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35 Cards in this Set

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Metabolism of salicylates
Dose-dependent due to saturation of conjugation pathways (esp. glycine conj.)
What is salicylate?
The deacetylated metabolite of aspirin
About how much aspirin is excreted as salicylate by the kidneys
10%
NSAID metabolism
Oxidative and conjugation rxns in the liver
NSAIDs with short half lives (< 6hrs.)
Aspirin
Ibuprofen
Indomethacin
NSAIDs with long half-lives (> 6 hrs)
Naproxen
Phenylbutazone
Salicylate
Metabolism of p-Aminophenols
(I assume this is tylenol)
In the liver by conjugation, dose dependent
Hepatotoxicity of Acetominophen
Increase after induction of P450 enzymes (e.g. by EtOH)
MA of hepatotoxicity of tylenol
Metabolites deplete glutathione, then reacts w/hepatic SH- impairs Ca handling--necrosis
Are most NSAIDs found in free form in the body?
No, most is bound to albumin
Free fraction increased in hypoalbuminemia
GI problems due to COX inhibitors
(there are 5)
Dyspepsia
Peptic ulcers--perf
Inflammation
Gastric erosion
Upper GI hemorrhage
Which COX inhibitor causes less GI toxicity?
COX-2 selective
Misoprostol (Cytotec)
Prostaglandin analog, prevention of gastric ulceration
Ranitidine
H2 receptor antagonists--reduces acid secretion
Treatment for GI problems caused by NSAIDS
Omeprazole
Reduces acid secretion, H+ blocking agent
Treament of NSAID GI problems
Sucralfate
Mucosal protectants
Useful with NSAIDs
COX-2 and the kidneys :)
COX-2 expression required for normal renal development
NSAIDs renal effects
(there are 7)
Decreased GFR
Edema
Papillary necrosis
Inhib of loop diuretics (requires PGs)
Acute/Chronic renal failure
Interstitial Nephritis
Hyperkalemia
Hypertensive effects of NSAIDs
Impairs HTN control in those taking B-adrenergic antags, diuretics, or ACEi
How do we get around impaired HTN control in those taking NSAIDs
Put them on Ca channel blockers for their HTN
Why use caution with Celebrex (Celecoxib)?
Increased risk of adverse CV effects with use of Celebrex (Celecoxib)
Why use caution with Naproxen?
Increased vascular risk
Why do aspirin and other NSAIDs impair hemostatsis?
Inhibit platelet aggregation
MA of NSAID induced Asthma
Blockage of COX shunts AA to leukotriene production-- BRONCHSPASM
COX inhibitor skin effects
Erythema multiforme, urticaria
COX inhibitor CNS rxns
Drowsiness and headache (10%)
Rare COX inhibitor side rxns
(there are 5)
Blood dyscrasias
Mild hepatic dysfxn
Severe hepatitis
Pneumonitis
Neurologic problems
Reye Syndrome
Caused by use of salicylate drugs during in viral infections (usually in kids)
Aspirin toxicity symptoms
Nausea, vomiting, tinnitus
GI bleeding
Impaired hemostasis
Resp. alkalosis
Resp. and metabolic acidosis at high toxic levels
Tylenol toxicity sequlae
Hepatotoxicity
Hypoglycemic coma
Renal tubuar necrosis
Hypersensitivity
NSAIDs may interact with what protein bound drugs?
(there are 4)
Warfarin
Phenytoin
Sulfonylureas
Methotrexate
NSAIDS may inhibit the metabolism of which drug
Phenylbutazone
Which drug causes increased acid transport in the kidney and therefore increased NSAID toxicity?
Probenecid
NSAID rxn with 1) EtOH 2) lithium
1) Increased risk of GI bleeding/hepatotoxicity

2) Decreased renal clearance, increased toxicity
NSAID rxn with 1)K+ sparing diuretics 2)B adrenergic antags, ACEi, diuretics
1) Sudden hyperkalemia
2) Hypotensive effects