Nsaids

Front 1

What is cycloocygenase?

Back 1

An enzyme that catalyzes the synthesis of prostaglandins from archidonic acid

Front 2

What is cycloocygenase also referred to as?

Definitely on test

Back 2

Prostaglandin H synthase

Front 3

How many enzymes is cycloocygenase associated with?

Back 3

3

Front 4

Cycloocygenase is required to produce these two things?

Back 4

prostacyclin and thromboxane

Front 5

Where is COX 1 found?

Back 5

gastric mucosa, renal parenychma, and platelets

Front 6

What processes does COX 1 mediate?

Back 6

physiological and homeostatic processes

Front 7

COX 2 is _______ and can be ______ at many site.

Back 7

inducible; expressed

Front 8

What does COX 2 mediate?

Back 8

inflammation, pain, fever, and carcinogenesis

Front 9

What processes does COX 2 mediate?

Back 9

Pathological

Front 10

COX 3 may be a target for what medication?

Back 10

acetaminophen

Front 11

NSAIDS are all inclusive of these 3 properties?

Back 11

analgesic, antipyretic, anti-inflammatory (at higher doses)

Front 12

These drugs inhibit both COX 1 and COX 2?

Back 12

traditional drugs

Front 13

Is COX 1 or COX 2 specific?

Back 13

COX 2

Front 14

Name some non-specific drugs.

Back 14

toradol, aspirin, ibuprofen, naproxen

Front 15

Name some specific drugs for the COX 2 portion of the enzyme?

Back 15

vioxx, bextra, celebrex,

Front 16

NSAIDS inhibit which COX enzymes?

Back 16

COX 1 and COX 2

Front 17

How is the MOA of NSAIDs mediated?

Back 17

prostaglandin and non-prostaglandin mediated MOA

Front 18

Describe the analgesic MOA of NSAIDs?

Back 18

Mediated through prostaglandin and non-prostaglandin mediation.

Prostaglandin MOA-NSAIDs inhibit prostaglandin synthatase peripherally

Non-prostaglandin MOA-NSAIDs also work by peripheral and chemical chemoreceptors

Front 19

All NSAIDs inhibit?

Back 19

cyclooxygenase, and prostaglandin and thromboxane synthesis

Front 20

Cyclooxygenase is required for conversion of ______ to ______.

Back 20

arachidonic acid (PGG2) to endoperoxide intermediate (PGH2)

Front 21

Prostaglandins and thromboxanes play crucial roles in?

Back 21

Pain, inflammation, fever, excessive blood clotting

Front 22

What are the most common side effects of NSAID's in the cardiovascular system?

Back 22

increased BP (by either selsective or non-selective NSAIDs)

Front 23

What are the most common side effects of NSAID's in the GI system?

Back 23

1. stomach upset (dyspepsia) short term use

2. peptic ulcer diease and bleeding from the stomach (long-term and in high doses)

Front 24

What are the most common side effects of NSAIDs in the Liver system?

Back 24

liver toxicity in long term use

Front 25

What are the main systemic side effects of NSAIDs?

Back 25

cardiac, GI, liver, kidney, tinnitus

Front 26

What are the most common side effects of NSAIDs in the kidney system?

Back 26

kidney toxicity (even with short term use of NSAIDs)

Front 27

In people with underlying kidney disease, what should be monitored yearly?

Back 27

BP and kidney function

Front 28

Is tinnitus more common in ASA or NSAIDs use?

Back 28

High dose aspirin use, but with NSAIDs as well. The ringing usually resolves when the dose is reduced.

Front 29

What causes Steven Johnson syndrome?

Back 29

Viral & bacterial infections

Drug reactions (NSAIDs)

Front 30

What are some adverse effects of NSAIDs

Back 30

1. hepatocellular injury

2. allergic rhinitis

3. inhibition of platelet aggregation (MI or CAD pts)

4. renal dysfunction

5. tinnitus

6. urticaria (hives)

7. gastric ulceration

Front 31

COX 2 inhibitors are more specific for ____ inhibitors?

Back 31

COX 2

Front 32

Do COX 2 inhibitors inhibit the COX 1 part of the enzyme?

Back 32

No

Front 33

What illnesses are COX 2 inhibitors useful in managing?

Back 33

osteoarthritis, acute gout, dysmenorrhea

Front 34

Most adverse effects of COX 2 inhibitors are seen in pts taking drugs chronically for this condition?

Back 34

arthritis

Front 35

Chronic use of ASA and other NSAIDs increases or decreases the risk of colon cancer? By how much?

