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Pharm I: Exam 2 > NSAIDS > Flashcards

Flashcards in NSAIDS Deck (49):
1

How do NSAIDs function? 

  • Inhibits COX enzymes NONSPECIFIC
  • Inhibits prostaglandin synthesis 

2

What are CLINICAL ACTIONS of NSAIDs?

  • Anti-flammatory 
  • Antipyretic
  • Analgesic

3

When should NSAIDs be used?

  • Muculoskeletal and joint diseases
  • MILD TO MODERATE pain 
  • FEVER relief

 

4

What is the importance of Misoprostol?

Treats NSAID-induced GI damage

5

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

Patients who have

  • Asthma
  • Renal Impairment
  • Thrombocytopenia

(Avoid NSAIDs at least 1 week prior to surgery)

6

What are some GI-related effects of NSAIDs?

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

 

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

7

What are some renal-related effects of NSAIDs?

  • Retention of Naand water (INC BP)
  • Edema
  • Hyperkalemia 
  • Hypoaldosteronism 
  • Vasoconstriction of afferent arterioles

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

8

How does Aspirin function? 

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

9

What are therapeutic uses of Aspirin? (THINK DOSING)

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

10

What are ADRs of Aspirin?

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

11

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

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

12

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

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

13

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

ASA administered with viral infections; S/S include:

  • Hepatitis
  • Encephalopathy

(often fatal)

14

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

  • 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)

15

What is Diflunisal?

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

16

How does Diflunisal compare to ASA

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

17

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

  • Ibuprofen
  • Fenoprofen
  • Flurbiprofen
  • Oxaprozin
  • Naproxen
  • Ketoprofen

 

18

What are the ACTIONS of propionic acid derivatives?

  • Anti-inflammatory
  • Antipyretic
  • Analgesic

 

19

What Propionic acid derivative has the longest half-life? 

Oxaprozin

20

What are the ADRs of Propionic Acid derivatives?

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

21

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

  • Indomethacin
  • Sulindac
  • Diclofenac
  • Tolmetin
  • Etodolac
  • Nabumetone 

22

What are ACTIONS of Indomethacin? 

VERY POTENT anti-inflammatory agent

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

23

What are Therapeutic uses for Indomethacin?

  • Gouty Arthritis
  • OA (hip)

24

What are ADRs of Indomethacin?

  • 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)

  • Piroxicam
  • Meloxicam

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)

  • Mefenamic acid
  • Meclofenamate

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

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)

  • Valdexcoxib (removed from market)
  • Celecoxib (BLACK BOX warning)
  • Rolecoxib (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