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Pharm I: Exam 2 > NSAIDS > Flashcards

NSAIDS Flashcards

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?

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)

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

What are ACTIONS of Indomethacin?

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?

A
  • Gouty Arthritis
  • OA (hip)
24
Q

What are ADRs of Indomethacin?

A
  • INC GI complaints (N/V/D, anorexia)
  • CNS effects
    • HA
    • Dizziness
    • Vertigo
    • Mental confusion
  • RARE: hepatic and pancreatic effects
25
Q

What are some Drug interactions with Indomethacin? (FAT BETA)

A

Will DEC effects of:

  • Furosemide
  • ACE Inhibitor
  • Thiazides
  • ß-blockers
26
Q

How does Sulindac compare with Indomethacin?

A

LESS POTENT than Indomethacin

27
Q

What are Therapeutic uses for Diclofenac? (3)

A
  • RA
  • OA
  • Ankylosing Spondylitis (AS)
28
Q

How does Diclofenac compare to Indomethacin or Naproxen?

A

MORE POTENT than Indomethacin/Naproxen

29
Q

What are ADRs of Diclofenac?

A

May ELEVATE hepatic enzymes

30
Q

What are ADRs of Etodolac?

A
  • Fluid retention
  • Kidney and liver function abnormalities
  • GI problems may be less
31
Q

What are drug interactions with Etodolac? (L DMC)

A
  • Lithium
  • Digoxin
  • MTX
  • Cyclosporine (enhances nephrotoxicity)
32
Q

What type of drug is Nabumetone?

A

Prodrug (metabolized to active form)

33
Q

What are therapeutic uses for Nabumetone (prodrug)?

A
  • OA
  • RA

(fewer side effects)

34
Q

What NSAID medications are considered Oxicam derivatives? (NAME: PM)

A
  • Piroxicam
  • Meloxicam
35
Q

What are therapeutic doses of Meloxicam? (Dose-related)

A
  • LOW-MODERATE DOSE: COX-2 selective
  • HIGH DOSE: NONSPECIFIC
36
Q

What are drug interactions of Oxicam derivatives? (“L” word)

A

Lithium (interferes with renal excretion, INC serum lithium levels)

37
Q

What are ADRs of Oxicam derivatives?

A

GI effects (HIGH incidence)

38
Q

What NSAID medications are considered Fenemates? (NAME: M&M)

A
  • Mefenamic acid
  • Meclofenamate
39
Q

What are ADRs of Fenamates?

A
  • SEVERE diarrhea (reason medication often not used)
  • Inflammation of bowels
  • Hemolytic anemia
40
Q

What are ACTIONS of Phenylbutazone?

A

POWERFUL anti-inflammatory; Limited use (SE: Agranulocytosis, Aplastic anemia)

41
Q

What are some ADRs of Phenylbutazone?

A
  • GI effects
  • Fluid retention
  • Insomnia
  • Blurred vision
  • Euphoria
  • Nervousness
42
Q

What are drug interactions with Phenylbutazone? (SOW)

A
  • Sulfonamide
  • Oral hypoglycemic
  • Warfarin

Displaces from protein binding sites

43
Q

What is Ketorolac? why is it important?

A

Pyrrolizine Carboxylic Acid derivative; ONLY injectable NSAID (IM, IV; also available in oral tablet and ophthalmic solution)

44
Q

What is an important consideration with Ketorolac?

A

MAX 5 days administration (HIGH RATE GI Bleeds)

45
Q

What NSAID medications are COX-2 inhibitors? (NAME: VCR) which has a BLACK BOX warning)

A
  • Valdexcoxib (removed from market)
  • Celecoxib (BLACK BOX warning)
  • Rolecoxib (removed from market)
46
Q

How do COX-2 inhibitors compare with other NSAIDs?

A

NO COX-1 inhibition (fewer GI bleeds but lack antiplatelet activity)

47
Q

What are the actions of Acetaminophen?

A
  • Analgesic
  • Antipyretic
  • WEAK Anti-inflammatory
  • NO Antiplatelet

(Inhibit prostaglandins in CNS, minimal effect in periphery)

48
Q

What are ADRs of Acetaminophen?

A

OVERDOSE (DO NOT exceed 3G/24H)

49
Q

What drug is utilized to counteract Acetaminophen OVERDOSE?

A

N-acetyl-benzoquinoneimine

Pharm I: Exam 2 (7 decks)

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