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Flashcards in Pharmacology Review Deck (53)
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1

Differently Classes of NSAIDs

Salicylate (acetylated)
Salicylate (non-acetylated)
Popionic acids (phenyl-propionic acid)
Acetic acids
Oxicams
Fenamates
Nonacidic
Selective COX-2 inhibitors

2

When is NSAID therapy considered a failure?

2 weeks at max anti-inflammatory dose

3

MOA of NSAIDs

Inhibit cyclooxyrgenase which impairs the transformation of arachidonic acid to prostaglandins to prostacyclin and thromboxanes

4

What do COX-1 enzymes regualte?

Normal cellular processes such as gastric cytoprotection, vascular homeostasis, platelet aggregation, kidney function

5

SE of NSAIDs

GI
Renal
CV
Liver
Pulmonary
Hematologic
Malignancy
Dermatologic
Healing of musculoskeletal injuries

6

Renal SE of NSAIDs

Renal vasoconstriction
Acute renal failure
Hypertension
Hyperkalemia
Hyponatremia
Edema
Increased risk of renal cell cancer

7

Hepatic SE of NSAIDs

Elevation of liver transaminases
NSAID associated liver injury
More common in SLE and RA

8

Pulmonary SE of NSAIDs

SE more related to nonselective COX 1/2 inhibitors (less with COX2 selective)
Bronchospasm
Pulmonary infiltrates with eosinophilia

9

Hematologic SE of NSAIDs

Neutropenia
Anti platelet effects due to COX-1 inhibition

10

Anti-platelet Activity with NSAIDs

Need to continue ASA for cardioprotection
Interaction with warfarin (increase INR)
Higher risk of bleeding with anticoagulant use

11

CNS SE with NSAIDs

Aseptic meningitis
Tinnitus (usually salicylates)
Psychosis and cognitive impairment (indomethacin, elderly)

12

Dermatologic SE with NSAIDs

Drug rash
Pseudoporphyria
Blistering skin lesions (TENS, SJS)

13

Fracture Healing Effects with NSAIDs

Non-union
Avoid NSAIDs up to 90 days post fracture

14

Contraindications for NSAIDs

N: nursing or pregnancy
S: serious bleeding
A: allergy, asthma, angioedema
I: impaired renal function
D: drug (anticoagulants)

15

Acetylated Salicylate Medication

Aspirin

16

How is the acetylated salicylate class different from the other classes?

Irreversible platelet inhibition for the life of the platelet

17

Medications in the Propionic Acids Class

Naproxen
Ibuprofen

18

Naproxen

Less CV risk
Naproxen base or naproxen sodium

19

Ibuprofen

Advil or Motrin
Short duration of effect
Alternative to naproxen

20

Medications in the Acetic Acids Class

IV Ketorolac (Toradol)
Indomethacin (Indocin)

21

Ketorolac (Toradol)

Adjust dose based on age and weight
Moderate to severe post-op pain
Risk of gastropathy >5 days
Not for chronic pain or inflammation

22

Indomethacin (Indocin)

Immediate release and extended release formulations
Treats acute gout and pericarditis
Not for chronic use
May be associated with aplastic anemia

23

Medications in the Oxicams Class

Meloxicam (Mobic)
Prioxicam (Feldene)

24

Meloxicam (Mobic)

Long duration
Slow onset
Low doses: COX-2 selective

25

Piroxicam (Feldene)

Treatment of chronic pain and inflammation poorly responsive to other NSAIDs
>20 mg QD = serious GI complications

26

Selective COX-2 Inhibitor Medication

Celecoxib (Celebrex)

27

Celecoxib (Celebrex)

No effect on platelets
Decreased GI toxicity
Dose related renal and CV effects (higher = more problems)

28

Pain Management with Fractures

Acetaminophen (APAP) or NSAID
Sometimes narcotic analgesic

29

Indications for Narcotics in Fractures

Significant soft tissue swelling or ecchymosis
Pain at rest
Night pain
Pain uncontrolled by NSAIDs or APAP
Anyone who had surgery
May just need at night

30

Narcotics for Pain Relief

Codeine
Hydrocodone
Oxycodone