Pharmacology-Ch36-Nsaids

Front 1

these two NSAIDs have moderate anti-inflammatory effectiveness

Back 1

Ibuprofen and Naproxen

Front 2

this NSAID has greater anti-inflammatory effectiveness than ibuprofen and naproxen?

Back 2

Indomethacin

Front 3

this NSAID has greater analgesic effectiveness?

Back 3

Ketorolac

Front 4

2 NSAIDs that are in the subgroup of selective COX2 inhibitors

Back 4

Celecoxib and Rofecoxib

Front 5

COX1 is primarily expressed on this cell type

Back 5

non-inflammatory

Front 6

COX2 is expressed on these cells?

Back 6

activated lymphocytes, polymorphonuclear cells, and other inflammatory cells

Front 7

what is the action of COX?

Back 7

cyclooxygenase is the enzyme at the head of the enzymatic pathway for prostaglandin synthesis

Front 8

define DMARDs and what htey are used for?

Back 8

Disease-modifying antirheumatic drugs, aka SAARDs (slow-acitng antirheumatic drugs). diverse drugs that modify the inflammatory processes underlying rheumatic disease; slow onset (weeks to months) for clinical effects

Front 9

what is Reye's syndrome?

Back 9

a rare syndrome of rapid liver degeneration and encephalitis in children treated with aspirin during viral infection

Front 10

name drugs in the class of uricosuric agents?

Back 10

prodenecid and sulfinpyrazone (increases renal excretion of uric acid)

Front 11

what enzyme metabolizes uric acid and what drug inhibits this enzyme?

Back 11

Xanthine oxidase (inhibited by Allopurinol)

Front 12

aspirin and the older non-selective NSAIDs inhibit both COX isoforms, what is the effect of this?

Back 12

decreases prostaglandin and thromboxane synthesis throughout the body (homestatic prostaglandins AND inflammatory prostaglandins)

Front 13

name two NSAIDs that have less effect on homeostatic prostaglandins?

Back 13

Celecoxib and Rofecoxib (selective for COX-2)

Front 14

what is the major difference between the MOA of aspirin and the other NSAIDs?

Back 14

Aspirin acetylates and thereby IRREVERSIBLY inhibits COX, other NSAIDS have reversible inhibition

Front 15

the irreversible action of aspirin results in longer duration of this effect?

Back 15

antiplatelet

Front 16

prostaglandin synthesis in the CNS that is stimulated by pyrogens is suppressed by NSAIDs, resulting in this effect?

Back 16

reduction of fever

Front 17

aspirin dose of less than 300mg/day is used for this?

Back 17

reducing platelet aggregation

Front 18

aspirin doses of 300 to 2400mg/day is used for this?

Back 18

antipyretic and analgesic effects

Front 19

aspirin doses of 2400 to 4000mg/day is used for this?

Back 19

anti-inflammatory effect

Front 20

salicylate is a _____(reversible or irreversible) nonselective inhibitor of COX

Back 20

REVERSIBLE

Front 21

elimination of salicylate is ___order

Back 21

FIRST

Front 22

how does salicylate leave the body?

Back 22

excreted via KIDNEYS

Front 23

COX-2 inhibitors are primarily used in these types of disorders?

Back 23

inflammatory

Front 24

this NSAID is used mainly as a SYSTEMIC ANALGESIC, NOT an ANTI-INFLAMMATORY?

Back 24

Ketorolac

Front 25

what is the only NSAID that is available in a PARENTERAL formulation?

Back 25

Ketorolac

Front 26

nonselective NSAIDs and COX-2 selective drugs have this effect in pts with primary familial adenomatous polyposis?

Back 26

reduction in polyp formation

Front 27

long term use of NSAIDs has this effect on colon cancer risk?

Back 27

reduces the risk

Front 28

chronic use of aspirin can have these negative effects?

Back 28

gastric ulceration, upper GI bleeding, renal effects, including acute failure and interstitial nephritis

Front 29

aspirin has this effect on bleeding time?

Back 29

increases it

Front 30

key clinical finding in aspirin hypersensitivity

Back 30

nasal polyps (may experience asthma from increased synthesis of leukotrienes as well)

Front 31

side effects of higher dose aspirin regimens?

Back 31

tinnitus, vertigo, hyperventilation, and respiratory alkalosis

Front 32

children with viral infections are at increased risk for developing this syndrome if given aspirin?

