Term
| How are most NSAIDs metabolised and excreted? |
|
Definition
| most are metabolized in the liver to conjugated and more soluble metabolites that are excreted renally |
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Term
| How can aspirin precipitate an attack of gout? |
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Definition
| competes for excretion in the proximal tubule w/ uric acid. At high doses, uric acid excretion is increased |
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Term
| Name an absolute contraindication to the use of aspirin? |
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Definition
| In a child w/ a viral illness. may cause Reye's syndrome which is often fatal liver dysfunction and encephalopathy |
|
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Term
| How can aspirin toxicity cause bronchospasms and renal dysfunction? |
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Definition
| The inhibition of COX enzymes leads to an accumulation of leukotrienes and PGI2 is needed to maintain GFR and kidney perfusion |
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|
Term
| Name 2 signs of salicylism |
|
Definition
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Term
| Acetominophen effects on inflammation, platelets, and GI? |
|
Definition
no anti-inflammatory action
No anti-platelet activity
No significant GI symptoms.
Used when aspirin is not indicated for temporary relief of pain and fever |
|
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Term
| Ibuprofen and Naproxen are used to treat what disorders and what are their effects? |
|
Definition
symptomatically treat gout, RA, and OA
they are anti-inflammatory and analgesic |
|
|
Term
| What is diflusinal and what does it do? |
|
Definition
its an NSAID
analgesic for OA and MSK sprains
inhibits thromboxane synthetase in platlets |
|
|
Term
| What is indomethacin and what is it used for? |
|
Definition
| NSAID highly indicated for RA, gout, OA or fo the closure of a patent ductus arteriosus |
|
|
Term
| Pharmacokinetics of indomethacin and its cellular effects? |
|
Definition
highly bound to plasma proteins, anti-inflammatory, anti-pyretic, analgesic.
Reduces PMN motility
Reduces vascular permeability |
|
|
Term
| What is sulindac used for? |
|
Definition
| acute and long term treatment of OA, RA, bursitis, and acute gout |
|
|
Term
|
Definition
| prodrug transformed by the liver that is a potent COX inhibitor |
|
|
Term
| Indications for use of Piroxicam and Meloxicam and why is it preferred? what enzyme does it effect |
|
Definition
for long term treatment of RA, OA, and gout. it has a long half life that permits once daily dosing
primarily affects COX-2 |
|
|
Term
| Uses and complications w/ ketorlac? |
|
Definition
used post-op as an option for non-opiod pain control. So used for short term moderate pain control.
Don't use for more that 5 days or else GI bleeds may occur |
|
|
Term
| MOA and uses for Dicolfenac? |
|
Definition
| highly selective COX-2 inhibitor for long term treatment of OA, ankylosing spondylitis and short term managment of MSK and post op pain. |
|
|
Term
| MOA and uses for Celecoxib |
|
Definition
selective for COX-2 w/ less GI and platlet effects.
used for dysmenorrhea, OA, RA, and post-op pain |
|
|
Term
| Contraindications for prescribing celecoxib? |
|
Definition
| do not use w/ HTN or other cardiac disorders |
|
|
Term
| What are some of the GI side effects of NSAIDs? |
|
Definition
| dyspepsia, abdominal pain, diarrhea, gastric/intestinal ulcers, peptic ulcers |
|
|
Term
| What are some ways to prevent NSAID related GI injury? |
|
Definition
use COX-2 specific inhibitor
low doses
administer GI protective agent such as misoprostol, H2 receptor antagonist, or PPI |
|
|
Term
| What are some drugs that pts should avoid while on NSAIDs |
|
Definition
| anti-coagulants or corticosteroids |
|
|
Term
| Which NSAIDS can cause significant cardiovascular disease such as increased risk of thrombosis, stroke, and MI? |
|
Definition
| COX-2 selective inhibitors |
|
|
Term
| NSAIDs can cause hypersensitivity reactions that produce what kinds of symptoms? |
|
Definition
| rhinitis, angioedema, urticaria, bronchoconstriction, flushing, hypotension |
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|
Term
|
Definition
| should be discontinued in the 3rd trimester due to risk of post-partum hemorrhage and delayed labor |
|
|
Term
| Name 4 drugs that would cause signifacnt toxicity by displacement by NSAIDs |
|
Definition
| phenytoin, anti-coagulants, sulfonamide, and sulfonylureas |
|
|
Term
| What are some complications of hyperuricemia? |
|
Definition
| acute gout, tophi, renal lithiasis, and acute tubular blockade |
|
|
Term
| What is the initial drug of choice for an acute attack of gout? |
|
Definition
indomethacin** or ibuprofen.
Naproxen or Diclofenac may be used too |
|
|
Term
|
Definition
| binds to tubulin in mitotic spindles and arrests cell division, mobility, and release of chemotactic factors. ultimately inhibits migration of inflammatory cells and mast cell degranulation |
|
|
Term
| side effects of colchicine? |
|
Definition
| severe diarrhea, nausea, and vomitting limit is use |
|
|
Term
| When are corticosteroids indicated for acute gouty attacks? which corticosteroids are used? |
|
Definition
when pts are unresponsive to NSAIDs or colchicine or polyarticular involvement
intrarticular triamcinolone
oral prednisone |
|
|
Term
MOA for allopurinol?
metabolization of allopurinol? |
|
Definition
competitive inhibition of xanthine oxidase
metabolized into active metabolite oxypurinol. Slowely excreted in urine over 15-30 hours. Dosage adjustment needed in hepatic or renally impaired |
|
|
Term
|
Definition
| for pts who are underexcretors of uric acid |
|
|
Term
|
Definition
| blocks the reabsorption of uric acid in the proximal tubule. |
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