NSAIDs and Acetaminophen Flashcards Preview

Pharm II MHM - FINAL > NSAIDs and Acetaminophen > Flashcards

Flashcards in NSAIDs and Acetaminophen Deck (84)
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1

Types of pain

-Nociceptive (somatic, visceral)
-Neuropathic
-Psychogenic

2

What is the mechanism of pain and what are its mediators?

-Neural mechanism
-Chemical mediators

3

Describe the stages of the neural pain pathway

-Stimulation
-Transmission
-Modulation

4

What occurs in the stimulation phase of the neural pain pathway?

-Noxious stimuli activate receptors
-Release of bradykinins, H and K ions, PGs, histamine, ILs, TNF, serotonin and Sub P

5

What occurs in the transmission phase of the neural pain pathway?

-A and C afferent nerve fibers stimulated
-Synapse along spinal cord dorsal horn releases NTs
-Impulses passed along ascending pathway to the brain

6

What occurs in the modulation phase of the neural pain pathway?

-Pain becomes a conscious experience via limbic system
-Endogenous opiate system in CNS modulates pain impulses
-Descending system of nerves may inhibit synaptic pain transmission

7

Describe inflammation

-Subset of nociceptive pain
-Natural shift from protection of damage to promotion of healing

8

Describe maladaptive inflammation

-Action outlives function
-Chemical properties of neurons change which effects transmission of pain
-Often caused by disease

9

What is the beginning component of the COX pathway normally?

Arachidonic acid
(released upon trigger of natural inflammatory cascade)

10

General function of COX?

Oxygenates arachidonic acid which forms PGs, prostacyclin, thromboxane

11

What is misoprostol and what does it do?

-Synthetic PGE1
-Induces uterine contractions
-Protects GI mucosa

12

What is alprostadil and what does it do?

-Synthetic PGE1
-Maintain patent ductus arteriosis

13

What is latanoprost and what does it do?

-Synthetic PGF2a
-Treatment of open angle glaucoma

14

What is prostacyclin and what does it do?

-Synthetic PGI2
-Treatment of pulmonary HTN

15

Describe selective NSAIDs

Selectively blocks COX-2 (over COX-1)

16

Describe COX-1

Physiological "housekeeping"
-Vascular homeostasis
-GI, renal blood flow
-Platelet function

17

Describe COX-2

Activated only as needed
-Inflammation, fever, pain
-Ovulation
-Placental function
-Uterine contractions

18

Major difference between aspirin and all other NSAIDs

Aspirin irreversibly (!) binds to COX-1 and COX-2

19

MOA of Aspirin

Irreversibly binds to COX-1 and COX-2 (inhibiting PG synthesis and preventing formation of TXA2)

20

Aspirin uses

-Anticoagulant (mainly)
-Antipyretic
-Analgesic (at high doses)
-Anti-inflamm (at high doses)

21

Peak plasma levels of aspirin occurs when?

1-2 hours

22

Is aspirin more selective to COX-1 or COX-2?

COX-1 as long as it is under 100 mg dosage

23

Contraindications to aspirin

-Pregnancy C/D (avoid esp in 3rd trimester)
-Hemophiliacs
-Children under 16 yo w/viral illness (risk of Reye's syndrome)
-Asthma, nasal polyps, recurrent sinusitis

24

How does aspirin (or any salicylates) toxicity present?

Tinnitus

25

What is the MC used non-selective NSAID?

Ibuprofen

26

Ibuprofen MOA and use

-Reversibly blocks COX-1 and 2
-Used in mild to moderate pain

27

What is the new formulation of ibuprofen and what does it do?

-Caldolor (IV)
-For moderate pain and used to decrease opioid dose required
-Very expensive

28

Pediatric use of ibuprofen?

-Commonly for fever and pain
-5 to 10 mg/kg/dose Q6-8h

29

Dosing of ibuprofen

It has both an OTC dose (200-400 mg Q6-8h) and a prescription dose (600-800 mg Q6-8h)

30

Toxicity of ibuprofen

-Similar to all non-selective NSAIDs
-May be more prone to GI side effects due to increased use vs. other products