Scc Pharmacology Exam 3 Aspirin, Nsaids & Acetaminophen

Front 1

The enzyme cyclooxygenase is responsible for the synthesis of what substance?

Back 1

Prostanoids (prostaglandins & related compounds)

Front 2

Name three adverse effects resulting from the inhibition of prostaglandins.

Back 2

Gastric erosion & ulceration, bleeding tendencies, renal impairment

Front 3

To what chemical family does aspirin belong?

Back 3

salicylates

Front 4

What is a common name for aspirin?

Back 4

Acetylsaicyclic acid

Front 5

What abbreviation might you see for aspirin? Note: Abbreviations for medications are strongly discouraged by JCAHO.

Back 5

ASA

Front 6

Name two sites of absorption of aspirin. How does the use of the rectal route affect the rate and extent of absorption?

Back 6

Small intestine
Rectal route – absorbed slowly and blood levels are lower than with oral dosing

Front 7

What is the term used for toxicity aspirin?

Back 7

salicylism

Front 8

Name five known and usual therapeutic uses for aspirin.

Back 8

Suppression of inflammation, analgesia, reduction of fever, dysmenorrheal, suppression of platelet aggregation

Front 9

For what types of pain is aspirin most effective?

Back 9

Rheumatoid arthritis, osteoarthritis & juvenile arthritis

Front 10

Why is aspirin not recommended in children?

Back 10

o Reye’s syndrome & use of aspirin by children who have influenza or chickenpox
o ASA should be avoided by children & teenagers suspected of having influenza or chickenpox

Front 11

What effect will aspirin have on normal body temperature?

Back 11

Will not lower normal body temperature

Front 12

Why is aspirin particularly effective in treating dysmenorrhea?

Back 12

Inhibiting prostaglandin synthesis in uterine smooth muscle which relieves cramping

Front 13

What would be considered a "low dose" of aspirin to reduce the risk of stroke and MI?

Back 13

75 – 81 mg/day

Front 14

How likely is aspirin to cause adverse effects when administered short term in analgesic or antipyretic doses?

Back 14

Rarely causes serious adverse effects

Front 15

When is aspirin toxicity more common?

Back 15

When treating inflammatory disorders which require high-dose long-term treatment

Front 16

What are the most common gastrointestinal side effects of aspirin?

Back 16

Gastric distress, heartburn & nausea

Front 17

Although in most cases the amount of blood lost due to GI irritation is insignificant, what may result with chronic aspirin use?

Back 17

Cumulative blood loss can result in anemia

Front 18

What life threatening adverse effect may occur with long term, high dose therapy?

Back 18

Gastric ulceration, perforation & bleeding

Front 19

Name 5 factors that might place a person at greater risk of ulceration when taking aspirin.

Back 19

o Advanced age
o A history of peptic ulcer disease
o Previous intolerance to aspirin or other NSAIDs
o Cigarette smoking
o History of alcohol abuse

Front 20

When should aspirin be discontinued prior to surgery? Why?

Back 20

In order to minimize blood loss during parturition and elective surgery high dose aspirin should be discontinued at least 1 week before surgery

Front 21

When may salicylism begin to develop?

Back 21

When ASA levels climb just slightly above therapeutic

Front 22

Name four overt signs of salicylism.

Back 22

Tinnitus, sweating, headache, dizziness

Front 23

What action is taken if salicylism develops?

Back 23

ASA should be withheld until symptoms subside, therapy should then resume but w/ a small reduction in dosage

Front 24

According to recommendations from the CDC (Centers for Disease Control) when should aspirin and other NSAIDs be avoided in children and teenagers?

Back 24

Suspected of having influenza or chickenpox

Front 25

Why is aspirin classified by the FDA (Food and Drug Administration) as Pregnancy Risk Category D?

Back 25

Anemia, postpartum hemorrhage, can prolong labor

Front 26

What signs and symptoms might a patient exhibit if having a hypersensitivity reaction to aspirin?

Back 26

Profuse watery rhinorrhea and may progress to generalized urticaria, bronchospasm, laryngeal edema & shock

Front 27

If taken with aspirin, what drug can increase the risk of gastric bleeding?

Back 27

Warfarin & Heparin

Front 28

If a person is taking low dose aspirin for prevention of MI or stroke and then uses ibuprofen anytime he has pain, what could be the effect?

