NSAIDs (Shelby 🐈)

Question 1

Name! That! NSAID!

Relatively short acting
Decreases arachidonic acid bioavailability

Answer 1

Diclofenac (Voltaren)

Question 2

Name! That! NSAID!

Potent, worst side effect profile

Answer 2

Indomethacin (Indocin)

Question 3

a very small portion of acetaminophen is metabolized this way:

Answer 3

A small portion is metabolized by the P450 system creating a free radical which is normally conjugated with glutathione and excreted

Question 4

How long can a patient be on Ketorolac (Toradol)

Answer 4

5 days

Question 5

How is Piroxican (Feldene), Meloxicam (Mobic) a better option NSAID for patients with hepatic disease

Answer 5

Decreases oxygen radical production

Question 6

Effects of acetaminophen in the body

normal doses NOT overdose

Answer 6

CNS effects only

no GI problems, no kidney adverse effects, no inhibition of blood clotting like NSAIDs

Question 7

What is the main effect of Specific inhibitors of COX-2 enzymes

Answer 7

Inhibition of the production of prostacyclin by endothelial cells

Question 8

Name! That! NSAID!

Very potent and very long acting - single daily dosing is possible

Answer 8

Naproxen (Naprosyn)

Question 9

acetaminophen is MOSTLY metabolized this way:

Answer 9

glucoronidated in the liver and excreted by the kidney

Question 10

What is Ketorolac (Toradol) used for

Answer 10

postsurgical pain

Can be combined with opioids to reduce side effects from opioids (constipation)

Question 11

DOC for small children with fever

Answer 11

acetaminophen

Question 12

What does acetaminophen do?

What does it NOT do?

Answer 12

Very good analgesic and antipyretic agent

Not an NSAID- does not have an anti-inflammatory effect

Question 13

Name! That! NSAID!

Not in the US, very potent and effective

Answer 13

Phenylbutazone

Question 14

Why do Specific inhibitors of COX-2 enzymes have less GI side effects than aspirin

Answer 14

Reduced effect on GI because they are not inhibiting COX-1, which produces the GI protecting prostaglandins

Question 15

Name! That! NSAID!

Can be combined with opioids to reduce side effects from opioids (constipation)

Answer 15

Ketorolac (Toradol)

Question 16

Patient has active PUD, what can you give them?

**********

Answer 16

acetaminophen and/or opioids only

NO NSAIDs

Question 17

Name! That! NSAID!

Decreases oxygen radical production, better for patients with hepatotoxicity

Answer 17

Piroxican (Feldene), Meloxicam (Mobic)

Question 18

Name! That! NSAID!

First choice drug, lowest incidence of side effects

Answer 18

Ibuprofen (Motrin)

Question 19

Diclofenac (Voltaren) is often combined with _______ to decrease GI side effects

Answer 19

misoprostol (Arthrotec)

Question 20

Benefit of Celecoxib (Celebrex)

Downside of Celecoxib (Celebrex)

Answer 20

Benefit: Less effect on GI (less cox-1 inhibition)

Downside: increased risk of cardiovascular disease (imbalance of prostacyclin and thromboxane)

Question 21

What happens if glutathione is exhausted in regards to acetaminophen excretion

Answer 21

the free radicals will cause severe liver necrosis

Question 22

Name! That! NSAID!

Extensively bound to plasma proteins, displacement causes adverse drug reactions with bound drugs (warfarin, anti-diabetics, etc)

Answer 22

Naproxen (Naprosyn)

Question 23

Name! That! NSAID!

Prodrug, long half life

Answer 23

Nabumetone (Felafen)

Question 24

acetaminophen overdose antidote:

Answer 24

N-acetylcysteine (Mucomyst)

Question 25

Why should patients that are chronic alcoholics NOT take acetaminophen

Answer 25

If there is an increased production of the metabolite as in chronic alcoholism, which induces the P450 system, this also leads to severe liver damage

Question 26

acetaminophen overdose causes:

Answer 26

fatal hepatic necrosis

Question 27

How does Indomethacin (Indocin) reduce inflammation in addition to being a cox blocker

Answer 27

Reduces PMN migration – additional anti-inflammatory effect Inhibits phospholipase A – decreases synthesis of prostaglandins from arachidonic acid

Question 28

Patient has history of PUD, but it is not currently active. What can you give them *************************************************

Answer 28

Celecoxib with or without antacids or some NSAIDs with Misoprostol or “-prazols”

Question 29

What is the only Specific inhibitor of COX-2 enzymes that is available in the US

Answer 29

Celecoxib (Celebrex)

Question 30

What is the major side effect caused by the imbalance between thromboxane and prostacyclin with Specific inhibitors of COX-2 enzymes

Answer 30

Excess Thromboxane in the absence of prostacyclin promotes the development of cardiovascular problems

Question 31

Name! That! NSAID! The reversible binding inhibits the irreversible binding of aspirin – decreases effects on platelet aggregation, should not be combined

Answer 31

Ibuprofen (Motrin)

Question 32

No history of PUD What can you give them *************************************************

Answer 32

any NSAID

Question 33

A 78 year old man is taking daily aspirin for stroke prevention. One day he decides to go to Tijuana to see a donkey show. He has a few margaritas while he is down there and tries to wave down a prostitute on the street at the end of the night. He ends up waving down an undercover Mexican cop and is arrested for the solicitation of a prostitute. The cop suddenly gets the urge that he has to IMMEDIATELY diarrhea from the tacos he hate for dinner. He leaves the man in his unlocked cop car so the old man decides to make a run for it. He leaps across the border and sprains his ankle. He limps into an urgent care and the NP decides not to ask any questions but just give him some Ibuprofen and tell him to get a life. What is going to happen?

Answer 33

1. The ibuprofen is going to INHIBIT the aspirins effect on platelets, and he is going to have a stroke 2. He is going to have an STI 3. He is going to get extradited to Mexico to serve time in a Mexican prison, where he will likely get more STIs

Question 34

Name! That! NSAID! Cannot be used longer than 5 days due to GI side effects

Answer 34

Ketorolac (Toradol)

Question 35

Name! That! NSAID! Long half life Inhibits PMN migration and Lymphocyte function

Answer 35

Piroxican (Feldene), Meloxicam (Mobic)

Question 36

Name! That! NSAID! Potent – can be used for postsurgical pain

Answer 36

Ketorolac (Toradol)

Question 37

Name! That! NSAID! Reduces PMN migration and Inhibits phospholipase A

Answer 37

Indomethacin (Indocin)

Question 38

Why do you not combine Ibuprofen (Motrin) and Aspirin

Answer 38

The reversible binding of Ibuprofen inhibits the irreversible binding of aspirin – decreases effects on platelet aggregation, should not be combined

Question 39

What is the problem with Specific inhibitors of COX-2 enzymes

Answer 39

Creates and imbalance between thromboxane and prostacyclin Excess Thromboxane in the absence of prostacyclin promotes the development of cardiovascular problems

Question 40

Name! That! NSAID! Used for patent ductus arteriosus

Answer 40

Indomethacin (Indocin)