Nsaid

Front 1

Histimine causes what

Back 1

dilation of blood vessels allowing phagocytes to migrate to area

Front 2

Cause of pain?

Back 2

1. Increased tissue pressure
2. Actions of inflammatory mediators

Front 3

How is phagocytosis initiated

Back 3

Opsonins molecule adaptors
→Coat foreign surfaces and SIGNAL leukos that a particle should be attacked

Front 4

Phagocytic cell with opsonized particle leads to

Back 4

engulfment and destruction of agent

Front 5

The cyclooxygenase pathway leads to the formation of what

Back 5

1.PGH2 – Used to synthesize prostaglandins (PGE2 and PFF2 alpha)
2.Prostacyclin
3.Thromboxanes (TxA2)

Front 6

Prostaglandins, PGE2, PGf2 acts where

Back 6

smooth muscle,

Front 7

PGE2?

Back 7

inflammation and fever

Front 8

what is Thromboxane (TxA2)

Back 8

Chief eiconsanoid product of platelets
→POTENT VASOCONSTRICTOR and PROMOTER of PLATELET ADHESION and AGGREGATION

Front 9

Prostacyclin (PGI-2) acts where and does what?

Back 9

Primary eiconsanoid product of vascular endothelium. Functions as a VASODILATOR, VENODILATOR, INHIBITOR OF PLATELET AGGREGATION

Front 10

What is critical in regulation of systemic blood pressure and thrombogenesis

Back 10

Local balance of TxA2 and PGI-2

Front 11

Housekeeping actions of COX 1

Back 11

1. Vascular homeostasis
2. Maintenance of Renal and GI blood flow
3. Renal Function
4. Intestinal Mucosal Proliferation
5. Platelet Function
6. Antithrombogenesis

Front 12

As needed functions of COX 2

Back 12

Inflammation, Fever, Pain, Transduction of Painful Stimuli in Spinal Cord, Mitogenesis, Renal Adaptation to Stresses, Deposition of Trabecular bone, Ovulation, Placentation, Uterine Contractions of Labor

Front 13

ACETAMINOPHEN MOA

Back 13

Believed to inhibit synthesis of prostaglandins in CNS (COX-3?)
→Works peripherally to inhibit pain impulse generation

Front 14

ACETAMINOPHEN used to TX

Back 14

Mild pain/febrile conditions

Front 15

What does acetaminophen lack?

Back 15

anti-inflammatory effects, antiplatelet effect and GI Toxicity

Front 16

Majore acetaminophen SE? how do you avoid this?

Back 16

HEPATOXICITY***** in overdosage
→Avoid or use lower daily dose in older adults and patients with risk for hepatoxicity such as: ALCOHOLICS &
MALNOURISHED

Front 17

What does acetaminophen interact with?

Back 17

INTERACTIONS WITH WARFARIN→Prolongs INR and CYP-450 inducing drugs

Front 18

SALICYLATES (Aspirin: Bayer, Ecotrin) MOA

Back 18

Irreversibly inhibits platelet function for the life of the platelet (7-10 days)

Front 19

Salicylate effects

Back 19

anti-inflammatory, analgesic, antipyretic, anti-platelet

Front 20

Salicylates anti-inflammatory effects due to

Back 20

reduced synthesis of eicosanoid mediators

Front 21

Salicylates analgesic effects?

Back 21

Peripherally and at site of inflammation and at Sub-cortical sites

Front 22

Salicylates antipyretic effects?

Back 22

1.Vasodilation (Heat dissipation)
2.Antagonizes pyrogen induced prostaglandin production
3.Blocks CNS response to Interleukin 1 (by macrophages)

Front 23

Salicylates anti-platelet effects?

Back 23

inhibition of thromboxane synthesis

Front 24

Uses of salicylates?

Back 24

1.Relief mild to moderate pain
2.High Dose- Significant anti-inflammatory properties
3.RA
4.Inflammatory Joint Diseases
5.Antipyretic
6.Antiplatelet:
• Decrease TIAs
• Unstable Angina
• Reduce CABG thrombosis
• Reduce Coronary artery thrombosis

Front 25

***BEST DRUG FOR* REDUCING FEVER!!!****

Back 25

salicylates

Front 26

Salicylates CNS SE?

Back 26

1. Tinnitus
2. Decreased Hearing
3. Vertigo
4. Hyperpnea (Inc. RR)

Front 27

AT low levels, what metabolic SE does salicylates have

Back 27

Respiratory Alkalosis secondary to increased ventilation

Front 28

Accumulation of salicyclic acid can cause what

Back 28

met. acidosis

Front 29

GI effects of salicylates?

Back 29

1.Gastric mucosal irritation (Undissolved tab)
2.GI bleeding associated with erosive gastritis due to inhibited prostaglandins

Front 30

Concurrent use of what meds lead to inc. Salicylate SE

Back 30

glucocorticoids, anticoagulants

Front 31

REnal Salicylate SE? why does this occur

Back 31

Reversible decrease in GFR (secondary to arteriolar vasoconstriction)

Front 32

Why may hypersensitivity reactions occur with salicylates

Back 32

Aspirin induced asthma (Due to leukotriene synthesis)

Front 33

When may Reye syndrome occur?

