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61 Cards in this Set
- Front
- Back
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How are NSAIDs metabolized?
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undergo hepatic metabolism and conjugation followed by renal excretion of inactive metabolites
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Which of the following are NSAIDs not indicated for?
a. to induce closure of clinically significant patent ductus arteriosus in premature infants when usual treatments are ineffective b. dysmenorhea c. sedation |
sedation
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What class of drug am I:
reversibly inhibits COX-1 and COX-2 enzymes resulting in decreased formation of prostaglandins |
NSAIDs
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What drug am I:
irreversibly inhibits COX-1 and COX-2 and thus formation of throboxane A2 resulting in inhibition of platelet aggregation |
aspirin
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In the pathway of arachidonic acid release and metabolims, what enzyme is responsible for arachidonic acid release?
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phospholipase A2
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List the following in the correct order of the arachidonic acid release and metabolism pathway.
a. arachidonic acid metabolized by Cox and Lox b. arachidonic acid released by phospholipase A2 c. Formation of prostaglandins, thromboxane, and leukotrienes |
1. arachidonic acid is released by phopholipase A2
2. arachidonic acid is metabolized by Cox and Lox 3. formation of prostaglandins, throboxane, and leukotrienes |
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prostaglandins, prostacylin and throboxane are formed from the metabolism of arachidonic acid by this enzyme
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COX
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HETEs, leukotrienes and lipoxins are formed from the metabolism of arachidonic acid by this ezyme
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lipooxygenase (LOX)
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Which isoform of COX am I:
constitutive responsible for the formation of eicosaniods important for homeostatis |
COX-1
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Which isoform of COX am I:
constitutive only in small amounts in certain tissues inducible at the site of inflammation |
COX-2
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Which isoform of COX is undesireable?
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COX-2
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This isoform of COX is important for homeostatic functions, GI tract, renal tract, platelet function, and macrophage differentiation
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COX-1
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Inhibition of this isoform of COX is undesirable
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COX-1
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Which of the following drugs have greater COX-2 selectivity?
indomethacin aspirin naproxen ibuprofen nabumetone diclofenac celecoxib |
nabumetone
diclofenac celecoxib |
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Which of the following have higher selectivity for COX-1?
indomethacin aspirin naproxen ibuprofen nabumetone diclofenac celecoxib |
indomethacin
aspirin naproxen ibuprofen |
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What are the risk factors for an NSAID adverse effect?
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advanced age
history of previous ulcer high dose of NSAID use of multiple NSAID |
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What type of NSAID (Cox-2 selective or non selective) is associated with reduced risk of GI irritation?
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COX-2 selective
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What agents can be given with NSAIDs to reduce risk of GI ulcer?
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H2 blocker
PPI misoprostol |
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Inhibiting which cox isoform will result in decreased renal function?
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cox-1
cox-2 |
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inhibition of which cox isoform will result in inhibition of PGI2 thus leading to increased platelet aggregation?
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cox-2
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inhibition of this cox isoform results in inhibition of throboxane A2 leading to decreased platelet aggregation
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cox-1
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Use of this drug in children with a viral illness is associated with Reye's sydrome (liver damage and encephalopathy)
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aspirin
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Which of the following have increased risk of MI and storke if used following CABG surgery?
a. meclofenamate b. indomethacin c. celecoxib |
c. celecoxib
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Which of the following is NOT true regarding NSIADs?
a. NSAIDs delay bone healing after fractures b. COX-2 inhibitors increase surgical bleeding c. Aspirin and NSAIDs induce exacerbation of asthma d. NSAIDs have increased toxicity in the elderly |
Cox-2 inhibitors increase surgical bleeding is not true
Cox-2 increase aggregation thus decrease bleeding Cox-1 decrease aggregation thus increase bleeding |
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What are the box warnings for NSAIDs?
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cardiovascular events
GI events |
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What drug am I:
NSAID-like drug less efficacy than NSAIDs have analgesic and antipyretic effects do not have anti-inflammatory effects |
apap
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What adverse effects can patients have if they have an acute overdose of apap?
