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85 Cards in this Set
- Front
- Back
NSAIDS inhibit what enzyme?
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Cyclooxygenase
(it converts arachidonic acid to prostaglandins) |
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Some NSAIDs have antipyretic properties (reduce fever)
Name 3 |
Ibuprofen
Naproxen Salicylates (Aspirin) |
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For Short Term Uses
Why should you prescribe an NSAID with a short half-life that can be taken frequently without risk of toxicity? |
Patients in pain will ignore physician instructions. If one pill is good, two is better.
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What circumstance?
Choose an NSAID with a longer half life |
When Anticipating Long Term Usage
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Prostaglandins cause
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Edema
Cellular exudation Pain |
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2 forms of COX
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COX-1
Isoenzyme => prostaglandins that maintain stomach lining and act in wound healing COX-2 Isoenzyme => prostaglandins that mediate inflammatory response |
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3 Selective COX-2 Inhibitors
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Celecoxib (Celebrex)
Rofecoxib (Vioxx*) Valdecoxib (Bextra*) * = not on market anymore |
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Pain scale level of pain indicated for NSAIDS use
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1-4 or 5 on 10-scale
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Primary Dysmenorrhea,
which is better, selective or non? |
non
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other indications for NSAIDS
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Acute or Chronic Inflammatory Conditions
Tendosynovitis Bursitis Osteoarthritis Rheumatoid Arthritis |
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Contraindications for NSAIDS
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Previous Hypersensitivity to the Class of Drug Being Used
Triad Asthma Asthma Nasal Polyps Aspirin Sensitivity History or Presence of Gastritis or Ulcer Disease |
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Common Side Effects of NSAIDS
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NSAID Gastropathy (big one - lots of deaths!)
Platelet Inhibition Edema (might swell up like a toad) Headache Impaired Wound Healing |
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Drug Interactions with NSAIDS
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Digoxin
Diuretics Warfarin Lithium Methotrexate Cyclosporine |
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What NSAIDS have Endoscopic injury worse than Aspirin?
(Aspirin's score is 1; >1 = worse) |
Ibuprofen
Naproxen Indomethacin Tolmetin |
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What NSAIDS have Endoscopic injury better than Aspirin?
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Nabumetone
Piroxicam |
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__________ mask the symptoms of gastropathy, but they are not protective of the stomach lining and may lead to sudden gastric perforation without warning.
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H2 Blockers & Proton Pump Inhibitors
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If your pt has NSAID gastropahy, what drug can you use to help
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Sucralfate (CARAFATE) may be better.
Misoprostol (CYTOTEC) is protective of stomach lining. 40% of patients on Misoprostol experience diarrhea as a side effect. |
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ALL NSAIDs are cleared via the ____
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kidneys
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Why estimate the GFR?
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to adjust NSAID dosage
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An estimate of the GFR may be obtained as follows:
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GFR = {(140 - age in years) x weight in kilograms} / (Serum Creatinine x 72)
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Classes of NSAIDs
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Salicylates
Acetic Acids Propionic Acids Fenamic Acids Pyranocarboxylic Acids Oxicams Naphthylalkanones Selective COX-2 Inhibitors |
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commercial types of aspirin (salicylates)
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Bufferin
Anacin (adds caffeine) Ascriptin (adds Maalox) Ecotrin (enteric coated) Excedrin (adds acetaminophen and caffeine) Alka-Seltzer (adds sodium bicarbonate and citric acid) |
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why is ecotrin not an effective idea for aspirin?
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helps the stomach, but is not absorbed well in a low acid environment
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half life of aspirin
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0.2 hrs
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Salicylates (2)
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Salsalate (DISALCID)
Choline Magnesium Trisalicylate (TRILISATE) |
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Salsalate (DISALCID)
Frequency? |
Frequency: bid - tid
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Salicylic Acid Derivative (1)
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Diflunisal (DOLOBID)
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Diflunisal (DOLOBID)
Frequency? |
Frequency: bid – tid
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Choline Magnesium Trisalicylate (TRILISATE)
liquid supply? (?mg/ml) frequency? |
Liquid - 500 mg/5cc (b/c of pill size)
Frequency: qd - bid |
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Diflunisal (DOLOBID)
is great b/c unlike all other NSAIDS, it doesn't cause what annoying problem? |
Tinnitus (inner ear)
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Caution with Diflunisal (DOLOBID)
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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 |
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Acetic Acids (5)
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Indomethacin (INDOCIN)
Sulindac (CLINORIL) Tolmetin sodium (TOLECTIN) Diclofenac sodium (VOLTAREN) Diclofenac potassium (CATAFLAM) |
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first acetic acid NSAID
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Indomethacin (INDOCIN)
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Indomethacin (INDOCIN)
How is it supplied? What is frequency? |
Supplied: 25 mg, 50 mg, 75 mg SR
50 mg Rectal Suppository 25 mg/5 cc Oral Suspension Frequency: tid - qid SR bid |
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DOC for anylosing spondylitis
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Indomethacin (INDOCIN)
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Acetic acid type of NSAID that has no renal effect
and Does not interfere with antihypertensive effects of diuretics. |
Sulindac (CLINORIL)
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Sulindac (CLINORIL)
Frequency? |
Frequency: bid
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Acetic acid NSAID that is approved for use in children > 2yrs
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Tolmetin sodium (TOLECTIN)
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Tolmetin sodium (TOLECTIN)
Frequency? |
Frequency: tid
Kids: 20 mg/kg/day |
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For patients with osteoarthritis and rheumatoid arthritis who are at high risk for developing NSAID gastropathy or duodenal ulcers.
