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Pharm I: Exam 2 > NSAIDS > Flashcards

NSAIDS Flashcards

(49 cards)

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1
Q

How do NSAIDs function?

A
  • Inhibits COX enzymes NONSPECIFIC
  • Inhibits prostaglandin synthesis
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2
Q

What are CLINICAL ACTIONS of NSAIDs?

A
  • Anti-flammatory
  • Antipyretic
  • Analgesic
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3
Q

When should NSAIDs be used?

A
  • Muculoskeletal and joint diseases
  • MILD TO MODERATE pain
  • FEVER relief
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4
Q

What is the importance of Misoprostol?

A

Treats NSAID-induced GI damage

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5
Q

What are some precautions should be taken with prescribing NSAIDs? (previous diagnoses)

A

Patients who have

  • Asthma
  • Renal Impairment
  • Thrombocytopenia

(Avoid NSAIDs at least 1 week prior to surgery)

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6
Q

What are some GI-related effects of NSAIDs?

A
  • Inhibits PG synthesis
  • INC gastric acid secretion
  • DEC mucus and bicarbonate protection

(ADR: Gastritis, GI bleeding, erosions, ulcerations)

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7
Q

What are some renal-related effects of NSAIDs?

A
  • Retention of Na+ and water (INC BP)
  • Edema
  • Hyperkalemia
  • Hypoaldosteronism
  • Vasoconstriction of afferent arterioles

(Patients w/ CHF, hepatic cirrhosis, renal insufficiency: possible ALREADY DEC BF and DEC GFR)

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8
Q

How does Aspirin function?

A
  • Irreversibly inhibits cyclooxygenase (NONSPECIFIC)
  • Anticoagulant effect (inhibition of TXA2)
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9
Q

What are therapeutic uses of Aspirin? (THINK DOSING)

A
  • CV: (prophylactic) DEC risk of TIAs, MIs, and Unstable Angina
  • Antipyretic and Analgesic (LOW DOSE)
  • Anti-inflammatory (HIGH DOSE)
  • Colon Cancer prevention (CHRONIC USE)
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10
Q

What are ADRs of Aspirin?

A
  • Salicylism (poisoning w/ salicylates)
  • Respiratory (Dose-related)
  • Reye’s Syndrome
  • Hypersensitivity
    • ​​Urticaria (hives)
    • Bronchoconstriction
    • Angioedema
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11
Q

What are related S/Sx of Salicylism (poisoning w/ salicylates)?

A
  • N/V
  • Hyperventilation
  • HA
  • Mental confusion
  • Dizziness
  • Tinnitus
  • Larger Doses:
    • Restlessness
    • Delirium
    • Hallucinations
    • Convulsions
    • Coma
    • Respiratory & Metabolic Acidosis
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12
Q

What are some Respiratory-related (Dose-dependent) ​ADRs of ASA?

A
  • Therapeutic: INC alveolar ventilation (INC CO2 and RR)
  • Higher: Hyperventilation (respiratory alkalosis)
  • TOXIC: central respiratory paralysis (respiratory and metabolic acidosis)
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13
Q

What is Reye’s syndrome? (ASA-related)

A

ASA administered with viral infections; S/S include:

  • Hepatitis
  • Encephalopathy

(often fatal)

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14
Q

What are some drug interactions of Aspirin? (HOAc(PS)gouty AI)

A
  • Heparin, Oral Anticoagulants (INC hemorrhage)
  • Probenecid, Sulfinpyrazone (DEC Urate excretion, contraindicated in patients with Gout)
  • Antacids (DEC rate of absorption)
  • Ibuprofen (Inhibits antiplatelets effects of LOW DOSE ASA)
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15
Q

What is Diflunisal?

A

Diflurophenyl derivative of salicylic acid (not metabolized to salicylic acid, no salicylic intoxication)

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16
Q

How does Diflunisal compare to ASA?

A
  • MORE POTENT than ASA
  • NO antipyretic activity (does not cross BBB)
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17
Q

What NSAID medications are Propionic acid derivatives? (NAME: IFFONK)

A
  • Ibuprofen
  • Fenoprofen
  • Flurbiprofen
  • Oxaprozin
  • Naproxen
  • Ketoprofen
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18
Q

What are the ACTIONS of propionic acid derivatives?

A
  • Anti-inflammatory
  • Antipyretic
  • Analgesic
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19
Q

What Propionic acid derivative has the longest half-life?

A

Oxaprozin

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20
Q

What are the ADRs of Propionic Acid derivatives?

