T3-Analgesics: NSAIDS-MJ

Question 1

Is acetaminophen technically a NSAID?

Answer 1

No

Question 2

What do both NSAIDs and acetaminophen do?

Answer 2

Both inhibit cox

Question 3

When there is tissue injury, arachidonic acid is going to be released, and two cox will be released from the arachidonic. What are the two cox?

Answer 3

COX-1

COX-2

Question 4

Which is the “good cox” and what does it do?

Answer 4

COX-1

Gastric protection, platelet activation

Question 5

What is the “bad cox” and what does it do?

Answer 5

COX-2

Pain, inflammation

Question 6

What do NSAIDs do?

Answer 6

Block COX-1 and COX-2

Question 7

Is there selectivity in regards to how much COX and which COX is being inhibited?

Answer 7

Yes, some NSAIDs block a little more COX-1, some may block a little more of COX-2

Question 8

What drugs are more selective for COX-1?

Answer 8

Aspirin
Naproxen
Ibuprofen

Question 9

What drugs are more selective for COX-2?

Answer 9

Meloxicam
Celecoxib
Diclofenac

Question 10

NSAIDS cause an ____ in Na and ____ in renal blood flow

Answer 10

Increase in Na

Decrease in renal blood flow

Question 11

Some of the adverse effects with NSAIDS deal with the blocking of pathways that can cause issues in the kidneys. What are some of those related issues?

Answer 11

Hypertension
Edema (may worsen heart failure)
Acute kidney injury

Question 12

NSAIDS are also highly associated with __ issues.

Answer 12

GI

Question 13

What are the two main GI issues that NSAIDs cause?

Answer 13

GI ulcerations

GI bleeding

Question 14

If you are taking NSAID meds for 3-6 months, what is your risk for GI issues? Is this a good percentage?

Answer 14

1%; it sounds good but in reality it isn’t since these NSAIDs are such common meds that the large population takes

Question 15

If you are taking NSAID meds for 12 months or so, what is your risk for GI issues?

Answer 15

2-4%

Question 16

Is there a black box warning for NSAIDs?

Answer 16

Yes

Question 17

The black box warning for NSAIDs is controversial. Why?

Answer 17

The warning came because there was an increase in stroke and MI with people taking COX-2 NSAID drugs. It is controversial because what about COX-1? There is no real evidence supporting COX-1 inhibiting NSAIDs do the same

Question 18

What is the ONE NSAID that is the exception to the black box warning? Why?

Answer 18

Aspirin; it PROTECTS against MI and stroke

Question 19

If someone is about to have surgery, is aspirin a suitable drug to give them?

Answer 19

No-bleeding risk

Question 20

What does aspirin do in the body that makes it so dangerous to take before surgery?

Answer 20

Aspirin binds to the platelets irreversibly! You can’t just stop taking aspirin one day before a surgery. It has to be a week or so because when aspirin binds to a platelet irreversibly you have to wait for your body to make NEW platelets before having a surgery. It may take the body a week or so to make the new platelets

Question 21

Can children take aspirin?

Answer 21

No

Question 22

Why can’t children take aspirin?

Answer 22

Increase risk for Reye’s Syndrome

Question 23

Is it okay to take aspirin during pregnancy?

Answer 23

No

Question 24

Why is it not good to take aspiring during pregnancy?

Answer 24

Increase risk for bleeding

Question 25

Can we give a patient acetaminophen before a surgery?

Answer 25

Yes

Question 26

What are some of the characteristics of acetaminophen? (four)

Answer 26

1. No anti-inflammatory effect 2. No platelet effect 3. No GI ulceration 4. No renal impairment

Question 27

Does acetaminophen work well for patients with arthritis?

Answer 27

No

Question 28

T or F: Acetaminophen is lipid soluble.

Answer 28

TRUE

Question 29

Where all does acetaminophen inhibit COX?

Answer 29

ONLY in the CNS

Question 30

Why is acetaminophen a good drug to give for patients with fever?

Answer 30

Fever is controlled centrally by the hypothalamus, which is why it's a good drug to take with fever

Question 31

What is acetaminophen's effect?

Answer 31

Reduces fever | Analgesia

Question 32

Should we only ever give acetaminophen or do we need to alternate?

Answer 32

Alternate

Question 33

What is acetaminophen toxic to?

Answer 33

Liver

Question 34

What is Ibuprofen toxic to?

Answer 34

Kidney and GI

Question 35

For example, why should we alternate giving a patient acetaminophen and Ibuprofen?

Answer 35

Since acetaminophen is toxic to the liver and ibuprofen is toxic to the kidney and GI, it is good to alternate giving these drugs so that it reduces stress on the organs those drugs are acting on

Question 36

What is the leading cause of liver failure?

Answer 36

Acetaminophen overdose

Question 37

What is the antidote for acetaminophen overdose?

Answer 37

Acetycysteine

Question 38

Giving acetyclysteins 8-10 hours within the time of overdose will ___% reverse the problems of liver failure.

Answer 38

100%

Question 39

What groups of people are most at risk for tylenol overdose?

Answer 39

Undernourished Heavy drinkers Liver disease

Question 40

What should a total daily tylenol dose be for patients with liver disease? Undernourished? Heavy drinkers?

Answer 40

ASK PRESCRIBER!; Undernourished= less than 3000 mg Heavy drinkers= less than 2000 mg