an NSAID?

A

YES!

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12
Q

What is also known as the Constitutive pathway?

A

COX 1

Because it will always be there

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13
Q

What is know as the inducible pathway?

A

COX 2

Because this is not always available, you have to turn this on when needed.

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14
Q

Why would you not want COX 2 to always be on?

A

Because It makes you more sensitive to pain, so only turn on when needed

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15
Q

What do NSAIDs inhibit?

A

COX 1 & COX 2 pathways

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16
Q

Where is Prostacycline (PGI2) located?

A

Vascular endothelium

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17
Q

Where is the Cyclooxygenase (COX) pathway located?

A

Endoplastmatic reticulum

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18
Q

What are the 3 Isoforms of COX?

A 
COX 1 (constitutive) -->Pysiological conditions
COX 2 (Inducible) ---> inflammation, pain
COX 3 --> Brain
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19
Q

Are NSAIDs selective or nonselective COX inhibitors?

A

NON selective

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20
Q

What is Acetylsalicylic acid?

A

Aspirin

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21
Q

What are some examples of Nonselective COX 1/COX 2 inhibitors?

A 
Acetylsalicylic acid
Diclofenac
Indomethacin
Sulindac
Piroxicam
Piroxicam beta-cyclodextrin (prodrug)
Lornoxicam
Tenoxicam
Flurbiprofen
Ibuprofen
Ketoprofen
Naproxen
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22
Q

What are the benefits of NSAIDs?

A
  • Analgesia–> Prevents pain
  • Antipyresis–> reduces body temp
  • Reduces inflammation
  • Anti-thrombotic action–> in low doses prevents clotting/platelet aggregation
  • Closes the Patent Ductus Arteriosus (Indomethacin)
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23
Q

What are some side effects of NSAIDs?

A 
Gastric mucosal damage
Bleeding
Decreased renal flow
Delay/prolonged labor/contractions
Asthma/anaphylaxis
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24
Q

What is a direct result of NSAID use that can cause ulcers

A

Direct toxicity “Ion trapping”

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25
What are the 2 compounds that Aspirin splits into when metabolized?
Acetic Acid | Salicylate
26
What happens to the Aspirin metabolites if oxidized?
Can become Gentisic Acid
27
What happens to the Aspirin metabolites if conjugated with glycine?
Become Salicyluric acid
28
What are some risks of Aspirin in children with rheumatoid arthritis?
Hepatic encephalopathy (Reyes Syndrome)
29
What is the lower age limit for Aspirin?
Under 15, unless specifically indicated for Juvenile arthritis
30
What is an effect of being on chronic Aspirin?
Thinning of blood, increased risked of hemorrhagic stroke
31
What happens in an Aspirin OD?
``` Fever N/V Decreased urination Diplopia Restlessness/irritability Dizzy/confused LOC, impaired cognition Drowsy Hallucinations ```
32
What is the interaction of ACE inhibitors with NSAIDs?
Decreases the affect of ACE (decrease antiHTN effect)
33
What is the interaction of Cyclosporine with NSAIDs?
Increased Nephrotoxicty
34
What is another name for Ibuprofen?
Advil
35
What is Ibuprofen a derivative of?
Phenylpropionic acid
36
How is oral Ibuprofen usually prescribed?
In a low dose b/c is has anlagesic but not anti-inflammatory effects
37
What would a liquid gel preparation of Ibuprofen be used for?
Postsurgical dental pain
38
What are some difference between Ibuprofen and Indomethocin?
Ibuprofen decreases urine output and causes less fluid retention
39
Are NSAIDs useful in closing the ductus arteriosus in preterm infants?
YES
40
What is Ketoprofen used for?
RA Osteoarthritis Gout Dysmenorrhea
41
What is Indomthacin used for?
``` Juvenile rheumatoid arthritis Gout Ankylosing spondylitis Postepisiotomy pain Treats patent ductus arteriosus reduces conjunctival inflammation Reduces pain after traumatic corneal abrasion Gingival inflammation ```
42
What are the side effects of Indomethacin?
``` GI and CNS side effects --> At high doses GI bleeding Diarrhea Frontal headache Mental confusion ```
43
What is Diclofenac used for>?
``` Prophylaxis for postoperative ophthalmic inflammation Intra-ocular lens implantation Strabismus surgery Solar Keratoses Analgesia Postoperative Nausea ```
44
What are the AEs of Diclofenac?
GI distress Occult bleeding Gastric ulceration
45
What happens when you combine Diclofenac and Misoprostol?
Decreases upper GI ulceration or Diarrhea
46
What are the indications for Piroxicam?
Rheumatic indications
47
What happens when Prioxicam is given at high doses?
Increases risk of peptic ulcer & bleeding (10x higher risk)
48
What is the MOA of Piroxicam?
A non-selective COX-1/COX-2 inhibitor inhibits polymorphonuclear leukocyte migration It decreases oxygen radical production, and inhibits lymphocyte function
49
What is the MOA of Indomethacin?
Non-selective COX inhibitor It can inhibit phospholipase A and C, reduce neutrophil migration, and decrease T cell and B cell proliferation
50
What are some examples of COX 2 inhibitors?
Celecoxib Meloxicam Nabumetone
51
Which of the 3 COX 2 inhibitors is preferentially selective instead of highly selective?
Meloxicam
52
What is the main risk with COX 2 inhibitors?
Infertility | Prothrombotic cardiovascular risk
53
What is the DOC for Acute rheumatic fever?
Aspirin
54
Which med is as effective as other NSAIDs in the treatment of rheumatoid arthritis and osteoarthritis, and in trials it has caused fewer endoscopic ulcers than most other NSAIDs, probably because it is a sulfonamide?
Celecoxib
55
What makes Acetominophen different Aspirin?
It is not an anti-inflammatory
56
What is the preferred drug for patients who are allergic to Aspirins or Salicylates?
Acetomoniphen
57
What is Acetominophen used for?
Mild to moderate pain --> HA, myalgia, postpartum pain
58
Would you give Aspirin or Acetominophen to a child with a viral infection?
Acetominophen
59
What are the AEs of Acetominophen?
Acute acetaminophen poisoning Hepatic toxicity Nephrotoxicity
60
What would you used to an alcoholic with side effects from Acetominophen?
Activated charcoal
61
What meds would you give for an acute Gout attack?
``` Colchicine PLUS pain reliever --> Diclofenac Indomethacin Naproxen Piroxiam ```
62
What meds would you give for chronic Gout?
Uricostatics (Xantine Oxidase inhibitors) Allopurinol (DOC) Febuxostat Uricosurics Probenecid, benzbromarone Sulfinpyrazone Uricolytics: Uricase, Rasburicase
63
What is a combo drug that could be used for Gout?
Harpagin (allopurinol & benzbromarone)

Pharm 4 (4 decks)

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