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A
  • GI effects (LESS INTENSE than ASA)
  • Dyspepsia (leads to bleeding)
  • CNS effects:
    • HA
    • Tinnitus
    • Dizziness
21
Q

What NSAID medications are considered Indoleacetic acids? (NAME: ISD TEN)

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A
  • Indomethacin
  • Sulindac
  • Diclofenac
  • Tolmetin
  • Etodolac
  • Nabumetone
22
Q

What are ACTIONS of Indomethacin?

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A

VERY POTENT anti-inflammatory agent

  • MORE EFFICIENT than ASA or other NSAIDs
  • Side effects limit use
23
Q

What are Therapeutic uses for Indomethacin?

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A
  • Gouty Arthritis
  • OA (hip)
24
Q

What are ADRs of Indomethacin?

Study These Flashcards
A
  • INC GI complaints (N/V/D, anorexia)
  • CNS effects
    • HA
    • Dizziness
    • Vertigo
    • Mental confusion
  • RARE: hepatic and pancreatic effects
25
What are some **Drug interactions** with **Indomethacin**? *(FAT BETA)*
Will **DEC effects** of: * Furosemide * ACE Inhibitor * Thiazides * ß-blockers
26
How does **Sulindac** compare with **Indomethacin**?
**LESS POTENT** than Indomethacin
27
What are **Therapeutic uses** for **Diclofenac**? (3)
* RA * OA * Ankylosing Spondylitis (AS)
28
How does **Diclofenac** compare to **Indomethacin** or **Naproxen**?
**MORE POTENT** than Indomethacin/Naproxen
29
What are **ADRs** of **Diclofenac?**
May **ELEVATE** hepatic enzymes
30
What are **ADRs** of **Etodolac**?
* Fluid retention * Kidney and liver function abnormalities * GI problems *may be less*
31
What are **drug interactions** with **Etodolac**? (*L DMC*)
* Lithium * Digoxin * MTX * Cyclosporine (enhances nephrotoxicity)
32
What type of drug is **Nabumetone**?
Prodrug (metabolized to active form)
33
What are **therapeutic uses** for **Nabumetone** (prodrug)?
* OA * RA (fewer side effects)
34
What **NSAID** medications are considered **Oxicam derivatives**? (NAME: *PM*)
* **P**iroxicam * **M**eloxicam
35
What are **therapeutic doses** of **Meloxicam**? (Dose-related)
* **LOW-MODERATE DOSE:** COX-2 selective * **HIGH DOSE:** NONSPECIFIC
36
What are drug interactions of **Oxicam derivatives?** *("L" word)*
**Lithium** (interferes with renal excretion, INC serum lithium levels)
37
What are **ADRs** of **Oxicam derivatives**?
GI effects (**HIGH** incidence)
38
What **NSAID** medications are considered **Fenemates**? (NAME: *M&M)*
* **M**efenamic **a**cid * **M**eclofenamate
39
What are **ADRs** of **Fenamates**?
* **SEVERE** diarrhea (reason medication often not used) * Inflammation of bowels * Hemolytic anemia
40
What are **ACTIONS** of **Phenylbutazone**?
POWERFUL **anti-inflammatory**; Limited use (**SE**: Agranulocytosis, Aplastic anemia)
41
What are some **ADRs** of **Phenylbutazone?**
* GI effects * Fluid retention * Insomnia * Blurred vision * Euphoria * Nervousness
42
What are **drug interactions** with **Phenylbutazone**? *(SOW)*
* Sulfonamide * Oral hypoglycemic * Warfarin ## Footnote **Displaces from protein binding sites**
43
What is **Ketorolac**? why is it important?
Pyrrolizine Carboxylic Acid derivative; **ONLY injectable NSAID** (IM, IV; also available in oral tablet and ophthalmic solution)
44
What is an important consideration with **Ketorolac**?
MAX 5 days administration (**HIGH RATE GI Bleeds**)
45
What **NSAID** medications are **COX-2 inhibitors**? (NAME: *VCR*) which has a BLACK BOX warning)
* **V**aldexcoxib (removed from market) * **C**elecoxib **(BLACK BOX warning)** * **R**olecoxib (removed from market)
46
How do **COX-2 inhibitors** compare with **other NSAIDs**?
**NO** **COX-1 inhibition** (fewer GI bleeds but **lack antiplatelet activity**)
47
What are the **actions** of **Acetaminophen**?
* Analgesic * Antipyretic * WEAK Anti-inflammatory * NO Antiplatelet (Inhibit prostaglandins in CNS, minimal effect in periphery)
48
What are **ADRs** of **Acetaminophen**?
**OVERDOSE** (DO NOT exceed 3G/24H)
49
What drug is utilized to **counteract Acetaminophen OVERDOSE?**
N-acetyl-benzoquinoneimine

Pharm I: Exam 2 (7 decks)

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