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Anesthesiology > NSAIDs > Flashcards

Flashcards in NSAIDs Deck (104):
1

what are 4 uses of NSAIDs?

- Mild to moderate pain relief
- Anti-inflammatory
- Analgesic
- Anti-pyretic

2

What is the largest group of drugs having adverse effects?

NSAIDs

3

The use of lower doses of multiple drug classes provides higher safety and less negative side effects is known as what?

Multi-modal analgesia

4

NSAIDs have sparing effects on what other category of drug?

Opioids

5

What is the rate-limiting step of the arachidonic acid cascade?

Release of AA from membrane phospholipid catalyzed by enzyme phospholipase A2.

6

Cyclooxygenase (COX) oxidizes arachidonic acid (AA) to what?

Prostaglandins (PGs)

7

Lipoxygenase (LOX) oxidizes AA to what?

Leukotrienes

8

Are prostaglandins continually synthesized?

Yes

9

Are prostaglandins stored?

No

10

Where do prostaglandins act?

Locally at site of production.

11

T/F: Prostaglandins have only a few physiological functions.

False - Prostaglandins have many physiological functions.

12

What can inhibition of prostaglandins result in?

Serious side effects.

13

What are 2 functions of COX 1?

- Mucosal defense
- Platelet function (TxA2)

14

What effect does COX 2 have on mucosa?

Prevents erosions & promotes healing.

15

Which COX acts as an anti-inflammatory?
How?

- COX 2
- Inhibits leukocyte adherence

16

Which COX offers renal protection?

COX 2

17

Which COX is involved with fever initiation?

COX 3

18

What are 4 functions COX inhibition affects?

- Primary plug formation of platelets
- Renal & gastric mucosa vascular tone
- Smooth muscle contraction
- Temperature regulation

19

T/F: Different drugs inhibit COX 1, 2 & 3 variably.

True

20

Which COX is involved with vicero-nociception and thermal stimulation?

COX 1

21

T/F: COX 1 is involved in constitutive functions with COX 2.

True

22

Which COX is inducible?

COX 2

23

Which COX is up-regulated during inflammatory states?

COX 2

24

There is over a 20 times greater presence of which COX at injured sites?

COX 2

25

Which COX has a key role in nociception?

COX 2

26

What are 2 functions of COX 3?

- Pyrexia
- Analgesia

27

Does COX 3 have better or poorer anti-inflammatory properties than COX 1 & 2?

Poorer

28

COX 3 is derived from what?

COX 1 gene

29

What are 5 drugs that inhibit both COX 1 & 2?

- Aspirin
- Phenylbutazone
- Ketoprofen
- Ketorolac
- Flunixin meglumine

30

What are 5 drugs that are COX 2 preferential and have weak COX 1 inhibition?

- Meloxicam
- Carprofen
- Etodolac
- Vedaprofen
- Tolfenamic acid

31

What are 3 drugs that are COX 2 selective?

- Deracoxib
- Firocoxib
- Robenacoxib

32

What are 2 drugs that are COX 3 preferential and have weak COX 1 & 2 inhibition?

- Acetaminophen
- Diclofenac

33

What is an example of a COX & LOX inhibitor?

Tepoxalin

34

What do prostaglandins mediate?

- Pain
- Inflammation

35

Prostaglandins have what type of central effects?

Central anti-nociceptive effects

36

Are NSAIDs highly protein bound?
How might this affect other drugs?

- Yes
- May displace other drugs and increase their plasma concentration.

37

What are 2 concerns with giving NSAIDs?

- Patient with underlying organ dysfunction.
- Patient receiving other highly protein-bound drugs with narrow therapeutic index.

38

Do NSAIDs have a wide or narrow safety margin?

Narrow

39

Can the upper dose limit be exceeded with NSAIDs?

No

40

What dose of NSAIDs should be used?

Lowest effective dose

41

How much time should be waited in between drugs?

Minimum of 7 days

42

How old do patients have to be for NSAIDs?

Over 6 weeks old

43

What should the hydration status be?

Well-hydrated

44

What are 3 contraindications for the use of NSAIDs?

- Concern for or evidence of GI ulceration
- Concurrent corticosteroid use
- Concurrent administration of other NSAID

45

What type of renal and hepatic function is needed?

Normal

46

Surgical preemptive use of NSAIDs should be avoided in what for cases?

- Expected hemorrhage
- Hypotension
- Prolonged procedure
- Any contraindications

47

How long does it take for therapeutic effects of NSAIDs to be seen with post-operative administration?
Does route of administration matter?

- 45 minutes or greater
- No

48

Should NSAIDs be given with food?

Yes

49

What should be avoided with NSAIDs?

Direct contact with gastric mucosa

50

What are 2 types of surgeries NSAIDs can provide post-operative pain management for?