Back 32

Reye's (hepatic fatty degeneration and encephalopathy)

Front 33

there is risk of damage to this organ with any of the NSAIDs?

Back 33

kidney (especially in pts with preexisitng renal disease)

Front 34

this older NSAID should not be used chronically because it causes aplastic anemia & agranulocytosis?

Back 34

Phenylbutazone

Front 35

the selective COX-2 inhibitors may have a reduced risk of GI effects?

Back 35

Celecoxib, Rofecoxib, and Valdecoxib

Front 36

this type of NSAID does not have antiplatelet effects and are therefore NOT cardioprotective?

Back 36

Selective COX-2 inhibitors (Celecoxib, Rofecoxib, and Valdecoxib)

Front 37

this NSAID is a sulfonamide and thus may cause hypersensitivity rxn in pts with sulfa allergy?

Back 37

Celecoxib

Front 38

these agents are called diseases modifying drugs because some evidence shows slowing or even reversal of joint damage, an effect NEVER seen with NSAIDs?

Back 38

DMARDS

Front 39

how long does it take for the effects of DMARDS to be evident?

Back 39

6 weeks to 6 months (thus also called SAARDS for slow acting effects)

Front 40

what anti-inflammatory drugs are intermediate between NSAIDS and DMARDS?

Back 40

Corticosteroids

Front 41

this class of drugs probably act by reducing the numbers of immune cells available to maintain the inflammatory response?

Back 41

cytotoxic drugs (eg Methotrexate)

Front 42

which component of Sulfasalazine is more important as an antirheumatic?

Back 42

Sulfapyridine moiety.... (conversely 5-aminosalicylic acid component more imp. for Ulcerative colitis)

Front 43

this drug may interfere with T lymphocyte activity, decrease leukocyte chemotaxis, stabilize lysosomal membranes, interfere with DNA & RNA synthesis and trap free radicals?

Back 43

Hydroxychloroquine

Front 44

what drug has similar anti-inflammatory effect as Hydroxychloroquine?

Back 44

Penicillamine

Front 45

this compound alters the activity of macrophages that play a central role in the inflammation of arthritis, and also suppresses the phagocytic activity of PMLs?

Back 45

Organic Gold Compounds

Front 46

this prodrug is rapidly metabolized to a compound that inhibits Dihydroorotate dehydrogenase, an enzyme required by activated lymphocytes for synthesis of pyrimidines that are needed for RNA synthesis?

Back 46

Leflunomide (inhibition of the enzyme results in cell cycle arrest in lymphocytes)

Front 47

Rheumatoid drug associated with these toxicities: rash, GI distubance, dizziness, headache and leukopenia?

Back 47

Sulfasalazine

Front 48

Rheumatoid drug associated with these toxicities: rash, GI disturbance, OTOTOXICITY, MYOPATHY, PERIPHERAL NEUROPATHY?

Back 48

Hydroxychloroquine

Front 49

Rheumatoid drug associated with these toxcities: Nausea, MUCOSAL ULCERS, hematotoxicity, TERATOGENICITY

Back 49

Methotrexate

Front 50

Rheumatoid drug associated with these toxicities: NEPHROTOXICITY, HYPERTENSION, peripheral neuropathy?

Back 50

Cyclosporine

Front 51

Rheumatoid drug associated with these toxicities: upper RESPIRATORY INFECTION, activation of latent TB?

Back 51

Infliximab

Front 52

Rheumatoid drug associated with these toxicities: INJECTION SITE REACTIONS?

Back 52

Etanercept

Front 53

Rheumatoid drug associated with these toxicities: TERATOGEN, HEPATOTOXICITY, GI disturbance, skin reactions

Back 53

Leflunomide

Front 54

Rheumatoid drug associated with these toxicities: diarrhea, dermatitis, HEMATOLOGIC abnormalities (APLASTIC ANEMIA)?

Back 54

Gold compounds

Front 55

Rheumatoid drug associated with these toxicities: PROTEINURIA, dermatitis, GI disturbance, APLASTIC ANEMIA (and other hematologic abnormalities)

Back 55

Penicillamine

Front 56

drug that is a chelating agent?

Back 56

Penicillamine

Front 57

two Anti-rheumatoid drugs that can be used in inflammatory bowel disease?

