Term
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Definition
| non-specific COX 1/2 inhibitors |
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Term
|
Definition
| non-specific COX 1/2 inhibitors |
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Term
|
Definition
| non-specific COX 1/2 inhibitors |
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Term
|
Definition
| non-specific COX 1/2 inhibitors |
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Term
|
Definition
| non-specific COX 1/2 inhibitors |
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Term
|
Definition
| non-specific COX 1/2 inhibitors |
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Term
|
Definition
| non-specific COX 1/2 inhibitors |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| non-NSAID antipyretic/analgesic |
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Definition
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Term
|
Definition
analgesia
antipyretic
anti-inflammatory |
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Term
| common mechanism of action for NSAIDs |
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Definition
inhibit COX
COX is a key enzyme responsible for synthesis of prostaglandins which contribute to a number of inflammatory processes |
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Term
| COX-1 is _________ active. |
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Definition
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Term
| COX-2 is ________ and is associated with disease states. |
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Definition
| inducible (by cytokines and other inflammatory mediators) |
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Term
| Traditional NSAIDs inhibit... |
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Definition
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Term
| Aspirin _______ inhibits COX-1 and COX-2. |
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Definition
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Term
| Recovery of COX in must tissues is by... |
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Definition
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Term
| Why is platelet inhibition irreversible? |
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Definition
| platelets cannot synthesize new COX |
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Term
| Other NSAIDs (besides aspirin) produce ______ inhibition of COX. |
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Definition
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Term
| What drugs are used for patients who need NSAID-like activity but do not want GI risks/upset? |
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Definition
selective COX-2 inhibitors
(celecoxib, meloxicam) |
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Term
| Selective COX-2 inhibitors do/do not affect platelets and bleeding time. |
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Definition
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Term
| selective COX-2 inhibitor contraindications |
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Definition
aspirin allergy
3rd trimester pregnancy |
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Term
| selective COX-2 inhibitor indications |
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Definition
dysmenorrhea
osteoarthritis
RA
acute post-op pain |
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Term
| black box warning on all NSAIDs |
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Definition
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Term
| COX-2 possible links to cardiac disease |
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Definition
1. COX-2 reduced prostacycline (PGI2) production by vascular endothelium with little or no inhibition of potentially prothrombotic platelet thromboxane A2
2. COX inhibition in general is associated with elevations in blood pressure |
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Term
| Why are some other NSAIDs marginally superior to aspirin? |
|
Definition
-more potent
-more efficacious at tolerated doses
-cause less GI irritation and other side effects
-longer duration of action so taken less frequently |
|
|
Term
| disadvantages of newer NSAIDs over aspirin |
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Definition
-more expensive
-some are more toxic |
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Term
| What enzyme is responsible for sensitizing pain nerve ending to the action of bradykinin, histamine, and substance P? |
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Definition
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Term
|
Definition
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Term
| NSAIDs are _____ analgesics effective against pain of _________________ intensity. |
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Definition
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Term
| What conditions can NSAIDs be superioor to intermediate efficacy opioids for? |
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Definition
post-op pain
pain associated with inflammation |
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Term
| What provides greater pain nrelief than intermediate opioids alone? |
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Definition
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|
Term
| Efficacy of pain relief provided by NSAIDs is higher/lower than with high-efficacy opioids. |
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Definition
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Term
| What opioid effects do NSAIDs lack? |
|
Definition
-respiratory depression
-development of physical tolerance/dependence |
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Term
| What type of pain is relieved and not relieved by NSAIDs? |
|
Definition
relieved: integumental structures
not relieved: hollow viscera |
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Term
|
Definition
| pyrogens (cytokines) from lymphocytes act on hypothalamus to increase body temp |
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Term
| What type of drugs can suppress fever? |
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Definition
| NSAIDs that cross the BBB |
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Term
| Describe the anti-inflammatory effects of NSAIDs. |
|
Definition
inhibit formation of PGE2 and PGI2, which are important mediators of localized erythema and edema
also inhibit activation and function of inflammatory cells, may stabilize lysosomal membranes, and inhibit phagocytosis |
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Term
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Definition
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Term
| PGE2, PGF2alpha, and PGI2 stimulate... |
