NSAIDs

Question 1

what do NSAIDs do to the body

Answer 1

reduce inflammation by decreasing production of prostaglandins, prostacyclin, and thromboxane in CNS and periphery

Question 2

MOA of NSAIDs

Answer 2

inhibit COX (needed to make PG)

Question 3

what does COX1 enzyme do?

Answer 3

makes PG for routine maintenance (protect stomach mucosa, regulate blood flow to kidneys, allow normal platelet fxn)

Question 4

what does COX2 enzyme do?

Answer 4

activated by inflammation

Question 5

GI SE of NSAIDs

Answer 5

GI upset

ulcerations (increase gastric acids)

Question 6

what groups are at increased risk of GI complications from NSAIDs?

Answer 6

Hx of ulcers
high dose NSAIDs
anticoagulants
steroids

Question 7

CVS SE of NSAIDs?

Answer 7

increase BP (8-10mmHg)
fluid/salt retention

Question 8

BB warning for NSAIDs?

Answer 8

increased risk of MI & thrombotic events

increases with duration of use

greater risk if other CVD risk factors (increased risk of death or repeat attack w/in 5 years after MI)

Question 9

liver monitoring/SE of NSAIDs?

Answer 9

hepatotoxicity

monitor LFTs for 1st 6 month q2-4 weeks

Question 10

least hepatotoxic NSAID

Answer 10

ibuprofen

Question 11

allergies to NSAIDs?

Answer 11

angioedema (10%): complement activated due to decreased Pg
(avoid ALL NSAIDs)

increased asthma (nasal polyps and Hx of asthma) Try to avoid regular NSAIDs

Question 12

blood effects by NSAIDs

Answer 12

anticoagulants
ASA lasts 8-10 days
nonacetylated salicylates: no effect

Question 13

liver effects of NSAIDs

Answer 13

acute renal failure or increased SCr because no PG means less blood flow to kidneys

don’t give to people with poor kidney function

Question 14

CNS affects of NSAIDs?

Answer 14

HA (increased with tolmetin & indomethacin)

confusion (old ppl)

aseptic meningitis (increased with ibuprofen)

Question 15

drug interactions of NSAIDs

Answer 15

diuretics, ACEI, ARBs (effectiveness)

ACEI & ARBs (hyperkalemia)

SSRIs (PUD)

Clopidogrel, warfarin, and heparins (PUD & GI bleed, perforations)

• increases in elderly
• don’t give NSAIDs to these patients

Question 16

peak plasma feel of ASA?

Answer 16

1-2 hours

Question 17

Doses of aspirin?

Answer 17

mild/mod: 325-650 q4 (4g)

high for arthritis: 650 q4 (5.4g)

unstable angina, TIAs, MIs, CABG: 81mg

Question 18

ASA SE?

Answer 18

fecal blood loss (tsp/dose)

salicylism

hyperpnea (resp. alkalosis)

Question 19

what is salicylism?

Answer 19

caused by high doses of ASA

vomitting
tinnitus
decreased hearing
vertigo

Question 20

antidote for hyperpnea caused by ASA?

Answer 20

stomach irrigation
IV fluids
SODIUM BICARB
dialysis (last resort)

Question 21

which is a more effective COX inhibitor: ASA or Nonacetylated salicylates?

Answer 21

ASA

so nonacetylated salicylate help less with inflammation

Question 22

should you use nonacetylated salicylates to anticoagulate?

Answer 22

No, use them when you DONT want increased risk of bleeding or asthma

Question 23

SE of celecoxib?

Answer 23

sulfa allergy

increased risk of thrombosis, MI, stroke with prolonged use due to inhibition of PG synthesis in vascular endothelium
(higher if known CV risk)

Question 24

benefits of celecoxib?

Answer 24

fewer ulcers

Question 25

benefits of meloxicam?

Answer 25

less GI upset no platlet inhibition less bleeding

Question 26

which drugs have antipyretic, anti-inflammatory, and analgesic effects?

Answer 26

COX2 inhibitors ASA NSAIDs Exceptions: - Ketorolac: not for inflammation

Question 27

max dose of toradol? use?

Answer 27

40 mg IM/d for 5 days or less (Due to risk of ulcers) ``` migraine labor delivery drug addict respiratory depression (COPD) ```

Question 28

NSAIDs with long half life (1x daily dosing)

Answer 28

oxaprozin piroxicam nabumetone

Question 29

when to switch NSAIDs when you see no effect? when you see some effect?

Answer 29

no effect: 2 weeks (or increase dose) chronic dz/some effects at 2 weeks: 6 weeks to 2 months

Question 30

who should avoid NSAIDs?

Answer 30

``` CHF renal failure active PUD steroids uncontrolled HTN steroids? anticoagulants? ```

Question 31

when to check BP with Hx of HTN on NSAIDs?

Answer 31

before starting 2 weeks after starting (>10mmHG increase change NSAID or give more BP meds)

Question 32

PUD risk factors and treatment for pain?

Answer 32

risk factors: >70 yo, Hx of ulcers, on many NSAIDs Tx: celecoxib OR NSAID with PPI or misoprostol

Question 33

who needs SCr rechecked when starting NSAIDs? when?

Answer 33

pt on diuretic or ACEI | 307 days after starting

Question 34

which of the following does acetaminophen not treat: inflammation, coagulation, fever, pain? when does it peak?

Answer 34

inflammation & coagulation (no platelet effects) onset: 30-60 minutes

Question 35

who gets a dose less than 3 grams of APAP?

Answer 35

elderly hepatic dysfunction alcoholics

Question 36

MOA of acetaminophen?

Answer 36

inhibits PG synthesis in CNS inhibits heat regulating center in hypothalamus

Question 37

Low dose & high dose effects of APAP?

Answer 37

low: mild elevation in LFTs high: dizziness, excitement, disorientation

Question 38

when is APAP favored over NSAIDs and ASA?

Answer 38

GI upset ulcer child with virus (risk of Reyes) bleeding disorder

Question 39

MOA of capsaicin

Answer 39

releases substance P, than stimulates nerve to deplete substance P which decreases pain

Question 40

SE of capsaicin?

Answer 40

erythema | blisters

Question 41

what does capsaicin work best for?

Answer 41

post-herpetic neuralgia & arthritis

Question 42

how long does it take lidocaine to work? what is lidocaine/prilocaine mainly used for?

Answer 42

20-30 minutes used in children to decrease pain before IV & circumcisions

Question 43

mild to moderate cancer pain treatment?

Answer 43

NSAIDs & narcotics