Back 57

Sulfasalazine and Infliximab

Front 58

anti-Rheumatoid drug that is also used as an Antimalarial?

Back 58

Hydroxychloroquine

Front 59

anti-Rheumatoid drug that is also an anti-Cancer agent?

Back 59

Methotrexate

Front 60

anti-Rheumatoid drug that is also used in tissue transplantation?

Back 60

Cyclosporine

Front 61

these drugs bind to and prevent the action of TNF-a, a cytokine key in chronic inflammation?

Back 61

Infliximab and Adalimumab (Monoclonal antibodies)

Front 62

drug that is a recominant fusion protein comprising 2 TNF receptors linked to immunoglobulin, thus acting as a "decoy" decreasing cellular actions of TNF-a?

Back 62

Etanercept

Front 63

what is the only OTC NON-anti-inflammatory analgesic commonly available in the US?

Back 63

Acetaminophen

Front 64

this drug is an analgesic and antipyretic agent LACKING ANTI-INFLAMMATORY or ANTI-PLATELET effects?

Back 64

Acetaminophen

Front 65

drug useful as an aspirin replacement in virus infected children?

Back 65

Acetaminophen

Front 66

analgesic drug that is metabolized in the liver and thus is unaffected by renal disease?

Back 66

Acetaminophen

Front 67

antidote to Acetaminophen overdose?

Back 67

Acetylcysteine, a sulfhydryl donor

Front 68

this group of people is at risk for acetaminophen induced hepatotoxicity?

Back 68

people who consume 3 or more ALCOHOLIC drinks per day

Front 69

this potent NSAID is effective in inhibiting the inflammation of acute gouty arthritis?

Back 69

Indomethacin

Front 70

drug that is a selective inhibitor of microtubule assembly, reduces leukocyte migration and phagocytosis, and may reduce produciton of leukotriene B4 and dec. free radical formation?

Back 70

Colchicine

Front 71

in addition to gouty use Colchicine can be used for this condition?

Back 71

Mediterranean fever (disease of unknown cause characterized by fever, hepatitis, peritonitis, pleuritis, arthritis, and amyloidosis (occassionally))

Front 72

toxicity of Indomethacin?

Back 72

renal damage or bone marrow depression

Front 73

short courses of this drug can cause BEHAVIORAL changes and IMPAIRED GLUCOSE CONTROL?

Back 73

Glucocorticoids

Front 74

these agents are weak acids that compete with uric acid for reabsorption by the weak acid transport mechanism in the PCT of the kidney?

Back 74

Uricosuric agents

Front 75

Uricosuric drugs inhibit a large # of other weak acids such as___ and ___ in addition to inhibiting reabsorption of uric acid?

Back 75

Penicillin and Methotrexate

Front 76

chronic Gout is treated with one of these agents?

Back 76

Uricosuric OR Allopurinol

Front 77

can Uricosurics or Allopurinol be used in an acute Gouty attack?

Back 77

NO! and they are best withheld for 1 to 2 weeks after an acute gouty episode

Front 78

this class of drugs may actually PRECIPITATE a gouty attack during the early phase of their action?

Back 78

Uricosuric agents (avoided by simulatneous admin. of Colchicine or Indomethacin)

Front 79

these gout drugs are sulfonamides, so may share allergenicity of other classes of sulfonamide drugs?

Back 79

Uricosuric drugs

Front 80

this drug is converted to Oxypurinol (alloxanthine) by Xanthine oxidase?

Back 80

Allopurinol

Front 81

what enzyme converts Hypoxanthine to Xanthine and Xanthine to Uric Acid?

Back 81

Xanthine Oxidase

Front 82

this drugs is an irreversible suicide inhibitor of Xanthine oxidase?

Back 82

Allopurinol (and oxipurinol)

Front 83

what is the result of inhibition of Xanthine oxidase?

Back 83

inc. conc. of more soluble Hypoxanthine and Xanthine and dec. conc or less soluble Uric Acid

Front 84

why is Allopurinol used as an adjunct in chemo?

Back 84

it slows the formation of Uric Acid from Purines released by the death of large #'s of neoplastic cells

Front 85

like Uricosuric drugs this drug can precipitate acute attacks of gout in the early phase of treatment?

Back 85

Allopurinol

Front 86

Allopurinol inhibits the metabolism of these two drugs that depend on Xanthine oxidase for elimination?

Back 86

Mercaptopurine and Azathioprine