Back 35

decreases; 40-50%

Front 36

Chronic NSAID use also decreases the risk of this disease?

Back 36

Alzehimer's

Front 37

How does ASA produce analgesia?

Back 37

Through it's ability to irreversibly acetylate COX enzyme leading to a decrease in the synthesis and release of prostaglandin

Front 38

Is ASA reversible?

Back 38

No, not until the life of the platelet is over.

Front 39

What things is ASA most used for?

Back 39

1. low intensity pain with muscle and H/A

2. osteoarthritis and RA

3. anti-platelet for preventation of MI (most common)

Front 40

ASA is confined to a very small or large dose range?

Back 40

small

Front 41

Does ASA have a celiling effect?

Back 41

Yes, you can increase the dose, but it won't help the pain any faster. It will just kill your kidneys.

Front 42

Is the antiplatelet effect of ASA reversible or irreversible? How?

Back 42

irreversible, due to acetlyzation of the platelet through the COX 1 enzyme

Front 43

What populations should ASA not be used in?

Back 43

children due to rye's syndrome

nursing mother'd due to internal bleeding

Front 44

ASA side effects are?

Back 44

Chair Gum

1. CNS stimulation

2. hepatic dysfunction

3. allergic reactions

4. inhibition of platelet function

5. renal dysfunction

6. GI dysfunction

7. uterine effects

8. metabolic alterations

Front 45

Is acetaminophen considered a true NSAID? Why?

Back 45

No, due to it's lack of anti-inflammatroy properties

Front 46

Is acetaminophen a good choice to treat arthritis or other inflammatory disorders?

Back 46

no

Front 47

What single dose of acetaminophen can cause hepatic necrosis and death?

Back 47

a single dose of greater than 15 mg/kg

Front 48

What is the max daily dose of acetaminophen?

Back 48

4 gms/day

Front 49

What was the first selective COX 2 inhibitor?

Back 49

Celecoxib (Celebrex)

Front 50

Celecoxib (Celebrex) is recommended for the pain and inflammation associated with ____ and ____?

Back 50

Rheumatoid arthritis and osteoarthritis

Front 51

What medication is similar to celecoxib (celebrex)?

Back 51

motrin

Front 52

Why was Vioxx (Rofecoxib) withdrawn from the market?

Back 52

Increased risk of heart attack and stroke aht W

Front 53

What conditions was vioxx (rofecoxib) marketed to treat?

Back 53

Osteoarthritis, acute pain conditions, and dysmenorrhea

Front 54

Vioxx (Rofecoxib) work on the COX 1 or COX 2 part of the enzyme?

Back 54

COX 2, because it's not keeping platelets from aggregating.

Front 55

Bextra (Valdecoxib) was initially approved then discontinued for the treatment of what conditions?

Back 55

Osteoarthritis, adult RA, primary dysmenorrhea

It was withdrawn because it was causing dysmenorrhea

Front 56

What other condition was associated with Bextra (Valdecoxib)

Back 56

Steven Johnson's syndrome

Front 57

Which COX 2 inhibitor was never approved by the FDA? What makes it different than the others?

Back 57

Parecoxib (Dynastat)

1. available in parental form

2. has no effect on platelet functionhtW

Front 58

What is one of the most potent inhibitors of the COX enzyme?

Back 58

Indomethicin

Front 59

What 3 properties does indomethacin possess?

Back 59

1. analgesic

2. antipyretic

3. anti-inflammatory

Front 60

What is the DOC for ankylosing spondylitis and Reiter's syndrome?

Back 60

Indomethacin

Front 61

Indomethacin is the DOC for what condition's?

Back 61

ankylosing spondylitis and Reiter's syndrome

Front 62

What is ankylosing spondylitis and Reiter's Syndrome?

Back 62

ankylosing spondylitis is a long term arthritis in the spine and pelvis

Reiter's syndrome is arthritic, eye swelling (conjunctivitis), women-cervical inflammation,

men-urethral inflammation

Front 63

What acute condition is indomethacin used to treat?

Back 63

gout

Front 64

Why is indomethacin not used to treat chronic pain?

Back 64

chronic gout needs the COX 2 enzyme

Front 65

How is indomethacin used to treat acute gout? What doesn't it correct?

Back 65

treats inflammation

it does not correct hyperuricemia

Front 66

What infant abnormality can indomethacin correct with a single dose?

Back 66

PDA- It closes the PDA

Front 67

What drug is a substitute analogue of indomethacin?

Back 67

Sulindac

Front 68

What is the drug of choice for pt's with renal impairment issues? Why?

