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Flashcards in Pharm2 7 Pain pt2 Deck (19)

Ibuprofen and Others NSAIDs
Therapeutic effects (2)
How does it effect COX?

Reversible inhibitors of COX - Inhibition only lasts for life of the DRUG.


Ibuprofen and Others NSAIDs can have adverse effects. why?

Nonselective inhibitor of COX (adverse effects)
Analgesic ceiling


Non-steroidals: Steve Nissen discovered they do what? With which drug specifically?

increase the risk of heart attack. This was first recognized as a possibility with Vioxx (Rofecoxib)


Of all the non-steoridals that are NOT selective, what has the highest risk of cv events?

Meloxicam. Despite this being very dangerous, it still continues to be written.


Every nonsteroidal increases cv risks, including aspirin! Why is it used then?

What's the #2 least likely non-steroidal to lead to cv risks?
Which drug has an increased risk of CHF?

But aspirin’s BENEFITS greatly exceed risks.


Naproxium sodium


Which NSAIDs for Young & healthy patients (2)

ibuprofen (3 or 4x day) or naproxium sodium (BID) – naproxium is more freq written b/c it’s easier to take


Which NSAID for patient at higher cv risk.

naproxium sodium as a first choice, unless there is any hx of CHF – then use ibuprofen


Which NSAID for if family hx of CVA or poorly controlled BP to put them at risk of CVA

back away from naproxium and use ibuprofen.


Ibuprofen adult regiment

100mg per hour. 800 mg every 8 hours, 600 mg tablet every 6 hours, etc. 2 200 tablets every 4 hours.
Cheapest formulation to buy it in: 200 mg. and you buy a big giant jar OTC and costco or cvs.


Ibuprofen's 3 effects. When is each?

Has analgesic, antipyretic, and antiinflammatory effects – BUT NOT AT THE SAME TIME!
analgesic & antipyretic – after the first dose.


Ibuprofen only has antiinflammatory effects when?

Ex: 400mg every 4 hours? how long will it take?

After 5 doses, aka when you reach steady state level.
20 hours.


Ibuprofen plan for a general injury.

600mg Motrin with food (substantial food or it’ll be irritating) after first dose you have a degree of analgesia and pain control.
What’s more important is icing and elevating your injury. That’ll have a bigger effect.
Tomorrow when you take your 5th dose you’ll start getting the antiinflammatory properties. So stress to the patient they need to ice and elevate until then.


___ is a “phenomenally good pain med, one of the best.”



if patient says they tried ibuprofen otc and it doesn’t work for them, but Aleve does...are they most likely telling the truth or not?

Yes, It makes sense b/c they go through 2 diff substrates of your CYP450 pathway.
So if someone says one or the other doesn’t work for them, switch pain meds. “I do that all the time.”


What is this?
When would this be used?

COX-2 selective NSAID.

If they’ve been on a PPI for the last 5 years to prevent ulcers & never had a medication reconciliation
. It does not eliminate GI bleeding. It reduces it by 8%.


Most NSAIDS are COX 1> COX-2

Name 2 drugs that are = for both
Name 3 drugs that are cox 2>cox 1

Nabumetone and Etodolac: COX-1 = COX-2

Celecoxib, Rofecoxib, Valdecoxib: COX-2 > COX-1


When would COX 2 > COX 1 be used?
(Celecoxib, Rofecoxib, Valdecoxib)

Name 3 drugs that fall under this

GI problems. If they’ve been on a PPI for the last 5 years to prevent ulcers & never had a medication reconciliation
You choose cox-2 b/c a pt has a GI problem. It does not eliminate GI bleeding. It reduces it by 8%..


Selective COX-2 inhibitors
2 therapeutic effects

Analgesic, Antiinflammatory.


Celecoxib (Celebrex)
Half life
Where's it metabolized?

Half life ~ 12 hours
Metabolized in liver
Relative CI with sulfa allergies (contains a sulfur atom)