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hepatic failure
renal failure |
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Liver toxicity of apap is due to the accumulation of this metabolite
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NAPQI
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What drug am I:
increase concentration of GSH (glutathione ) to convert NAPQI to safe conjugate metabolite |
N-acetylcysteine
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This drug is used as the antidote for acute overdose of apap
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N-acetylcyteine
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What am I:
systemic disease caused by the build up of uric acid in the joints |
gout
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This is the time between two gouty arthritic attacks
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intercritical period
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This is the rate limiting step in the formation of uric acid
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xanthine oxidase
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List the following in the correct order of the uric acid pathway
a. purines form hypoxanthine b. xanthine oxidase converts xanthine to uric acid b. xanthine oxidase converts hypoxanthine to xanthine |
1. purine form hypoxanthine
2. xanthine oxidase converts hypoxanthine into xanthine 3. xanthine oxidase converts xanthine into uric acid |
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a defect in purine metabolism resuting in uric acid overproduction is term...
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overproducers
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impaired renal clearance of uric acid is term...
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undersecretors
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acute gouty arthritic attacks are caused by deposition of _____ in the synovium of the joints.
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monosodium urate crystals
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the inflammatory reaction of gout is a result of _______ bursting and releasing it's contents.
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leukocytes
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In acute gouty attacks, urate crystals undergo phagocytosis by ________
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polymorphomuclear leukocytes
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Which of the following are NOT used for the treatment of acute gouty arthritic attacks?
a. NSAID b. colchicine c. corticosteroids d. allopurinol |
d. allopurinol
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What is colchicine indicated for?
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prophylaxis of recurrent episode of gouty arthritis attacks and terminatio of gouty attacks
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What drug am I:
produce antiinflammatory effect by binding to the intracellular protein tubulin thereby preventing it's polymerization into microtubules leading to "inhibition of leukocytes migration and phagocytosis" |
colchicine
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What adverse effect of colchine would warrant termination of treatment?
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diarrhea
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Which of the following are not used for gout during the intercritical period?
propencid sulfinpyrazone allopurinol febuxostat indomethacin |
indomethacin
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Which of the following are not xanthine oxidase inhibitors?
allopurinol propencid febuxostat |
propencid
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propencid and sulfinpyrazone fall under this class of drugs for gout drug therapy
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uricosuric agents
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What are uricosuric agents indicated for?
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undersecretors
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When can uricosuric agents be started?
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must wait at least 2-3 weeks after an acute attack
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What type of patients should not use uricosuric agents?
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overproducers of uric acid
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What class of drug am I:
competitively inhibits reabsorption of uric acid at the proximal convoluted tubule thereby promoting its excretion and reducing serum uric acid levels |
uricosuric agents
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uricosuric agent increase plasma levels of these drugs by competively inhibiting their renal tubular secretion
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weak organic acids (B-lactam antibiotics)
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What are the ADR of uricosuric agents?
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GI irritation
uric acid stones |
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Which of the following are NOT true regarding uricosuric agents?
a. maintain adequate hydration to minimize possibility of stone formation b. titirate dose upward slowly to minimize possibility of stone formation c. do not use with patients with CrCl <50 d. use with aspirin or aspirin-containing substances |
use with aspirin or aspirin-containing substace is NOT true
should avoid use with aspirin due to antagonistic effect |
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What are xanthine oxidase inhibitors indicated for?
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chronic management of hyperuricemia in patients with gout
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This drug is an isomer of hypoxanthine and competitively inhibits xanthine oxidase
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allopurinol
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allopurinol is metabolized into this compound which is also a competitive inhibitor of xanthine oxidase
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oxypurinol
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This drug is a non-purine, non-competitive inhibitor of xanthine oxidase
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febuxostat
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which of the following are NOT ADRs of xanthine oxidase inhibitors?
a. cardiovascular b. GI discomfort c. rash d. liver function abnormalities |
a. cardiovascular
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xanthine oxidase inhibitors increase the serum level of these agents
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azathioprine
6-mercaptopurine |
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Concomittant administration of these agents with allopurinol increase risk of rash
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ampicillin or amoxicillin
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Which of the following is NOT true regarding xanthine oxidase inhibitors?
a. to reduce the risk of precipitating an acute gout attack, titrate dose upward slowly b. patient with renal insufficiency do not require dose adjustments c. allopurinol is the standard care therapy for gout in the intercritical period |
patients with renal insufficiency do not require dose adjustment is NOT true
patients with renal insufficiency requires dose adjustment |
