Term
| 60-81 mg of ASA will irreversibly inhibit _____________ production in PLTs and will inhibit their aggregation. |
|
Definition
|
|
Term
| Why should you D/C salicylates one week prior to surgery? |
|
Definition
|
|
Term
| Mild salicylate toxicity is called: |
|
Definition
|
|
Term
|
Definition
N/V
HA
mental confusion
tinnitis
dizziness |
|
|
Term
| Severe salicylate toxicity sxs include: |
|
Definition
those of salicylism plus
restlessness, delirium, hallucinations,
convulsions, coma,
resp. & metabolic acidosis
and death from resp. failure |
|
|
Term
| How do you treat severe salicylate toxicity? |
|
Definition
dialysis and
frequent correction of acid-base & electrolyte imbalance
Na Bicarbonate |
|
|
Term
|
Definition
mild analgesic
antipyretic
minimal anti-inflammatory effect |
|
|
Term
| How is acetaminophen metabolized? |
|
Definition
1. by several pathways in the liver, excreted renally
2. a small portion is converted into a hepatotoxic metabolite by CYP 450 |
|
|
Term
| How long does it take for acetaminophen toxicity to occur? |
|
Definition
|
|
Term
| Ingestion of __________ mg of tylenol is enough to cause life-threatening hepatotoxicity? |
|
Definition
|
|
Term
| What can you use to treat tylenol toxicity? |
|
Definition
Acetylcysteine
(it conjugates the intermediate compound and makes it harmless) |
|
|
Term
| What do you use to treat inflammatory arthritidies? |
|
Definition
NSAIDs
corticosteroids
DMARDs |
|
|
Term
| which drugs are best to use during acute phase inflammation? |
|
Definition
|
|
Term
| which drugs are best to use during chronic phase inflammation? |
|
Definition
|
|
Term
| Which cyclooxygenase enzyme is widespread with relatively constant levels in various tissues? |
|
Definition
|
|
Term
| Which cyclooxgenase enzyme is called the "housekeeping enzyme" and is produced in response to pro-inflammatory substances? |
|
Definition
|
|
Term
| Which cytokines are the most important in terms of their roles in the inflammatory process? |
|
Definition
|
|
Term
| What different properties do NSAIDs have? |
|
Definition
analgesic
antipyretic
anti-inflammatory |
|
|
Term
| NSAIDs inhibit _____________, the enzymes in the synthesis of _______________ from arachidonic acid and other fatty acids. (MOA) |
|
Definition
cyclooxygenase
prostagladins |
|
|
Term
| NSAIDS, at low doses, are indicated for: |
|
Definition
mild to moderate pain
counteracting fever |
|
|
Term
| NSAIDs, at high doses, are indicated for: |
|
Definition
| treating inflammatory responses assc. with arthritic conditions |
|
|
Term
| What are some of the AEs associated with NSAID use? |
|
Definition
GI toxicity
renal impairment, fluid retention
hypersensitivity reactions
inhibition of uterine contrations
premature closure of the ductus arteriosus |
|
|
Term
| Which drug is used to treat patent ductus arteriosus? |
|
Definition
|
|
Term
| What are some of the AEs of NSAIDs that are not associated with COX inhibition? |
|
Definition
| hepatic, dermatologic and CNS effects |
|
|
Term
| NSAIDs may increase ___________ levels by inhibiting its excretion. |
|
Definition
|
|
Term
| ASA competes with what drug for protein binding sites? |
|
Definition
|
|
Term
| Which drugs, when combined with NSAIDs, enhance the chance of peptic ulceration? |
|
Definition
|
|
Term
| NSAIDs decrease the ___________ of methotrexate. |
|
Definition
|
|
Term
| Which patients should use NSAIDs with caution? |
|
Definition
those with renal impairment,
HF, HTN, edema, or
hypersensitivity reactions to any other NSAIDs |
|
|
Term
| Aspirin, Salsalate and Diflunisal are what type of NSAID? |
|
Definition
|
|
Term
| Which salicylate has an active metabolite and what it is? |
|
Definition
|
|
Term
| Which salicylates irreversibly inhibit cyclooxygenase and which reversibly inhibit it? |
