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47 Cards in this Set

  • Front
  • Back
What is the goal of anti-inflammatory drugs?
• reduce pain of inflammation
• reduce tissue damage cauased by inflammation or disease
Give examples of chemical mediators that trigger inflammation
• amines (ex. histamine, serotonin)
• lipids (ex. prostaglandins, leukotrienes, thromboxanes)
• peptides (ex. bradykinin, interleukins, interferons)
Prostaglandins, thromboxanes, and leukotrienes are all synthesized from what?
arachadonic acid (released from phospholipids of the cell membrane)
What enzyme converts arachadonic acid to prostaglandins and thromboxane?
What enzyme converts arachidonic acid to leukotrienes?
What is the MOA of aspirin?
• irreversibly inhibits cycloxygenase (COX)
• inhibits the synthesis of porstaglandins and thromboxanes
• reduces fever, inflammation, & pain
Generally, what are actions of aspirin?
• anti-inflammatory (by inhibiting prostaglandins)
• analgesic (by inhibiting PGE2)
• antypyretic
• GI effects
• kidney effects
• platelet effects
• respiratory effects
How does aspirin exhibit antipyretic effects?
• by reducing prostaglandin synthesis in the thermoregulatory center in the hypothalamus
• also can cause vasodilation
What are respiratory effects of aspirin?
• causes hyperventilation and respiratory alkalosis at high doses
• can cause metabolic & respiratory acidosis at toxic doses
How does aspirin exhibit its GI effects?
• ASA increases gastric acid secretion by blocking PGI2
• reduces mucous production causing epigastric distress, ulcerations, & hemmorrhage (can cause upper GI bleeds)
What are effects of aspirin on platelets?
• irreversibly inhibits thromboxane production in platelets
• reduces platelet aggregation
What are effects of aspirin on the kidney?
• prostaglandins cause vasodilation
• aspirin inhibits prostaglandins, resulting in unopposed vasoconstriction
• causes sodium & water retention and edema
• can induce renal failure
What are uses of aspirin?
• decrease pain of headache, arthralgias, myalgias
• reduce fever, pain, inflammation
• rheumatoid arthritis
• reduces platelet aggregation
Where is aspirin best absorbed?
True/False: Aspirin can cross the blood-brain barrier.
The correct answer is: True
What is the half-life of aspirin?
• at low doses: 3½ hrs
• at high doses: 15 hrs or more
What are adverse effects of aspirin?
• blood: prolongs bleeding time (should be D/C 1 week before surgery)

• GI: gastric bleeding

• Hypersensitivity

• Respiration: toxic doses cause respiratory depression and respiratory and metabolic acidosis

• Reye's syndrome
What is the treatment for aspirin toxicity?
• increase urine pH to hasten renal elimination
• IV fluids, dialysis, and correction of acid-base and electrolyte disturbances
Describe the different levels of pain according to the World Health Organization (WHO) Pain Ladder?
• Step 1: mild
• Step 2: mild to moderate
• Step 3: moderate to severe
Give examples of drugs used to treat pain at the different pain levels (according to the WHO)?
• Step 1: Non-opioids (aspirin, paracetamol, NSAID)
• Step 2: Opioids (ex. Codeine)
• Step 3: Opioids (ex. morphine, oxycodone, fetanyl)

* can add non-opioid or adjuvant therapy to each
List the general classes of NSAIDS
• Salicylates
• Proprionic Acid Derivatives
• Fenemates
• Acetic Acid Derivatives
• Enolic Acids
• Non-acidic compounds
• COX-2 inhibitors
List examples of salicylates
• aspirin
• choline magnesium trisalicylate (Trilisate)
• Diflunisal (Dolobid)
• Salsalate (Disalcid)
List examples of proprionic acid derivatives
• Ibuorifen
• Naproxen
• Fenoprofen (Nalfon)
• Flurbiprofen (Ansaid)
• Ketoprofen (Orudis)
• Oxaprozin (Daypro)
Give examples of acetic acid derivatives
• Diclofenac (Voltaren)
• Etodolac (Lodine)
• Indomethacin (Indocin)
• Ketorolac (Toradol)
• Sulindac (Clinoril)
• Tolmetin (Tolectin)
Give examples of enolic acids
• Meloxicam (Mobic)
• Piroxicam (Feldene)
What is an example of a non-acidic compound?
Nabumetone (Relafen)
Name a COX-2 inhibitor
celecoxib (Celebrex)
What is the NSAID drug of choice for a gouty arthritis attack?
Indomethacin (Indocin)
What are uses for Indomethacin (Indocin)?
• more effective that ASA in gouty arthritis (less effective than ASA in rheumatoid arthritis)
• arthritis of the spine
• to close patent ductus arteriosus (PDA) and to avoid the surgery in neonates
How is Indomethacin (Indocin) eliminated from the body?
• metabolized by the liver
• excreted in urine and bile
What are adverse effects of Indomethacin (Indocin)?
• acute pancreatitis
• allergic reactions
• GI
• neutropenia
• thrombocytopenia
What are common names of ibuprofen?
• Motrin
• Advil
• Nuprin
What are adverse drug effects of ibuprofen?
same as ASA:

• blood: prolongs bleeding time (should be D/C 1 week before surgery)
• GI: gastric bleeding
• Hypersensitivity
• Respiration: toxic doses cause respiratory depression and respiratory and metabolic acidosis
• Reye's syndrome
What is the only IV NSAID?
Ketoralac (Toradol)
What are indications for using Ketoralac (Toradol)?
• indicated for the short-term (up to 5 days in adults) management of moderately severe acute pain that requires analgesia at the opioid level

* not indicated for minor or chronic painful conditions
What are contraindications of Ketoralac (Toradol)?
• pts w/ renal impairment
• pts w/ epidurals
True/False: Ketoralac (Toradol) can be given as an alternative to a patient who is allergic to aspirin
• A patient will have a hypersensitivity reaction Ketoralac (Toradol) if allergic to aspirin
• The correct answer is: False
What are available formulations of Ketoralac (Toradol)?
• injection
• tablet
What is the maximum oral dose for Ketoralac (Toradol)?
40 mg per day
What is the maximum IM/IV dose?
• 120 mg per day

* should never give 60 mg IV (will have a hypersensitivity reaction and hypotension)
What are actions of COX-2 inhibitors?
• anti-inflammatory, analgesic, & antipyretic effects
• reduces inflammation, pain, and fever mediated by prostaglandins
What are adverse effects of COX-2 inhibitors (ex. Celebrex)?
• GI: nausea/vomiting/diarrhea
• edema
What are indications for using COX-2 inhibitors?
• osteoarthritis
• rheumatoid arthritis
What are actions of acetaminophen (Tylenol)?
• inhibits prostaglandin synthesis in the CNS
• reduces pain and fever
• less effect on cycloxygenase (COX) in peripheral tissue
What are some effects that acetominophen (Tylenol) does not have?
• no effect on platelets
• no anti-inflammatory effects
What are uses of acetominophen (Tylenol)?
• reduces pain, fever, and headache
• reduces fever in viral infections
How do you adjust the max dose of Tylenol if the patient is also taking Warfarin?
lower Tylenol max dose from 4 gm/day to 2 gm/day