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Definition
| synthesis of bicarbonate and mucous |
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Term
| PGE2 promotes mucosal ____________. |
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Definition
|
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Term
| What causes the GI irritation associated with NSAID use? |
|
Definition
| inhibition of all of the effects of prostaglandins (PGE2) and prostacyclin (PGI2) |
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Term
| GI side effects of NSAIDs |
|
Definition
epigastric distress
nausea/vomiting
microhemorrhage
ulceration
anemia |
|
|
Term
| aspirin effect on platelets |
|
Definition
| low doses irreversibly inhibit COX and platelet aggregation for the life of the platelet (8-11 days) |
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Term
| Low dose aspirin together with diet and exercise is useful for the prophylaxis of... |
|
Definition
-coronary artery disease
-DVT
-unstable angina
-prophylaxis and treatment of MI and stroke |
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Term
| What situations can cause NSAIDs to reduce renal blood flow? |
|
Definition
high levels of circulating vasoconstrictors
-compensated CHF
-chronic renal disease |
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|
Term
| What type of effect to NSAIDs have on hypertensive regimens? |
|
Definition
reduce effectiveness
(retention of sodium and water) |
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Term
| NSAID and COX-2 cautionary conditions |
|
Definition
reduced renal function
heart failure
liver dysfunction
ACE inhibitors
diuretics (esp. in elderly) |
|
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Term
| What can the use of aspirin and salicylates during infection with chicken pox, varicella, and influeza viruses cause? |
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Definition
|
|
Term
| major salicylate contraindication |
|
Definition
| children or adolescents with chicken pox or varicella (Reye's syndrome) |
|
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Term
| What does Reye's syndrome cause? |
|
Definition
liver damage
encephalopathy |
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Term
| therapeutic uses for analgesic-antipyretics |
|
Definition
| pain and fever of low-to-moderate intensity |
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|
Term
| NSAIDs other than aspirin are typically used for.... |
|
Definition
chronic treatment
(ibuprofen or naproxen) |
|
|
Term
| NSAIDs suppress the clinical signs in __________, but subsequent tissue damage is not halted. |
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Definition
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|
Term
| NSAIDs do not induce _________. |
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Definition
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|
Term
| What NSAID is often used to stimulate closure of a patent ductus arteriosus? |
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Definition
|
|
Term
| indomethacin mechanism of action in PDA |
|
Definition
| inhibition of PGE2 which keeps the ductus arteriosus open |
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Term
| What condition is currently under research for the use of COX-2 inhibitors? |
|
Definition
familial adenomatous polyposis (FAP)
studies show reduction in number of polyps with COX-2 inhibitors |
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Term
|
Definition
GI irritation
prolonged bleeding time
hypersensitivity reactions
Reye's syndrome
salicylism |
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Term
| How long should a patient be off of aspirin products before having surgery? |
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Definition
|
|
Term
| conditions that predispose you to having hypersensitivity reaction |
|
Definition
asthma
nasal polyps
chronic urticaria |
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Term
|
Definition
actacids
phenytoin, thyroxine, thiopental
anticoagulants (risk of bleeding)
uricosuric effect in gout pts |
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Term
|
Definition
|
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Term
|
Definition
nausea/vomiting
tinnitus
hyperventilation
headache
confusion
dizziness |
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|
Term
| symptoms of NSAID overdose |
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Definition
*acute medical emergency*
fever, dehydration, delerium, hallucination, convulsions, coma, respiratory/metabolic acidosis, death
children especially vulnerable |
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Term
| NSAID adverse effects during pregnancy |
|
Definition
low birth weight
increased perinatal mortality
anemia
antepartum and postpartum hemorrhage
prolonged gestation
premature closure of ductus arteriosus |
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Term
| What drug is more efficacious than aspirin, but its toxicity limits its usefulness? |
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Definition
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Term
| What drug can be used in resistant RA, gout, suppression of uterine contraction in preterm labor, and PDA? |
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Definition
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|
Term
| What drug is a potent analgesic but has weak anti-inflammatory effect? |
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Definition
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|
Term
| What selective COX-2 inhibitor was withdrawn from the market first? |
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Definition
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Term
| What drug needs to be used with caution in patients taking warfarin even though it does not have effect on platelets and bleeding time? |
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Definition
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|
Term
| What is acetaminophen (Tylenol) NOT used for? |
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Definition
|
|
Term
| mechanism of acetaminophen toxicity |
|
Definition
|
|
Term
| adverse effects of acetaminophen |
|
Definition
rare in therapeutic usage
occasional skin rash or allergy
OD can result in fulminant hepatic necrosis and liver failure |
|
|
Term
| fatal dose of acetaminophen |
|
Definition
>10g
may be lower in chronic alcoholics of those with underlying liver disease |
|
|
Term
| clinical features of acetaminophen overdose |
|
Definition
up to 24 hours: none or nausea/vomiting
>24 hours: nausea, vomiting, RUQ pain, jaundice, encephalopathy |
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Term
| What should you consider giving for acetaminophen overdose? |
|
Definition
| n-acetylcysteine infusion |
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