|
Definition
ASA - irreversibly
Diflunisal and Salsalate - reversibly |
|
|
Term
|
Definition
| the sensitization of pain receptors to both mechanical and chemical stimuli |
|
|
Term
| How is the antipyretic effect of salicylates achieved? |
|
Definition
| by block PG synthesis at the thermoregulatory centers in the hypothalamus |
|
|
Term
| Which salicylate is used as an antipyretic? |
|
Definition
|
|
Term
| It takes about ______ times the analgesic dose of aspirin to provide an anti-inflammatory effect. |
|
Definition
|
|
Term
| Why should you not give a child aspirin if you think they may have a viral infection? |
|
Definition
bc they may get Reye's syndrome
(a fatal, fulminating hepatitis with cerebral edema) |
|
|
Term
| How do salicylates effect respiration? |
|
Definition
1. at therapeutic doses: increases respiration
2. at higher doses: may cause hyperventilation and resp. alkalosis
3. at toxic doses: central resp. paralysis and resp. acidosis |
|
|
Term
| What is the HL of salicylates? |
|
Definition
at low, analgesic doses: 4-6 hrs
at high, anti-inflammatory doses: 15-30 hrs |
|
|
Term
| Why is ASA not very popular? |
|
Definition
| bc of its assc with peptic ulcers |
|
|
Term
| How much occult blood can you lose in one day taking normal doses of aspirin? |
|
Definition
|
|
Term
| How do salicylates effect the GI system? |
|
Definition
They increase gastric acid secretion by inhibiting PGI2 and they decrease mucus secretion by inhibiting PGE-2 and PGF-2
this can cause peptic ulceration, occult blood loss and rarely hemorrhage |
|
|
Term
| What is the dosage range of ASA used to prevent PLT aggregation? |
|
Definition
|
|
Term
| What salicylate SEs are associated with their effect on the kidneys? |
|
Definition
edema (from Na and water retention)
hyperkalemia |
|
|
Term
| Which NSAID cannot cause interstitial nephritis? |
|
Definition
|
|
Term
| Salicylic acid is used to treat: |
|
Definition
| corns, warts and calluses |
|
|
Term
| Methyl salicylate is used topically as... |
|
Definition
| a counterirritant in liniments |
|
|
Term
| How are salicylates absorbed? |
|
Definition
1. Through intact skin
2. Though the stomach and small intestine (PO)
3. rectally (slow and unreliable) |
|
|
Term
| To whom might you give salicylate suppositories? |
|
Definition
|
|
Term
| what salicylate does not cross the BBB or placenta? |
|
Definition
|
|
Term
| What percentage of people taking salicylates will have a hypersensitivity reaction? |
|
Definition
|
|
Term
| How is aspirin eliminated when taken at low doses? |
|
Definition
| renally by first order kinetics |
|
|
Term
| How is aspirin eliminated when taken at high, anti-inflammatory doses? |
|
Definition
| hepatic metabolite pathways are saturates and zero order kinetics occur |
|
|
Term
| What are the symptoms of salicylate hypersensitivity? |
|
Definition
urticaria
bronchoconstriction
angioneurotic edema |
|
|
Term
| What are the 5 different groups of NSAIDs? |
|
Definition
1. salicylates
2. proprionic acids
3. acetic acid derivatives
4. alkones
5. oxicams |
|
|
Term
| What are the AEs of salicylates? |
|
Definition
- gastric distress, N/V
- microscopic GI bleeding
- prolonged BT
- resp. distress at high doses
- hyperthermia at toxic doses
- hypersensitivity
- Reye's Syndrome |
|
|
Term
| Ibuprofen and Naproxen are in what group of NSAIDs? |
|
Definition
| proprionic acid derivatives |
|
|
Term
| What is the max dose for proprionic acid derivatives? |
|
Definition
|
|
Term
| What different properties do proprionic acid derivatives have? |
|
Definition
analgesic
antipyretic
anti-inflammatory
anti-PLT, although they are not prescribed for this action |
|
|
Term
| What are the most common SEs of proprionic acid derivatives? |
|
Definition
N, heartburn,
epigastric pain,
