Omm 10-18-07 Nsaids

Front 1

NSAIDS inhibit what enzyme?

Back 1

Cyclooxygenase

(it converts arachidonic acid to prostaglandins)

Front 2

Some NSAIDs have antipyretic properties (reduce fever)


Name 3

Back 2

Ibuprofen
Naproxen
Salicylates (Aspirin)

Front 3

For Short Term Uses

Why should you prescribe an NSAID with a short half-life that can be taken frequently without risk of toxicity?

Back 3

Patients in pain will ignore physician instructions. If one pill is good, two is better.

Front 4

What circumstance?
Choose an NSAID with a longer half life

Back 4

When Anticipating Long Term Usage

Front 5

Prostaglandins cause

Back 5

Edema
Cellular exudation
Pain

Front 6

2 forms of COX

Back 6

COX-1
Isoenzyme => prostaglandins that maintain stomach lining and act in wound healing
COX-2
Isoenzyme => prostaglandins that mediate inflammatory response

Front 7

3 Selective COX-2 Inhibitors

Back 7

Celecoxib (Celebrex)
Rofecoxib (Vioxx*)
Valdecoxib (Bextra*)

* = not on market anymore

Front 8

Pain scale level of pain indicated for NSAIDS use

Back 8

1-4 or 5 on 10-scale

Front 9

Primary Dysmenorrhea,

which is better, selective or non?

Back 9

non

Front 10

other indications for NSAIDS

Back 10

Acute or Chronic Inflammatory Conditions
Tendosynovitis
Bursitis
Osteoarthritis
Rheumatoid Arthritis

Front 11

Contraindications for NSAIDS

Back 11

Previous Hypersensitivity to the Class of Drug Being Used
Triad Asthma
Asthma
Nasal Polyps
Aspirin Sensitivity
History or Presence of Gastritis or Ulcer Disease

Front 12

Common Side Effects of NSAIDS

Back 12

NSAID Gastropathy (big one - lots of deaths!)
Platelet Inhibition
Edema (might swell up like a toad)
Headache
Impaired Wound Healing

Front 13

Drug Interactions with NSAIDS

Back 13

Digoxin
Diuretics
Warfarin
Lithium
Methotrexate
Cyclosporine

Front 14

What NSAIDS have Endoscopic injury worse than Aspirin?
(Aspirin's score is 1;
>1 = worse)

Back 14

Ibuprofen
Naproxen
Indomethacin
Tolmetin

Front 15

What NSAIDS have Endoscopic injury better than Aspirin?

Back 15

Nabumetone
Piroxicam

Front 16

__________ mask the symptoms of gastropathy, but they are not protective of the stomach lining and may lead to sudden gastric perforation without warning.

Back 16

H2 Blockers & Proton Pump Inhibitors

Front 17

If your pt has NSAID gastropahy, what drug can you use to help

Back 17

Sucralfate (CARAFATE) may be better.
Misoprostol (CYTOTEC) is protective of stomach lining.
40% of patients on Misoprostol experience diarrhea as a side effect.

Front 18

ALL NSAIDs are cleared via the ____

Back 18

kidneys

Front 19

Why estimate the GFR?

Back 19

to adjust NSAID dosage

Front 20

An estimate of the GFR may be obtained as follows:

Back 20

GFR = {(140 - age in years) x weight in kilograms} / (Serum Creatinine x 72)

Front 21

Classes of NSAIDs

Back 21

Salicylates
Acetic Acids
Propionic Acids
Fenamic Acids
Pyranocarboxylic Acids
Oxicams
Naphthylalkanones
Selective COX-2 Inhibitors

Front 22

commercial types of aspirin (salicylates)

Back 22

Bufferin
Anacin (adds caffeine)
Ascriptin (adds Maalox)
Ecotrin (enteric coated)
Excedrin (adds acetaminophen and caffeine)
Alka-Seltzer (adds sodium bicarbonate and citric acid)

Front 23

why is ecotrin not an effective idea for aspirin?

Back 23

helps the stomach, but is not absorbed well in a low acid environment

Front 24

half life of aspirin

Back 24

0.2 hrs

Front 25

Salicylates (2)

Back 25

Salsalate (DISALCID)
Choline Magnesium Trisalicylate (TRILISATE)

Front 26

Salsalate (DISALCID)

Frequency?

Back 26

Frequency: bid - tid

Front 27

Salicylic Acid Derivative (1)

Back 27

Diflunisal (DOLOBID)

Front 28

Diflunisal (DOLOBID)

Frequency?

