Term
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non-specific COX 1/2 inhibitors |
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Definition
non-specific COX 1/2 inhibitors |
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non-specific COX 1/2 inhibitors |
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non-specific COX 1/2 inhibitors |
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Definition
non-specific COX 1/2 inhibitors |
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Definition
non-specific COX 1/2 inhibitors |
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Definition
non-specific COX 1/2 inhibitors |
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Definition
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Definition
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non-NSAID antipyretic/analgesic |
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Definition
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Term
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Definition
analgesia antipyretic anti-inflammatory |
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common mechanism of action for NSAIDs |
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Definition
inhibit COX
COX is a key enzyme responsible for synthesis of prostaglandins which contribute to a number of inflammatory processes |
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Term
COX-1 is _________ active. |
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Definition
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COX-2 is ________ and is associated with disease states. |
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Definition
inducible (by cytokines and other inflammatory mediators) |
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Traditional NSAIDs inhibit... |
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Definition
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Term
Aspirin _______ inhibits COX-1 and COX-2. |
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Definition
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Recovery of COX in must tissues is by... |
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Definition
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Term
Why is platelet inhibition irreversible? |
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Definition
platelets cannot synthesize new COX |
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Term
Other NSAIDs (besides aspirin) produce ______ inhibition of COX. |
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Definition
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Term
What drugs are used for patients who need NSAID-like activity but do not want GI risks/upset? |
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Definition
selective COX-2 inhibitors (celecoxib, meloxicam) |
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Term
Selective COX-2 inhibitors do/do not affect platelets and bleeding time. |
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Definition
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Term
selective COX-2 inhibitor contraindications |
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Definition
aspirin allergy 3rd trimester pregnancy |
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Term
selective COX-2 inhibitor indications |
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Definition
dysmenorrhea osteoarthritis RA acute post-op pain |
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Term
black box warning on all NSAIDs |
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Definition
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Term
COX-2 possible links to cardiac disease |
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Definition
1. COX-2 reduced prostacycline (PGI2) production by vascular endothelium with little or no inhibition of potentially prothrombotic platelet thromboxane A2
2. COX inhibition in general is associated with elevations in blood pressure |
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Term
Why are some other NSAIDs marginally superior to aspirin? |
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Definition
-more potent -more efficacious at tolerated doses -cause less GI irritation and other side effects -longer duration of action so taken less frequently |
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Term
disadvantages of newer NSAIDs over aspirin |
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Definition
-more expensive -some are more toxic |
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Term
What enzyme is responsible for sensitizing pain nerve ending to the action of bradykinin, histamine, and substance P? |
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Definition
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Definition
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NSAIDs are _____ analgesics effective against pain of _________________ intensity. |
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Definition
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What conditions can NSAIDs be superioor to intermediate efficacy opioids for? |
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Definition
post-op pain pain associated with inflammation |
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Term
What provides greater pain nrelief than intermediate opioids alone? |
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Definition
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Term
Efficacy of pain relief provided by NSAIDs is higher/lower than with high-efficacy opioids. |
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Definition
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Term
What opioid effects do NSAIDs lack? |
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Definition
-respiratory depression -development of physical tolerance/dependence |
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Term
What type of pain is relieved and not relieved by NSAIDs? |
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Definition
relieved: integumental structures not relieved: hollow viscera |
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Term
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Definition
pyrogens (cytokines) from lymphocytes act on hypothalamus to increase body temp |
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Term
What type of drugs can suppress fever? |
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Definition
NSAIDs that cross the BBB |
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Term
Describe the anti-inflammatory effects of NSAIDs. |
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Definition
inhibit formation of PGE2 and PGI2, which are important mediators of localized erythema and edema
also inhibit activation and function of inflammatory cells, may stabilize lysosomal membranes, and inhibit phagocytosis |
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Term
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Definition
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PGE2, PGF2alpha, and PGI2 stimulate... |
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Definition
synthesis of bicarbonate and mucous |
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PGE2 promotes mucosal ____________. |
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Definition
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Term
What causes the GI irritation associated with NSAID use? |
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Definition
inhibition of all of the effects of prostaglandins (PGE2) and prostacyclin (PGI2) |
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Term
GI side effects of NSAIDs |
