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Pharmacology (Dale Turley) > Tx of Bone and Joint disorders > Flashcards

Tx of Bone and Joint disorders Flashcards

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1
Q

Acetylsalicylic Acid (Aspirin) facts ?

A

Aspirin was first introduced by the drug and dye firm Bayer in 1899

Classified among the nonsteroidal anti-inflammatory drugs (NSAIDs)

Inhibits prostaglandin and thromboxane synthesis

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2
Q

Acetylsalicylic Acid (Aspirin) what is required for effective anti-inflammatory action ?

A

Higher dose

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3
Q

Acetylsalicylic Acid (Aspirin) low doses ?

A

typically 75 to 81 mg/day

inhibits platelet generation resulting in an antithrombotic effect.

anti platelet effect

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4
Q

Acetylsalicylic Acid (Aspirin) intermediate doses ?

A

(650 mg to 4 g/day)

inhibit COX-1 and COX-2, blocking prostaglandin (PG) production, analgesic and antipyretic effects.

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5
Q

Aspirin anti platelet effect ?

A

Measurable prolongation of bleeding time (PTT)

Inhibitory effect on platelet aggregation lasts for up to 8 days

Significantly reduces the incidence of stroke and myocardial infarction in patients at risk

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6
Q

Common in patients who self-medicate ?

A

Watch for salicylism (salicylate poisoning) pg. 47

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7
Q

Salicylism ?

A

Mild chronic salicylate intoxication after repeated administration of high doses

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8
Q

Aspirin, pharmacokinetics change at ?

A

higer doses

Severe form requires immediate treatment (within 1 to 2 hours)

  • *watch people with liver disease you can send them into an OD
  • *
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9
Q

Salicylism sxs ?

A

headache,

dizziness,

tinnitus,

hearing loss,

mental disturbances,

sweating,

thirst,

hyperventilation,

nausea,

vomiting,

and sometimes diarrhea

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10
Q

Salicylism tx ?

A

Immediate treatment needed

Gastric lavage (NG tubes)

Activated charcoal to adsorb drug left in the stomach / dialysis

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11
Q

An association between aspirin use and induction of ___________ exists in children

A

Reye’s syndrome

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12
Q

FDA recommends NO ASA to those under the age of __ ?

A

16

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13
Q

what is Reyes syndrome ?

A

Reye’s syndrome is a rapidly progressive encephalopathy which usually begins shortly after recovery from an acute viral illness, especially influenza and varicella (chickenpox).

liver encephalopathy

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14
Q

The exact cause is unknown and, while it has been associated with aspirin consumption by children with viral illness ?

A

Reyes syndrome

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15
Q

Reye’s syndrome elevates blood _____ levels , lowers blood _____ .

A

ammonia

sugar

ammonia level to see if they are truly encephalopathic

hepatic encephalopathy

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16
Q

Reye’s syndrome results in

A

Fatty liver with minimal inflammation and cerebral edema

Effects many organs, especially the brain and liver

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17
Q

Reye’s syndrome classic features ?

A

rash, vomiting, and liver damage

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18
Q

ASA dose ?

A

325 mg

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19
Q

ASA complication and precautions ?

A

GI bleeding

coagulation disorder

G6PD deficiency

influenza, varicella, or febrile viral infection (pts <20 yo)

caution in pts 80 yo and older

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20
Q

Theenzyme ____________________ responsible for the formation of prostanoids

A

cyclooxygenase (COX)

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21
Q

Precursor to formation of three main groups ?

A

Prostanoids

Prostacyclins

Thromboxanes

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22
Q

Cyclooxygenase-1 (COX-1) is known to be present in most ______

A

tissues

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23
Q

In the gastrointestinal tract, COX-1 maintains the ______________.

A

normal lining of the stomach

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24
Q

COX-1 also involved in ?