Back 28

Frequency: bid – tid

Front 29

Choline Magnesium Trisalicylate (TRILISATE)

liquid supply? (?mg/ml)
frequency?

Back 29

Liquid - 500 mg/5cc (b/c of pill size)

Frequency: qd - bid

Front 30

Diflunisal (DOLOBID)
is great b/c unlike all other NSAIDS, it doesn't cause what annoying problem?

Back 30

Tinnitus (inner ear)

Front 31

Caution with Diflunisal (DOLOBID)

Back 31

CAUTION: May increase the risk of thrombotic coronary events, sometimes fatal.
Risk increases with duration of use
Contraindicated for the treatment of pain post CABG

Front 32

Acetic Acids (5)

Back 32

Indomethacin (INDOCIN)
Sulindac (CLINORIL)
Tolmetin sodium (TOLECTIN)
Diclofenac sodium (VOLTAREN)
Diclofenac potassium (CATAFLAM)

Front 33

first acetic acid NSAID

Back 33

Indomethacin (INDOCIN)

Front 34

Indomethacin (INDOCIN)

How is it supplied?
What is frequency?

Back 34

Supplied: 25 mg, 50 mg, 75 mg SR
50 mg Rectal Suppository
25 mg/5 cc Oral Suspension

Frequency: tid - qid
SR bid

Front 35

DOC for anylosing spondylitis

Back 35

Indomethacin (INDOCIN)

Front 36

Acetic acid type of NSAID that has no renal effect

and Does not interfere with antihypertensive effects of diuretics.

Back 36

Sulindac (CLINORIL)

Front 37

Sulindac (CLINORIL)

Frequency?

Back 37

Frequency: bid

Front 38

Acetic acid NSAID that is approved for use in children > 2yrs

Back 38

Tolmetin sodium (TOLECTIN)

Front 39

Tolmetin sodium (TOLECTIN)

Frequency?

Back 39

Frequency: tid

Kids: 20 mg/kg/day

Front 40

For patients with osteoarthritis and rheumatoid arthritis who are at high risk for developing NSAID gastropathy or duodenal ulcers.

Back 40

Diclofenac sodium with Misoprostol (ARTHROTEC)

Front 41

Diclofenac sodium without Misoprostol

Back 41

Diclofenac sodium (VOLTAREN)

Front 42

Diclofenac sodium (VOLTAREN)

frequency?

Back 42

Frequency: bid
SR qdaily

Front 43

Type of Acetic acid NSAID that has No sodium retention edema.
Rapid onset - 10 minutes

Back 43

Diclofenac potassium (CATAFLAM)

Front 44

Dose of Diclofenac potassium (CATAFLAM)

Frequency?

Back 44

Frequency: bid - tid

Front 45

Propionic Acid NSAIDs (7)

Back 45

Ibuprofen (MOTRIN)
Flurbiprofen (ANSAID)
Fenoprofen Calcium (NALFON)
Ketoprofen (ORUDIS)(ORUVAIL) (ORUDIS-KT)
Naproxyn (NAPROSYN)
Naproxyn sodium (ANAPROX) (ALEVE)
Oxaprozin (DAYPRO)

Front 46

Ibuprofen (MOTRIN)

Supplied how?
Dose max / day?
Frequency?

Back 46

Supplied: 200, 400, 600, 800 mg
Dose: 4000 mg / day maximum
Frequency: tid - qid

Front 47

max daily dose of Ibuprofen (MOTRIN)

Back 47

4000 mg / day maximum

Front 48

Flurbiprofen (ANSAID)

frequency?

Back 48

Frequency: bid, tid, qid

Front 49

More common association with nephrotic syndrome than other NSAIDs.

Back 49

Fenoprofen Calcium (NALFON)

Front 50

Dose of Fenoprofen Calcium (NALFON)

Frequency?

Back 50

tid - qid

Front 51

Dose of Ketoprofen (ORUDIS)

Frequency?

Back 51

tid - qid

Front 52

Ketoprofen
(ORUVAIL) dose

Sustained Release Preparation

What is frequency?

Back 52

Frequency: qd

Front 53

ORUDIS-KT

supplied how?

Back 53

12.5 mg OTC

Front 54

Propionic Acids that Does not interfere with antihypertensive effects of diuretics.

Back 54

Naproxyn (NAPROSYN)

Front 55

Propionic Acids Approved for use in children.
Dose: 10 mg / kg / day

Back 55

Naproxyn (NAPROSYN)

Front 56

Naproxyn (NAPROSYN)


What is dose of Oral Suspension?

