NSAIDs

Question 1

Classify an NSAIDs

Answer 1

1. Nonselective COX inhibitors
   a) salicylates
   b) propanoic acid derivatives
   c) fenamic acid derivatives
   d) acetic acid derivatives
   e) enolic acid derivatives
2. Preferential COX2 inhibitors
3. highly selective COX2 inhibitors
4. analgesic and antipyretics with poor anti-inflammatory effect

Question 2

Name nonselective COX inhibitors that are salicylates

Answer 2

1. Aspirin
2. diflunisal

Question 3

Name nonselective COX inhibitors that are propanoic acid derivatives

Answer 3

1. Ibuprofen
2. naproxen
3. ketoprofen
4. Flurbiprofen

Question 4

Name fenamic Acid derivatives of nonselective COX inhibitors

Answer 4

1. Mefenamic acid
2. Flufenamic

Question 5

Name nonselective COX inhibitors that are ascetic acid derivatives

Answer 5

1. Ketorolac
2. Indomethacin

Question 6

Name nonselective COX inhibitors that are in enolic acid derivatives

Answer 6

1. Piroxicam
2. Tenoxicam
3. Lornoxicam

Question 7

Name preferential COX2 inhibitors

Answer 7

1. Diclofenac
2. meloxicam
3. Aceclofenac
4. Nimesulide

Question 8

Name highly selective COX2 inhibitors

Answer 8

1. Etroicoxib
2. Patecoxib
3. Lumiracoxib
   

Question 9

Name analgesic and antipyretic with poor anti-inflammatory effect

Answer 9

1. Paracetamol
2. Nefopam 

Question 10

What is the mechanism of action of NSAIDs

Answer 10

Inhibit both COX1 and COX2 Isoforms. Thereby decreasing PGs and thromboxane synthesis.

Question 11

All NSAIDs Cause reversible inhibition of COX enzyme except for which drug

Answer 11

Aspirin

Question 12

Name the pharmacological action of NSAIDs

Answer 12

1. Analgesic effect
2. Anti-pyretic effect by inhibition of PGs in hypothonimus
3. anti-inflammatory effect by inhibition of PG synthesis
4. antiplatelet effect: inhibits TXA2 synthesis
5. Acid base electrolyte balance
6. GIT produces vomiting and Irritates gastric mucosa
7. CVS: sodium and water retention can cause CCF and hyper tension
8. urate excretion
   

Question 13

What is the dosage of regimen of aspirin for analgesic dose

Answer 13

2 to 3 g /day in divided doses

Question 14

What is the dosage regimen of anti-inflammatory dose of aspirin

Answer 14

4 to 6 g /day in divided doses

Question 15

What is the dosage regimen for aspirin for antiplatelet dose

Answer 15

50 to 325 mg/day 

Question 16

What are the adverse effects of NSAIDs

Answer 16

1. GIT: Nausea, vomiting, dyspepsia, epigastric pain, acute gastritis, aspiration and G.I. bleeding
2. Hypersensitivity:  skin rashes, Urticara, Rhinitis, bronchial spasm, angioneurotic edema And rarely anaphylactic reaction
3. People with G6PD deficiency haemolytic anaemia
4. Decreased synthesis of clotting factors, interference with vitamin K
5. Reye’s syndrome
6. Pregnancy: Delay onset of labour and increase chances of postpartum hemorrhage.
7. Analgesic nephropathy
8. Salicylism (Vertigo, tinnitus, headache, confusion, nausea, vomiting, diarrhea, sweating, electrolyte imbalance, etc.)

Question 17

What are the manifestations of acute salicylate poisoning

Answer 17

1. Vomiting, dehydration
2. acid base and electrolyte imbalance
3. restlessness, confusion, convulsions
4. cardiovascular collapse, pulmonary oedema
5. hyperpyrexia and death

Question 18

What is the treatment of acute salicylate poisoning

Answer 18

1. Hospitalization
2. gastric Lavage followed by administration of active charcoal
3. Maintain fluid and electrolyte balance. Correct acid base disturbances
4. IV sodium bicarbonate to treat metabolic acidosis
5. external cooling
6. haemodialysis in severe cases
7. vitamin K1 and blood transfusion if there is bleeding

Question 19

What are the drug interactions of NSAIDs

Answer 19

1. NSAIDs x glucocorticoids: G.I. complications such as nausea, vomiting, dyspepsia, epigastric pain, acute gastritis, ulceration, G.I. bleeding
2. NSAIDs x thiazides/furosemide decrease their diuretic efficacy by inhibiting PG synthesis which promote sodium and water retention
3. NSAIDs potential the effects of oral anticoagulants, hypoglycaemic agents and methotric sa by displacing them from plasma protein binding sites
4. NSAIDs impair clearance of lithium leading to its toxicity 

Question 20

What are the clinical uses of NSAIDs

Answer 20

1. As an analgesic
2. antipyretic
3. osteoarthritis
4. rheumatoid arthritis
5. acute rheumatic fever
6. thromboembolic disorders such as transit ischaemic attacks and MI
7. others including:
   a) medical closure of patent ductus arteriosus
   b) colon and rectal cancer
   c) reduce the risk and onset of Alzheimer’s disease
   d) control radiation induced diarrhoea
   e) control pruritus and flushing
   f)useful in pre-eclampsia

Question 21

What are the actions and uses of indomethacin

Answer 21

1. Inhibits migration of neutrophils to inflamed area
2. is very effective in ankylosing spondylitis
3. acute gout
4. psoriatic arthritis
   

Question 22

Which drug is most useful in cancer pain

Answer 22

Ketorolac

Question 23

Which drugs inhibit the migration of leucocytes

Answer 23

1. Naproxen
2. Indomethacin 

Question 24

What are the uses of paracetamol

Answer 24

1. Antipyretic
2. an analgesic

Question 25

What are the side effects/adverse effects of paracetamol

Answer 25

1. Skin rashes, nausea 2. hepatotoxicity 3. nephrotoxicity

Question 26

 What are the manifestations of acute paracetamol poisoning

Answer 26

1. Vomiting, diarrhea, abdominal pain 2. Hypoglycaemia 3. hypotension  4. hypoprothrombinemia 5. coma 

Question 27

What are the two major differences between nonselective COX inhibitors and selective COX2 inhibitors

Answer 27

1. G.I. side effects are more in nonselective COX inhibitor as compared to selective COX2 inhibitors 2. There is no platelet effect in selective COX2 inhibitors while there is anti-platelet effect in nonselective COX inhibitors

Question 28

what is the antidote for paracetamol poisoning

Answer 28

N-acetylcysteine

Question 29

 What is the treatment for paracetamol toxicity

Answer 29

1. Is detoxified by conjugation with glutathione 2. N-acetylcysteine oral methionine replenish glutathione stores in the liver 3. Activated charcoal is administer to decrease the absorption of ParacetamolFrom the gut. 4. Haemodialysis may be required in acute renal failure

Question 30

Name topical NSAIDs 

Answer 30

1. Ibuprofen 2. diclofenac 3. naproxen 4. Flurbiprofen