Back 68

Sulindac, because it does not affect the renal synthesis of prostaglandins as much as other drugs

Front 69

What drug is more potent than salicylates, but less potent than indomethacin?

Back 69

Tolmetin (not on test)

Front 70

Name 3 examples of Propionic Acid Derivatives?

Back 70

Din

ibuprofen, naproxen, and diclofenac (Voltaren)

Front 71

What conditions do propionic acid derivatives treat?

Back 71

arthritis (gouty, rheumatoid, osteoarthritis)

Front 72

What is unique about naproxen?

Back 72

it has a uniquely long elimination half life (can dose it twice a day)

Front 73

If someone is allergic to salisylates, what other type of medication are they allergic to?

Back 73

propionic acid derivatives

Front 74

Phenylbutazone is effective in treating what conditions?

Back 74

gout and RA

Front 75

This medication is very powerful and has toxic side effects and should be given for no longer than 7 days for acute pain.

Back 75

Phenylbutazone

Front 76

What are the side effects of phenylbutazone?

Back 76

anemia

agranulocytosis

n/v

epigastric distress

gastric upset

Front 77

This medication is different that other NSAIDs, it is more like salicylates and inhibits prostaglandin synthesis, and is used to reduce pain, swelling, and joint stiffness?

Back 77

Piroxicam

Front 78

What medication has potent analgesic effects and mild anti-inflammatory activity?

Back 78

Toradol

Front 79

Toradol 30 mg IM is the analgesia equivalent to?

Back 79

morphine 10 mg

Demerol 100 mg

Front 80

Does toradol effect ventilatory or cardiac depression?

Back 80

no

Front 81

Does toradol inhibit platelets?

Back 81

yes

Front 82

Waht conditions is toradol good to treat?

Back 82

menstrual cramps

hystecectomies

D & C

Front 83

Which drug is associated with Samter's Triad (Aspirin Triad)?

Back 83

Toradol

Front 84

What types of pts are susceptible to Samter's triad?

Back 84

people with nasal polyps, asthma, and aspirin intolerant patients

Front 85

What will happen if toradol is given to an asthma pt?

Back 85

may cause bronchospasm and be life threatening

Front 86

Should toradol be given to asthma pts?

Back 86

no, they may bronchospasm and die

Front 87

What is colchicine used to treat? How?

Back 87

acute gouty arthritis, it decreases inflammation and pain

Front 88

What is the medication that is unique for the prevention and treatment of gout?

Back 88

Colchicine

Front 89

Is colchicine a good analgesic?

Back 89

No, it only treats inflammation.

Front 90

What is the MOA of colchicine?

Back 90

it pulls out uremic acid to where it can be excreted in urine and stool

Front 91

What are some side effects of colchicine?

Back 91

n/v

diarrhea

abdominal pain

Front 92

What medication may prolong survival in cirrhosis?

Back 92

Colchicine

Front 93

What medication is the preferred therapy of primary hyperuricemia in gout?

Back 93

Allopurinol

Front 94

What are the most common side effects of allopurinol?

Back 94

Maculopapular rash and itching

Front 95

How many COX enzymes have been identified?

Back 95

3

Front 96

Which statement best describes the COX 2 enzyme?

Back 96

highly inducible and production is boosted during the inflammatory process.

Front 97

COX 2 inhibitors may produce a prothrombotic effect by their effect on which fatty acid?

Back 97

thromboxane

Front 98

Should one NSAID be taken with another NSAID?

Back 98

No, it will increase the side effects

Front 99

Should people taking warfarin and coumadin take NSAIDS?

Back 99

Not generally, it puts them at increased risk of bleeding when both classes are taken together.

Front 100

Is celebrex (celecoxib) okay to take with NSAIDs?

Back 100

Should be taken with caution and under supervision of a clinician

Front 101

What happens when ASA and NSAIDs are taken together?

Back 101

May increase the risk of bleeding

Front 102

What happens if phenytoin and NSAIDS are taken together?

Back 102

The phenytoin level can increase

Front 103

If ASA and NSAIDs are taken together, how should the ASA be taken to preserve the low dose ASA for the heart?

Back 103

ASA should be taken at least two hours before the NSAID.

Front 104

What risk is involved if cyclosporines and NSAIDs are taken to together?

Back 104

theoretical risk of kidney damage

Front 105

If people are taking NSAIDs and phenytoin together what lab test needs to be monitored and when?

Back 105

phenytoin level should be drawn when starting or increasing the dose of an NSAID.

Front 106

In addition to transplant pts, what other types of pts take cyclosporines?

Back 106

Osteoarthritis and RA pts