Back 56

125 mg / 5 cc

Front 57

Naproxyn (NAPROSYN)

What is frequency?

Back 57

bid

Front 58

Naproxyn sodium (ANAPROX)

Frequency?

Back 58

tid - qid

Front 59

OTC Naproxyn sodium

Back 59

ALEVE

Front 60

ALEVE

How supplied?

Back 60

OTC - 220 mg

Front 61

Oxaprozin (DAYPRO)

Frequency?

Back 61

qd - tid

Front 62

Fenamic Acids Principally used for Dysmenorrhea

Back 62

Meclofenamate sodium (MECLOMEN)

Front 63

problem with Meclofenamate sodium (MECLOMEN)

Back 63

25% of patients taking MECLOMEN get diarrhea.

Front 64

Meclofenamate sodium (MECLOMEN)


Frequency?

Back 64

tid - qid

Front 65

another Fenamic Acids
Principally used for Dysmenorrhea
Half Life = 4 hours

Back 65

Mefenamic Acid (PONSTEL)

Front 66

Pyranocarboxylic Acid

May promote healing of cartilaginous erosions.

Back 66

Etodolac (LODINE)

Front 67

Etodolac (LODINE)

Frequency?

Back 67

tid - qid

Front 68

Pyranocarboxylic Acid
For short term use only.
Excellent Non-addictive analgesic.

Back 68

Ketorolac Tromethamine (TORADOL)

Front 69

Ketorolac Tromethamine (TORADOL)


What are Oral and IM doseages?

Back 69

Oral: 10-mg q4-6h prn pain
IM: 15, 30, 60 mg - q3-4h prn pain

Front 70

Ketorolac Tromethamine (TORADOL) 30mg IM


What are comparable IM doses of morphine and meperidine?

Back 70

Comparable Doses
TORADOL - 30 mg IM
Morphine - 12 mg IM
Meperidine - 100 mg IM

Front 71

Piroxicam (FELDENE)

What is frequency?
How long does it take to reach steady state level?

Back 71

qd

7-12 days

Front 72

the other oxicam

What is frequency?

(tried to claim that it was a selective COX-2 inhib, but it wasn't)

Back 72

Meloxicam (MOBIC)

Frequency: qd

Front 73

Lowest incidence of gastropathy of all NSAIDs

Back 73

Naphthylalkanones

Front 74

Naphthylalkanones example?

what is frequency?

Back 74

Nabumetone (RELAFEN)

qd - bid

Front 75

Metabolism of celecoxib

Back 75

Cytochrome P450 2C9

Front 76

Incidence of Gastroduodenal Ulcers in 3 months

compare celecoxib, naproxen, ibuprofen, and diclofenac

Back 76

For celecoxib = 7.5%
For Naproxen = 34.6%
for Ibuprofen = 23.3%
for Diclofenac = 9.7%

Front 77

This subject is not highlighted, but it seems important.

Contraindications for celecoxib

Back 77

allergy to sulfonamides
kidney disease

Front 78

Celecoxib (Celebrex)

Frequency?

Back 78

qd - bid

Front 79

This is not highlighted, but it looks important.

What are the drug Interactions of celecoxib?

Back 79

ACE inhibitors: Decreases antihypertensive effect.
Fluconazole: Two-fold increase in celecoxib concentration

Front 80

Rofecoxib (Vioxx)

Why should we not dwell on this one?

Back 80

Withdrawn from market

Front 81

Propionic Acids (7)

Back 81

Ibuprofen (MOTRIN)
Flurbiprofen (ANSAID)
Fenoprofen Calcium (NALFON)
Ketoprofen (ORUDIS)(ORUVAIL) (ORUDIS-KT)
Naproxyn (NAPROSYN)
Naproxyn sodium (ANAPROX) (ALEVE)
Oxaprozin (DAYPRO)

Front 82

Fenamic Acids (2)

Back 82

Meclofenamate sodium (MECLOMEN)
Mefenamic Acid (PONSTEL)

Front 83

Pyranocarboxylic Acid (2)

Back 83

Etodolac (LODINE)
Ketorolac Tromethamine (TORADOL)

Front 84

Oxicams (2)

Back 84

Piroxicam (FELDENE)
Meloxicam (MOBIC)

Front 85

Naphthylalkanones (1)

Back 85

Nabumetone (RELAFEN)