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49 Cards in this Set
- Front
- Back
Type of pain NSAIDS do not help
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visceral
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Type of pain NSAIDS do help
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pain cause by sensitization of pain receptors by PGE and PGI
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Effect of NSAIDS on vascular permeability
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Indirect decrease. potentiates action of mediators like histamine and bradykinin that lead to edema
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NSAIDS effects on chronic inflammation
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may worsen. the blocked prostaglandins can decrease lysosomal enzyme, reduce toxic O2 and inhibit lymphocyte activation
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Co-administer with NSAIDS to limit GI side effects
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Misoprostol (PGE analog)
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Effects of NSAIDS on labor
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Decrease uterine contractions and delay labor. DANGER: can close Ductus Arteriosus
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NSAIDS on renal function
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May lower renal function on already compromised individuals. Promotes Na retention and edema.
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What electrolites may be effects by NSAIDS?
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Sodium can be retained. K is then also retained b/c less Na in distal tubule for exchange
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Nephropathy associated with this in older NSAIDS
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phenacetin
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Shunting of arachdonic acid to leukotriens may cause
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Hypersensitivity
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Aspirin absorption oddity?
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A weak acid, but absorbed better with increasing pH
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Aspirin half-life/dose relationship
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High dose results in higher half life by overwhelming metabolism
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Urine pH and excretion with Aspirin
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Increasing pH increases excretion
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Contraindications for Aspirin
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Increase in Reye's syndrome assoc with viral illness. Not for use in chicken pox or influenza
Also CI for asthmatics or pts with nasal polyps |
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Salicylic Acid
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too irritating orally, used for warts and corns
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Uric acid secretion with Salicylates
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Low concentraion, high serum urate and vice versa.
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Salicylates and CNS function
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at High Conc: stimulate resp, excitation confusion nausea and vomiting
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pH and Salicylate toxicity
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Early, hypervent, low CO2, high pH. Late, resp failure, norm to high CO2, acidemia
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Indomethacin
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high side effects
treat refractory fever in Hodgkins treat acute gout prevent labor close ductus arteriosus |
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Indomethacin and gout
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not a uricosuric, but potent anti inflam, so it is used
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Indomethacin and labor
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may prevent premature labor, but can close DA. Good for closing DA after birth
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Sulindac
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metabolized form 500 times more potent. less GI toxicity than Indo, less renal side effects (less active compound regenerated in kidneys)
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Tolmetin
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rh arthritis, osteoarth and ankylosing spondylitis (RA, O, AS).
Plasma bound but doesnt interfere with others can cause anaphylaxis, even if other NSAIDS don't |
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Ketorolac
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better pain relief than most NSAIDS, but high GI toxicity. Used IV after surgery
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Mefanamic acid
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no advantages
cause diarrhea only for analgesia |
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Proprionic Acid Derivates
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Ibuprofen and Naproxen
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Half life of Ibuprofen vs Naproxen
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IB 2 hours
Naproxen 14 hours |
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Contraindications for Ibuprofen
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Pregnant women or breast feeders. Crosses placent and appears in milk
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Piroxicam
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RA, O, AS
long half life of 50 hrs |
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Phenylbutazone
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cause bone marrow suppresion
displaces other plasma bound drugs urcosuric for gout |
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Apazone
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less toxic than pheynylbutazone
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Three COX-2 inhibitors and their trade names
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Celecoxib = Celebrex
Rofecoxib = Vioxx Valdecoxib = Bextra |
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Half lifes of:
Celecoxib Valdecoxib |
11 hours
8 hours |
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Half life of Acetominophen
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2 hours
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Acetominophen effects
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Lowers fever
Reduces pain No anti-inflammatory No blood thinings No excretion of uric acid |
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Major pathway for metabolism of acetominophen
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Conjugate with glucouronic acid
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P450 breaks som tylenol into reactive intermediate that is combines with what to be eliminated?
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Glutathione
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Overwhelming glutathione causes?
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adducts in cellular proteins leading to hepatic necrosis
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Used to treat acetominophen poisoning
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N-acetylcysteine
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Last line drugs for rheumatoid arthritis
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Gold compounds
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List the three gold compounds
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Aurothioglucos
Gold Sodium Thiomalate Auranofin |
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Which gold compound is taken orally
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Auranofin
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Contraindication of gold therapy
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Renal disease
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More potent than Indomethacin with less GI and renal side effects
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Sulindac
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Good for post op pain relief when given IV (not for oral use)
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Ketorolac
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This drug is more effective than aspirin for dymenorrhea
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Ibuprofen
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equivalent to other NSAIDS but has very long half life
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Piroxicam
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Less toxic form of phenylabutazone and its use
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Apazone, gout
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N-acetylcysteine
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Used to treat acetominophen poisoning
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