A

kidney and platelet function

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25
Cyclooxygenase-2 (COX-2) is primarily present at sites of ___________ ?
inflammation
26
Traditional NSAIDs are considered "nonselective" because they inhibit both ?
COX-1 and COX-2
27
Inhibition of COX-1 is
undesirable
28
inhibition of COX-2 is considered ?
desirable
29
What are the three categories of NSAIDs ?
Salicylates (aspirin) Traditional NSAIDs (non-selective) COX-2 selective NSAIDs
30
Non-selective NSAID’s examples ?
Indomethacin (Indocin) Ibuprofen (Motrin) Naproxen (Anaprox) Ketoralac (Toradol) - GI offensive but great in IV form in ER - works well with real stones or renal colic ( great IV NSAIDs in acute care setting)
31
NSAIDs choice is typically determined via ?
trial and error
32
NSAID’s facts and choice ?
Patient choice Typically cause GI effects Use with H2 blockers chronic use Acetaminophen preferred for mild to moderate pain without inflammation **watch GI effects with non selectives , use you pepcids with with like the H2 ’s **
33
NSAID’s Pharmacokinetics
 ?
Rapidly and completely absorbed GI tract Crosses placenta Metabolized by Liver watch if liver disease Excreted in Urine
34
________ enters breast milk
Naproxen * *watch special populations * *
35
______ does not enter breast milk
Motrin back pain patient in female
36
NSAID’s HL: Children ?
(under 8 years old) 8-17 hours on call peds: motrin every 8 hours
37
NSAID’s HL: Adolescents ?
(8-14 years) 8-10 hours
38
NSAID’s HL: Adults ?
(over 14 years) 10-20 hours
39
NSAID’s common side effects ?
``` Coagulation disorders (Avoid with anticoagulant therapy) synergistic effect ``` Metabolic acidosis Rash Blurred vision, tinnitus, amblyopia (lazy eye) GI bleed, N/V, abd pain Headache, altered mental (ASA toxicity)
40
NSAID’s Safety
" concerned prescribing ?
GI increased risk bleeding Renal impairment, HTN, heart failure Contraindicated in Third Trimester – premature closure of ductus arteriosus (pulmonary artery to the heart) Elderly and alcohol users
41
Acetaminophen (Tylenol)
 has what properties ?
Analgesic and Antipyretic properties NSAIDs dont
42
Acetaminophen (Tylenol)
 class ?
analgesic / antipyretic
43
Acetaminophen (Tylenol)
 is Ineffective as an____________________
anti-inflammatory agent
44
Acetaminophen (Tylenol)
 is different than NSAIDs in that ?
Tylenol has no... Has no COX-1 or COX-2 effects No GI effects generally Mediator for inhibiting prostaglandin synthesis in the CNS, brain and spinal cord (Cox-3) you get the effect through the COX 3 pathway
45
Tylenol doses up to _ grams four times a day
1
46
Tylenol High dose greater than 2 grams daily increase risk of ?
Increased risk bleeding with Coumadin Increased risk liver toxicity (liver disease, alcoholics)
47
Tylenol adults dosage ?
325mg, 650mg, 1000mg Extra Strength 500mg tabs
48
Tylenol meds dosage ?
15
49
Why is tylenol better than NSAIDs ?
Analgesic action Antipyretic action Significantly reduced gastric irritation
50
When prescribing patients tylenol be sure to watch for ?
acetaminophen poisoning
51
what happens in acetaminophen poisoning ?
Potentially fatal hepatic necrosis over 7 to 8 days
52
acetaminophen poisoning | Day 1-2 sxs. ?
day 1: nausea, vomiting, diaphoresis both: liver enzymes, ALT, bilirubin, and PT rise
53
acetaminophen poisoning Day 3-4 sxs ?
peak hepatotoxicity
54
acetaminophen poisoning Day 7-8 sxs ?
death or recovery unless aggressively treated
55
acetaminophen poisoning tx ?
Treatment must be immediate
56
Acetaminophen Overdose tx ?
Presentation similar hepatic encephalopathy Treatment with N -acetylcysteine (NAC) NAC is nearly 100% hepatoprotective when it is given within 8 hours after an acute acetaminophen ingestion Activated charcoal
57
Nomogram ?
based on time, dosage and serum levels tracking OD
58
Acetaminophen Overdose facts ?
More 3 glasses wine may produce hepatotoxicity – discuss alcohol use Discuss doses with parents due to different concentrations 15mg/kg oral remember this dose!
59
Cytoprotective agents ?
Misoprostol
60
Misoprostol trade ?
(Arthrotec/Cytotec)
61
Cytoprotective agents MOA ?
Increases production of mucous lining the stomach Inhibits gastric acid secretion
62
Misoprostol (Cytotec) | is a what combination ?
Dicloenac Sodium (NSAID) combination
63
Misoprostol (Cytotec) | indications ?
Indicated NSAID induced ulcer or protection
64
Misoprostol (Cytotec) | is used with ?
Used with NSAID’s / ASA
65
Misoprostol (Cytotec) | o used in ?
Used in early pregnancy termination
66
Misoprostol (Cytotec) BBW ?
Black Box warning with pregnancy / miscarriage **cytotec is actually a abortion medicine - so that is BBW
67
Arthrotec reduces incidence of ulcers by __% compared to Diclofenac
60% arhtrotec combos are alot better as far as producing ulcers
68
Ibuprofen trade ?
Advil, Motrin, Nuprin
69
Ibuprofen is in a sub-class of ?
propionic acid derivative that inhibits COX
70
Ibuprofen primary used because ?
used for its anti-inflammatory properties
71
Ibuprofen is effective a relieving ?
mild to moderate pain
72
Ibuprofen is NOT used for what ? But is does have what action ?
anti platelet activity Anti-pyretic action
73
Ibuprofen pharmacokinetics and HL ?
Metabolized by Liver Excreted by Kidneys Half-life 2-4 hours for the standard does but it can go up if people taking it chronically
74
Ibuprofen adverse reactions ?
Prolonged bleeding times, Thrombocytopenia (avoid bleeding conditions) ``` Rash Arrhythmias Edema Headache, psychosis May inhibit antiplatelet activity of ASA Chewable contain aspartame (caution phenylketonuria) ```
75
COX-2 Inhibitors own notes ?
more specific ones used more as a target for RA and chronic inflammatory states
76
COX-2 Inhibitors are more specific to ?
inflammation
77
COX-2 Inhibitors are free of ?
GI side effects
78
COX-2 Inhibitors may produce what ?
NSAID induced nephrotoxicity (COX-2 produced in the kidney)
79
COX-2 Inhibitors example ?
Celecoxib
80
Celecoxib trade ?
Celebrex
81
What two previous COX2-Inhibitors were removed from the market ?
Vioxx Bextra
82
When COX-2 Inhibitors reach therapeutic levels, there is little or no effect on ?
COX-1
83
Celecoxib (Celebrex) | adverse reactions ?
edema HTN increased risk of MI Rash Renal toxicity Fatigue, headaches, flu-like symptoms **once starting it they can get this serum sickness when they first start it : flue achy, N/V**

Pharmacology (Dale Turley) (31 decks)

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