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Diclofenac sodium with Misoprostol (ARTHROTEC)
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Diclofenac sodium without Misoprostol
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Diclofenac sodium (VOLTAREN)
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Diclofenac sodium (VOLTAREN)
frequency? |
Frequency: bid
SR qdaily |
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Type of Acetic acid NSAID that has No sodium retention edema.
Rapid onset - 10 minutes |
Diclofenac potassium (CATAFLAM)
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Dose of Diclofenac potassium (CATAFLAM)
Frequency? |
Frequency: bid - tid
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Propionic Acid NSAIDs (7)
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Ibuprofen (MOTRIN)
Flurbiprofen (ANSAID) Fenoprofen Calcium (NALFON) Ketoprofen (ORUDIS)(ORUVAIL) (ORUDIS-KT) Naproxyn (NAPROSYN) Naproxyn sodium (ANAPROX) (ALEVE) Oxaprozin (DAYPRO) |
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Ibuprofen (MOTRIN)
Supplied how? Dose max / day? Frequency? |
Supplied: 200, 400, 600, 800 mg
Dose: 4000 mg / day maximum Frequency: tid - qid |
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max daily dose of Ibuprofen (MOTRIN)
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4000 mg / day maximum
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Flurbiprofen (ANSAID)
frequency? |
Frequency: bid, tid, qid
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More common association with nephrotic syndrome than other NSAIDs.
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Fenoprofen Calcium (NALFON)
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Dose of Fenoprofen Calcium (NALFON)
Frequency? |
tid - qid
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Dose of Ketoprofen (ORUDIS)
Frequency? |
tid - qid
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Ketoprofen
(ORUVAIL) dose Sustained Release Preparation What is frequency? |
Frequency: qd
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ORUDIS-KT
supplied how? |
12.5 mg OTC
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Propionic Acids that Does not interfere with antihypertensive effects of diuretics.
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Naproxyn (NAPROSYN)
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Propionic Acids Approved for use in children.
Dose: 10 mg / kg / day |
Naproxyn (NAPROSYN)
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Naproxyn (NAPROSYN)
What is dose of Oral Suspension? |
125 mg / 5 cc
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Naproxyn (NAPROSYN)
What is frequency? |
bid
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Naproxyn sodium (ANAPROX)
Frequency? |
tid - qid
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OTC Naproxyn sodium
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ALEVE
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ALEVE
How supplied? |
OTC - 220 mg
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Oxaprozin (DAYPRO)
Frequency? |
qd - tid
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Fenamic Acids Principally used for Dysmenorrhea
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Meclofenamate sodium (MECLOMEN)
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problem with Meclofenamate sodium (MECLOMEN)
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25% of patients taking MECLOMEN get diarrhea.
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Meclofenamate sodium (MECLOMEN)
Frequency? |
tid - qid
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another Fenamic Acids
Principally used for Dysmenorrhea Half Life = 4 hours |
Mefenamic Acid (PONSTEL)
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Pyranocarboxylic Acid
May promote healing of cartilaginous erosions. |
Etodolac (LODINE)
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Etodolac (LODINE)
Frequency? |
tid - qid
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Pyranocarboxylic Acid
For short term use only. Excellent Non-addictive analgesic. |
Ketorolac Tromethamine (TORADOL)
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Ketorolac Tromethamine (TORADOL)
What are Oral and IM doseages? |
Oral: 10-mg q4-6h prn pain
IM: 15, 30, 60 mg - q3-4h prn pain |
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Ketorolac Tromethamine (TORADOL) 30mg IM
What are comparable IM doses of morphine and meperidine? |
Comparable Doses
TORADOL - 30 mg IM Morphine - 12 mg IM Meperidine - 100 mg IM |
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Piroxicam (FELDENE)
What is frequency? How long does it take to reach steady state level? |
qd
7-12 days |
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the other oxicam
What is frequency? (tried to claim that it was a selective COX-2 inhib, but it wasn't) |
Meloxicam (MOBIC)
Frequency: qd |
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Lowest incidence of gastropathy of all NSAIDs
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Naphthylalkanones
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Naphthylalkanones example?
what is frequency? |
Nabumetone (RELAFEN)
qd - bid |
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Metabolism of celecoxib
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Cytochrome P450 2C9
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Incidence of Gastroduodenal Ulcers in 3 months
compare celecoxib, naproxen, ibuprofen, and diclofenac |
For celecoxib = 7.5%
For Naproxen = 34.6% for Ibuprofen = 23.3% for Diclofenac = 9.7% |
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This subject is not highlighted, but it seems important.
Contraindications for celecoxib |
allergy to sulfonamides
kidney disease |
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Celecoxib (Celebrex)
Frequency? |
qd - bid
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This is not highlighted, but it looks important.
What are the drug Interactions of celecoxib? |
ACE inhibitors: Decreases antihypertensive effect.
Fluconazole: Two-fold increase in celecoxib concentration |
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Rofecoxib (Vioxx)
Why should we not dwell on this one? |
Withdrawn from market
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Propionic Acids (7)
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Ibuprofen (MOTRIN)
Flurbiprofen (ANSAID) Fenoprofen Calcium (NALFON) Ketoprofen (ORUDIS)(ORUVAIL) (ORUDIS-KT) Naproxyn (NAPROSYN) Naproxyn sodium (ANAPROX) (ALEVE) Oxaprozin (DAYPRO) |
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Fenamic Acids (2)
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Meclofenamate sodium (MECLOMEN)
Mefenamic Acid (PONSTEL) |
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Pyranocarboxylic Acid (2)
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Etodolac (LODINE)
Ketorolac Tromethamine (TORADOL) |
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Oxicams (2)
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Piroxicam (FELDENE)
Meloxicam (MOBIC) |
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Naphthylalkanones (1)
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Nabumetone (RELAFEN)
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