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Definition
epigastric distress nausea/vomiting microhemorrhage ulceration anemia |
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Term
aspirin effect on platelets |
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Definition
low doses irreversibly inhibit COX and platelet aggregation for the life of the platelet (8-11 days) |
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Term
Low dose aspirin together with diet and exercise is useful for the prophylaxis of... |
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Definition
-coronary artery disease -DVT -unstable angina -prophylaxis and treatment of MI and stroke |
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Term
What situations can cause NSAIDs to reduce renal blood flow? |
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Definition
high levels of circulating vasoconstrictors
-compensated CHF -chronic renal disease |
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Term
What type of effect to NSAIDs have on hypertensive regimens? |
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Definition
reduce effectiveness (retention of sodium and water) |
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Term
NSAID and COX-2 cautionary conditions |
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Definition
reduced renal function heart failure liver dysfunction ACE inhibitors diuretics (esp. in elderly) |
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Term
What can the use of aspirin and salicylates during infection with chicken pox, varicella, and influeza viruses cause? |
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Definition
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Term
major salicylate contraindication |
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Definition
children or adolescents with chicken pox or varicella (Reye's syndrome) |
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Term
What does Reye's syndrome cause? |
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Definition
liver damage encephalopathy |
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Term
therapeutic uses for analgesic-antipyretics |
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Definition
pain and fever of low-to-moderate intensity |
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Term
NSAIDs other than aspirin are typically used for.... |
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Definition
chronic treatment
(ibuprofen or naproxen) |
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Term
NSAIDs suppress the clinical signs in __________, but subsequent tissue damage is not halted. |
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Definition
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Term
NSAIDs do not induce _________. |
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Definition
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Term
What NSAID is often used to stimulate closure of a patent ductus arteriosus? |
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Definition
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Term
indomethacin mechanism of action in PDA |
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Definition
inhibition of PGE2 which keeps the ductus arteriosus open |
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Term
What condition is currently under research for the use of COX-2 inhibitors? |
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Definition
familial adenomatous polyposis (FAP)
studies show reduction in number of polyps with COX-2 inhibitors |
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Term
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Definition
GI irritation prolonged bleeding time hypersensitivity reactions Reye's syndrome salicylism |
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Term
How long should a patient be off of aspirin products before having surgery? |
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Definition
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Term
conditions that predispose you to having hypersensitivity reaction |
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Definition
asthma nasal polyps chronic urticaria |
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Term
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Definition
actacids phenytoin, thyroxine, thiopental anticoagulants (risk of bleeding) uricosuric effect in gout pts |
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Term
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Definition
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Term
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Definition
nausea/vomiting tinnitus hyperventilation headache confusion dizziness |
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symptoms of NSAID overdose |
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Definition
*acute medical emergency*
fever, dehydration, delerium, hallucination, convulsions, coma, respiratory/metabolic acidosis, death
children especially vulnerable |
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Term
NSAID adverse effects during pregnancy |
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Definition
low birth weight increased perinatal mortality anemia antepartum and postpartum hemorrhage prolonged gestation premature closure of ductus arteriosus |
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Term
What drug is more efficacious than aspirin, but its toxicity limits its usefulness? |
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Definition
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Term
What drug can be used in resistant RA, gout, suppression of uterine contraction in preterm labor, and PDA? |
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Definition
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Term
What drug is a potent analgesic but has weak anti-inflammatory effect? |
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Definition
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Term
What selective COX-2 inhibitor was withdrawn from the market first? |
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Definition
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Term
What drug needs to be used with caution in patients taking warfarin even though it does not have effect on platelets and bleeding time? |
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Definition
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Term
What is acetaminophen (Tylenol) NOT used for? |
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Definition
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Term
mechanism of acetaminophen toxicity |
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Definition
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Term
adverse effects of acetaminophen |
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Definition
rare in therapeutic usage
occasional skin rash or allergy
OD can result in fulminant hepatic necrosis and liver failure |
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Term
fatal dose of acetaminophen |
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Definition
>10g
may be lower in chronic alcoholics of those with underlying liver disease |
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Term
clinical features of acetaminophen overdose |
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Definition
up to 24 hours: none or nausea/vomiting
>24 hours: nausea, vomiting, RUQ pain, jaundice, encephalopathy |
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Term
What should you consider giving for acetaminophen overdose? |
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Definition
n-acetylcysteine infusion |
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