Back 28

Can reduce the antiplatelet effects of aspirin

Front 29

What age patient is at greatest risk for a lethal overdose of aspirin?

Back 29

children

Front 30

Why did the pharmaceutical industry first produce NSAIDs?

Back 30

Wanted to produce drugs with actions similar to Aspirin, Cause reversible inhibition

Front 31

What medical conditions does aspirin protect against that might actually be increased with some NSAIDs

Back 31

MI & Stroke

Front 32

Name two common brand names for ibuprofen

Back 32

Advil & Motrin

Front 33

Name three actions of Ibuprofen.

Back 33

Treat fever, mild to moderate pain & arthritis

Front 34

How significant are the side effects of GI bleeding and inhibition of platelet aggregation with ibuprofen?

Back 34

less than aspirin

Front 35

Identify the five doses of standard tablets for ibuprofen

Back 35

o Standard tablets (100, 200, 400, 600 & 800 mg)
o Chewable tablets (50 and 100 mg)
o Capsules (200 mg)
o A 20 mg/mL oral suspension
o A 40 mg/mL oral suspension

Front 36

Name four brand names for naproxen or naproxen sodium.

Back 36

Aleve, Anaprox, Naprelan, Naprosyn

Front 37

What are the approximate half-lives of naproxen or naproxen sodium? How does that affect the frequency of administration?

Back 37

12-17, has a prolonged half-life and cam ne administered less frequently

Front 38

How well tolerated are naproxen and naproxen sodium?

Back 38

Better tolerated

Front 39

How frequently is it recommended that naproxen or naproxen sodium to be given?

Back 39

Rheumatoid arthritis – twice daily, mild to moderate pain – q6-8h

Front 40

Name two ways acetaminophen is like aspirin and one way it is not like aspirin.

Back 40

- Like: analgesic & antipyretic properties
- Unlike: devoid of clinically useful anti-inflammatory and antiheumatic actions

Front 41

Why is acetaminophen effective in treating fever and pain but not in reducing inflammation

Back 41

By decreasing prostaglandin synthesis in the CNS it is able to reduce fever/pain but the inability of acetaminophen to inhibit prostaglandin synthesis outside the CNS may explain the absence of anti-inflammatory effects

Front 42

Briefly summarize the relationship of the major and minor pathways of metabolism to toxic metabolites and liver damage.

Back 42

- Major pathway – acetaminophen undergoes conjugation w/ glucuronic acid & other compounds to form nontoxic metabolites
- Minor pathway – acetaminophen is oxidized by a cytochrome P450-containing enzyme into a highly reactive & toxic compound.
- All of the drug is converted to nontoxic compounds via the major pathway

Front 43

How common are adverse effects to acetaminophen at therapeutic doses.

Back 43

Extremely rare, does not cause gastric ulceration or renal impairment and doesn’t inhibit platelet aggregation

Front 44

What is the benefit of using acetaminophen instead of aspirin for children?

Back 44

Lack of association w/ Reye’s syndrome, preferred for use by children suspected of having chickenpox & influenza

Front 45

What serious adverse effect is a greater risk when large doses are combined with alcohol consumption?

Back 45

Liver injury

Front 46

What is the maximum daily dose of acetaminophen recommended by some authorities if a person drinks alcohol on a regular basis?

Back 46

Low therapeutic doses

Front 47

Even though acetaminophen does not decrease platelet aggregation, what is the suspected reason there is an increased risk of bleeding when combined with warfarin?

Back 47

Acetaminophen may inhibit warfarin metabolism, which would cause warfarin levels to rise

Front 48

Name two populations of patients where acetaminophen is preferred over aspirin and NSAIDs.

Back 48

Patients w/ peptic ulcer disease & patients who have experienced aspirin hypersensitivity reactions

Front 49

How does acetaminophen rank among other causes of acute liver failure in the United States?

Back 49

Leading cause of acute liver failure, accounting for 50% of all cases

Front 50

Name a specific antidote to acetaminophen overdose.

Back 50

Hepatic necrosis

Front 51

What is significant about the fact that many over the counter products and prescription drugs include acetaminophen?

Back 51

- It creates a significant risk of overdose
- Patients who don’t carefully read the labels may well take 2 or more products that contain acetaminophen, thereby exceeding the safe dosage