rash, dizziness |
|
|
Term
| What percentage of patients on Naproxen experience GI toxicity? |
|
Definition
|
|
Term
| Fenoprofen (a proprionic acid derivative) is used exclusively as an: |
|
Definition
|
|
Term
| What is Ketoprofen (a proprionic acid derivative) indicated for? |
|
Definition
RA, OA
mild to moderate pain
dysmenorrhea |
|
|
Term
| Ketoprofen is more _________ than other proprionic acid derivatives. |
|
Definition
|
|
Term
| Why is it good practice to not leave a patient on a proprionic acid derivative for long periods of time? |
|
Definition
|
|
Term
| Oxaproxin (a proprionic acid derivative) is approved for: |
|
Definition
|
|
Term
| How often must one take Oxaproxin? |
|
Definition
| once a day bc it has a long DOA |
|
|
Term
| Which Acetic Acid Derivative accumulates in the joints? |
|
Definition
|
|
Term
| Which drugs are Acetic Acid Derivatives? |
|
Definition
Indomethacin
Ketoralac
Etodolac
Sulindac
Diclofenac
Tometin |
|
|
Term
| All Acetic Acid Derivatives are good _____________ but are not used as _____________. |
|
Definition
pain relievers
antipyretics |
|
|
Term
| What are the indications for Indomethacin? |
|
Definition
RA, OA
Acute gouty arthritis
ankylosing spondylitis
closure of a patent ductus arteriosus |
|
|
Term
| Indomethacin is not recommended as... |
|
Definition
| a simple analgesic or antipyretic bc of its potential for toxicity |
|
|
Term
| Indomethacin produces more ____ and ____ effects than most other NSAIDs. |
|
Definition
|
|
Term
| What percentage of Indomethacin users get a severe frontal HA? |
|
Definition
|
|
Term
| What are the SEs of Indomethacin? |
|
Definition
Severe HA
Vertigo, confusion and psych disturbances
GI problems
Major hematologic problems
Ocular problems
Hepatitis, pancreatitis
hypersensitivity reaction |
|
|
Term
| Which Acetic Acid Derivative is administered as a prodrug? |
|
Definition
|
|
Term
| What is Sulindac used to treat? |
|
Definition
OA, RA
Gout
Ankylosing Spondylitis |
|
|
Term
| Which Acetic Acid Derivative is ONLY used as an analgesic? |
|
Definition
|
|
Term
| Ketoralac is used to for: |
|
Definition
| moderate to severe, acute pain management |
|
|
Term
| How long should someone take Ketoralac? |
|
Definition
|
|
Term
| what are ketoralac's contraindications? |
|
Definition
ASA allergy
PUD, GI bleed or perforation
renal or hepatic disease
labor and delivery
any bleeding tendency
nursing moms |
|
|
Term
| Which drug is an Alkone NSAID? |
|
Definition
|
|
Term
| Nabumetone is used for ______________ only. |
|
Definition
|
|
Term
| Which drugs are Oxicam NSAIDs? |
|
Definition
|
|
Term
| What is Meloxicam's biggest use? |
|
Definition
|
|
Term
| Which NSAID is the most selective for COX-2? |
|
Definition
|
|
Term
| The frequency of GI SEs is less with ___________ than with other NSAIDs. |
|
Definition
|
|
Term
| Piroxicam has a long _______ and used to treat ____________. |
|
Definition
|
|
Term
| What are your first and second choices for COX-2 inhibition? |
|
Definition
1. Celecoxib (celebrex)
2. Meloxicam |
|
|
Term
| COX-2 selective inhibitors are associated with an increased incidence of ___________ as compared to NSAIDs. |
|
Definition
| severe adverse effects (including CV) |
|
|
Term
| Max adult dose of tylenol |
|
Definition
|
|
Term
| Tylenol is not very helpful in treating what kind of arthritidies? |
|
Definition
|
|
Term
| TNF alpha and IL-1 contribute to __________ seen in chronic inflammation arthritis |
|
Definition
|
|
Term
| _______________ and ___________ are targets of antiiflammatory drug therapy |
|
Definition
|
|
Term
| what drug is the only COX-2 inhibitor still on the market? |
|
Definition
|
|
Term
| All NSAIDs should be taken with ______ |
|
Definition
|
|
Term
| which drugs prompted the use of child-safe caps? |
|
Definition
|
|