Back 33

aspirin Use in children during/following viral infection can cause Reye Syndrome

Front 34

What are PROPIONIC ACID DERIVATIVES

Back 34

Ibuprofen








Naproxenn (Naprosyn, Aleve), Ketoprofen (Orudis, Oruvail), Flurbiprofen (Ansaid)

Front 35

what are propionic acid derivatives used for

Back 35

Potent analgesic used in:
1. RA
2. OA
3. Ankylosin Sponylitis
4. Gout
5. Primary Dysmenorrhea

Front 36

Compare propionic acid derivatives compared to aspirin?

Back 36

→Less frequent GI irritation/Bleed than aspirin
→Platelet effects are REVERSIBLE for all non selective NSAID’s except Aspirin

Front 37

Propionic acid derivatives CI

Back 37

1. Nasal Polyps
2. Angioedema
3. Aspirin Sensitivity

Front 38

How can propionic acid derivatives Can alter cardioprotective effect of low dose aspirin

Back 38

competing for binding sites

Front 39

Naproxenn (Naprosyn, Aleve) features

Back 39

Longer Half Life, 20 Times more potent than aspirin, Less Severe GI effects than aspirin

Front 40

Ketoprofen (Orudis, Oruvail) features

Back 40

25 mg dose comparable to 400 mg of ibuprofen

Front 41

Flurbiprofen (Ansaid) featues

Back 41

Can be used as a topical ophthalmic for inhibition of intra-operative miosis

Front 42

ACETIC ACID DERIVATIVES MOA

Back 42

Besides inhibiting cyclo-oxygenase, many AAD’s promote unesterified AA into triglyceride reducing substrate for Cyclooxygenase and lipoxygenase

Front 43

types of ACETIC ACID DERIVATIVES?

Back 43

Indomethacin (Indocin), Sulindac (Clinoril), Etodolac (Lodine), Diclofenac (Voltaren), Ketorlac (Toradol)

Front 44

Indomethacin (Indocin) MOA and use

Back 44

Direct inhibitor of neutrophil motility
→Specific use in promoting closure of PDA in newborns by inhibiting vasodilatory eicosanoids PGE2 and PGI-2

Front 45

Indomethacin (Indocin) SE

Back 45

GI and CNS adverse effect more severe than other NSAIDs

Front 46

Sulindac (Clinoril

Back 46

More frequently implicated in HEPATOXICITY than other NSAIDs

Front 47

Etodolac (Lodine)

Back 47

200 mg dose comparable to effect of 400mg ibuprofen

Front 48

Diclofenac (Voltaren)

Back 48

More potent anti-inflammatory than indomethacin and naproxen, Used widely in treatment of pain associated with RENAL STONES

Front 49

How is Diclofenac available

Back 49

topical patch for pain due to trauma and gel for painful joints

Front 50

Ketorlac (Toradol) use and forms available

Back 50

Strong analgesic properties particular for post-surgical patients, AVAILABLE AS IV FORMUALTION

Front 51

Ketorlac (Toradol) SE

Back 51

RENAL TOXICITY- Limit use to 3-5 days

Front 52

Examples of OXICAM DERIVATIVES

Back 52

Piroxicam (Feldene), Meloxicam (Mobic)

Front 53

Piroxicam (Feldene) MOA

Back 53

As effective as other NSAIDs but may be better tolerated
→Modulates neutrophil function by inhibiting collagenase proteoglycanase and oxidative burst

Front 54

Piroxicam (Feldene) pharmokinetics

Back 54

Long half life, may be administered once daily

Front 55

Meloxicam (Mobic) MOA and AE

Back 55

Reported to be more COX-2 selective at low dose, Overall adverse effects similar to other NSAIDs

Front 56

KETONE NSAIDs: Nabutemone (Relafen) MOA

Back 56

Prodrug

Reported to be comparatively COX-2 selective at low dose

Front 57

KETONE NSAIDs: Nabutemone (Relafen) AE and pharmkinetics

Back 57

Overall Adverse effects when dosed in the usual range are similar to NSAIDs

May give once or twice daily

Front 58

What are the COX-2 SELECTIVE INHIBITORS

Back 58

Celecoxib (Celebrex)
Refecoxib (Vioxx) (withdrawn)
Valdecoxib (Bextra) (withdrawn)
Celecoxib (Celebrex

Front 59

COX-2 effects? what do they NOT effect?

Back 59

100 x greater COX-2 selectivity
1.Anti-inflammatory
2.Antipyretic
3.Analgesic

NO anti-platelet effect

Front 60

COX 2 AE

Back 60

Increased THROMBOGENICITY (Prolonged inhibition of vascular COX-2 with endothelial cells→PGI-2)

Front 61

COX 2 NSAIDS has reduced what

Back 61

GI tox

Front 62

Refecoxib was withdrawn in 2004 due to what

Back 62

increased thrombogenicity with prolonged use→ MI & STROKE

Front 63

What is celecoxib used for

Back 63

Approved for OA, RA and juvenile RA (OVER 2 Y/O)

Ankylosing Spondylitis, Acute pain in adults, primary dysmenorrhea

Reduction of adenomatous colorectal polyps in FAP.

Front 64

What is celecoxib an option for

Back 64

patient requiring chronic NSAID use with risk of gastropathy

Front 65

increased risk of what with celecoxib?

Back 65

fatal and dose dependent C/V thrombotic events (STROKE) as well as
1.Hypertension
2.Edema
3.Heart Failure

Front 66

Celecoxib is CI in what

Back 66

Treatment of pain with CABG