- Orthopedic surgeries
- Soft tissue surgeries

51

What should NSAIDs be co-administered with for post-operative pain management?

Opioid

52

What needs to be done with long-term NSAID use?

Monitor the patient

53

Are coagulopathies a contraindication for NSAID use?

Yes

54

Are breeding/pregnancy a contraindication for NSAID use?

Yes

55

What are 2 side effects seen with aspirin?

- GI ulceration
- Decreased platelet activity

56

What formulation does aspirin come in?

Tablet

57

What type of COX inhibitor is aspirin?

Non-selective COX inhibitor (Inhibits 1 & 2)

58

Phenylbutazone is commonly used in what 2 species?
What species is it not recommended in?

- Horses & cattle
- Dogs

59

What are 3 formulations that phenylbutazone comes in?

- Powder
- Paste
- Parenteral

60

What is the duration of phenylbutazone?

12 hours

61

There is a high risk of what 2 side effects with phenylbutazone?

- GI ulceration
- Nephrotoxicity

62

Residues of phenylbutazone are toxic to what species?
Should be avoided in cattle of what age?

- Humans
- Greater than 20 months old

63

What type of COX inhibitor is phenylbutazone?

COX 1 & 2

64

What 2 species is flunixin meglumine used in?
What species in Europe?

- Ruminants
- Horses
- Dogs in Europe

65

What is the DOA for flunixin meglumine?

12-24 hours

66

What are 4 side effects seen with flunixin meglumine?

- Local swelling
- GI ulceration
- Nephrotoxicity
- Hepatotoxicity

67

What type of COX inhibitor is flunixin meglumine?

COX 1 & 2

68

What species is carprofen widely used in?
What species in Europe?
In UK?

- Dogs
- Cats
- Horses

69

What are 2 formulations for carprofen?

- Tablet
- Parenteral

70

What is the DOA of carprofen?

12-24 hours

71

What are 4 side effects seen with carprofen?

- Nephrotoxicity
- Hepatotoxicity
- GI ulceration
- Hemostatic deficiencies

72

Hepatotoxicity from carprofen is seen particularly in what dog breed?

Labs

73

What type of COX inhibitor is carprofen?

COX 2 preferential

74

What are 4 species meloxicam can be used in?

- Dogs
- Cats
- Horses
- Cattle

75

What are 3 formulations for meloxicam?

- Oral liquid
- OTM spray
- Parenteral

76

What is the DOA for meloxicam?

12-48 hours

77

What are 4 side effects seen with meloxicam?

- Vomiting
- Diarrhea
- Increase in liver/kidney enzymes
- Decrease in appetite

78

What type of COX inhibitor is meloxicam?

COX 2 preferential

79

What formulation does deracoxib come in?

Tablet

80

What is the DOA for deracoxib?

24 hours

81

What are 5 side effects of deracoxib?

- Vomiting/diarrhea
- Hematochezia
- Melena
- Anorexia
- Renal issues

82

What type of COX inhibitor is deracoxib?

COX 2 selective

83

What formulation does firocoxib come in for dogs?
What 2 forms for horses?

- Dog: tablet
- Horse: paste & parenteral

84

What is the DOA for firocoxib?

24 hours

85

What are 5 side effects seen with firocoxib?

- Abdominal pain
- Diarrhea
- Urticaria
- PU/PD
- Renal

86

What type of COX inhibitor is firocoxib?

COX 2 selective

87

What 2 formulations does robenacoxib come in?

- Tablet
- Parenteral

88

What is the DOA of robenacoxib?

24 hours

89

What are 3 side effects seen with robenacoxib?

- Vomiting/diarrhea
- GI ulceration
- Renal toxicity

90

What type of COX inhibitor is robenacoxib?

COX 2 selective

91

What 2 formulations does acetaminophen come in?

- Tablet
- Oral suspension

92

Is acetaminophen approved for use in veterinary patients?

No

93

What is the DOA?

8 hours

94

What species should acetaminophen not be used in?

Cats

95

What are 3 side effects seen with acetaminophen?

- Hepatic damage
- Renal damage
- GI ulceration

96

What type of COX inhibitor is acetaminophen?

COX 3 preferential

97

What species is tepoxalin used in?

Dogs

98

What formulation does tepoxalin come in?

Dissolvable wafer

99

What is the DOA of tepoxalin?

24 hours

100

Is tepoxalin commercially available?

No

101

What type of inhibitor is tepoxalin?

COX 1, 2 and LOX

102

What does LETD stand for?

Locally enhanced topical delivery

103

What is an example of a topical NSAID?
Use?

- Surpass (diclofenac)
- Equine osteoarthritis

104

Are there any ophthalmic topical NSAIDs approved for veterinary use?

No