NSAIDs

Question 1

What parts of the pain pathway do NSAIDs act on?

Answer 1

modulation and transduction

Question 2

What are the main effects of NSAIDs?

Answer 2

They prevent inflammation by inhibiting cyclooxygenase (COX) enzymes.

Question 3

Aside fro analgesia, what are other uses for NSAIDs?

Answer 3

anti-pyretic and inhibit tumor growth (anti-angiogenesis)

Question 4

T/F: NSAIDs and steroids can be used together.

Answer 4

False

Question 5

What is the function of COX-1 and what 2 hormones does it produce?

Answer 5

Constitutive, physiologic production of prostaglandins that play an important role in normal homeostasis. Thromboxane A2 and Prostaglandin E1 (PGE1)

Question 6

COX-2 functions in what?

Answer 6

Inducible production of prostaglandins produced during times of inflammation.

Question 7

T/F: selective COX-2 inhibitors are over the counter.

Answer 7

False. They are RX only.

Question 8

T/F: NSAIDs are weak acids.

Answer 8

True.

Question 9

Which is the strongest NSAID?

Answer 9

Aspirin.

Question 10

T/F: NSAIDs have a greater effect on chronic inflammation than acute inflammation.

Answer 10

False. greater effect on acute inflammation.

Question 11

Are NSAIDs highly protein bound?

Answer 11

Yes, about 95-99% of them are protein bound.

Question 12

T/F: NSAIDs can cross the BBB into the CNS

Answer 12

True

Question 13

Where are NSAIDs metabolized and where are they excreted?

Answer 13

metabolized in the liver (both phase 1 and 2 if hepatic metabolism in the liver), and excreted in the urine.

Question 14

T/F: biliary excretion and enterohepatic recirculation is never seen with NSAIDs

Answer 14

False. It is seen with some NSAIDs.

Question 15

After how many half-lives are drugs nearly completely excreted?

Answer 15

5

Question 16

What are 2 special uses of NSAIDs?

Answer 16

antithrombotic effects and antineoplastic effects.

Question 17

What are some adverse effects NSAIDs can have?

Answer 17

GI irritation/ulceration, vomiting, anorexia, diarrhea, renal damage and decreased blood flow, as well as post-op analgesia and hypotension.

Question 18

Does vomiting, diarrhea, and anorexia mean that there is an ulcer present?

Answer 18

No.

Question 19

Who is at higher risk of renal damage when using NSAIDs?

Answer 19

Cats

Question 20

When should NSAIDs be used post-op?

Answer 20

After recovery from anesthesia.

Question 21

Can hepatotoxicity occur as an adverse effect when using NSAIDs?

Answer 21

Yes, especially in cats. Acetaminophen gets metabolized into toxic intermediates by phase 1 metabolism.

Question 22

What large animal NSAID is used as an analgesic for colic and endotoxemia in horses, for visceral pain in cattle, and is not recommended for use in small animals?

Answer 22

flunixin meglumine (Banamine)

Question 23

T/F: flunixin meglumine (Banamine) can be administered PO and IV in cattle.

Answer 23

False, only IV in cattle.

Question 24

Should flunixin meglumine be used IM in horses? Why or why not?

Answer 24

No, because muscle necrosis has been reported to occur with IM administration.

Question 25

T/F: flunixin meglumine can be administered IM in pigs.

Answer 25

True

Question 26

What species should not be given flunixin meglumine?

Answer 26

Birds, causes renal toxicity.

Question 27

This drug is used commonly in horses, banned from being used in dairy cattle, and is indicated for treatment of musculoskeletal pain.

Answer 27

Phenylbutazone (bute)

Question 28

What are the routes of administration of phenylbutazone?

Answer 28

PO (most common) and IV. NOT IM/SC.

Question 29

What can happen if phenylbutazone is administered via intracarotid injection?

Answer 29

Seizures and CNS stimulation.

Question 30

What drugs are COX-2 preferentials?

Answer 30

Carprofen, meloxicam, and deracoxib

Question 31

Which 2 of the COX-2 preferentials are available as injectables (SQ)?

Answer 31

carprofen and meloxicam.

Question 32

What COX-2 preferential is approved for single use in cats?

Answer 32

Meloxicam

Question 33

What drugs fall under the COX-2 selective class?

Answer 33

Firocoxib and robenacoxib.

Question 34

Which COX-2 selective is approved for multiple doses in cats (ip to 3 days)?

Answer 34

Robenacoxib (Onsior)

Question 35

How long should the washout period be if switching from an NSAID to a steroid?

Answer 35

1-2 weeks.

Question 36

If changing from a steroid to an NSAID, what should the washout period be?

Answer 36

minimum 1 week after weaning off of the steroid.

Question 37

If you are switching from NSAID to another NSAID, should you still have a washout period?

Answer 37

Yes, based on half life or go for 1 week (conservative default).

Question 38

T/F: Acetaminophen inhibits COX

Answer 38

False.

Question 39

Should acetaminophen be used in cats?

Answer 39

No.

Question 40

What is the most important form of toxicity caused by acetaminophen? What other toxic effect can be seen?

Answer 40

methemoglobinemia. Hepatic necrosis can also be seen.

Question 41

What is grapiprant's mode of action?

Answer 41

antagonist at prostaglandin E2 EP4 receptor.

Question 42

This drug is a neural steroid used in dogs, cats, and horses, and is mainly used to control neuropathic pain.

Answer 42

gabapentin.

Question 43

Can gabapentin be used as an adjunct treatment for laminitis in horses?

Answer 43

Yes.

Question 44

When should you be careful using gabapentin?

Answer 44

in renal insufficiency cases because it is renally excreted.

Question 45

Does amantadine inhibit cox?

Answer 45

No. It has NMDA receptor antagonist properties.

Question 46

This medication is a less common adjunctive analgesic, it is good for neuropathic or "wind up" pain, and is available as an oral medication.

Answer 46

amantadine

Question 47

What is the mode of action of Omega 3 fatty acids? What pathways produce these mediators?

Answer 47

modulation of inflammation. COX, LOX, and cytochrome P450 pathways.

Question 48

Aside from modulating inflammation, what other effects do omega 3 fatty acids have?

Answer 48

they affect immune cell response by regulating gene expression, they act as a ligand for nuclear receptors, they inhibit TLR4 by endotoxin, and produce substrates for resolvins and protectins.