NSAIDs

Question 1

Are NSAIDs more effective than paracetamol?

Answer 1

• In a single dose = comparable
• But in regular full dosage of NSAIDs, it has both lasting and anti-inflammatory effect
• NSAIDs are better than paracetamol and opioids in managing pain associated with inflammation e.g. arthritis

Question 2

Which enzymes do
NSAIDs work on?

Answer 2

Cox-1 and Cox-2 enzymes

Question 3

List the selective cyclo-oexygenase-2
(COX-2) NSAIDs?

Answer 3

Etoricoxib
Celecoxib

Question 4

Group the NSAIDs in Strong, Intermediate, and weak in terms of anti-inflammatory properties.

Answer 4

Strongest
- Flurbiprofen
- Indometacin
Intermediate
- Naproxen
- Diclofenac
- Piroxicam
- Fenoprofen
- Aceclotenac
- Etodolac
- Tiaprofenic acid
- Nabumetone
- Selective-COX-2 inhibitors
Weakest
- Ibuprofen
- Ketoprofen
- Mefenamic acid

Question 5

What are the side-effects of NSAIDs?

Answer 5

• Asthma (can cause bronchoconstriction)
• CV events (e.g. stroke or MI)
• Gl SEs
• Renal damage (can cause AKl, especially if taken with ACE-inhibitor, or acute excessive alcohol consumption)

Question 6

NSAIDs + ACEi

Answer 6

AKI

Question 7

Which electrolytes do
NSAIDs disturb?

Answer 7

HYPERkalaemia
HYPOnatraemia

Question 8

NSAIDs and cardiovascular events

Answer 8

• Small increased risk of thrombotic
  events (e.g. myocardial infarction and stroke)
• High dose = greater
• The lowest effective dose for shortest period of time to control symptoms

Question 9

Which NSAIDs are associated with cardiovascular events?

Answer 9

All including COX 2

Question 10

NSAIDs associated with greater risk of
cardiovascular events

Answer 10

• Selective COX-2 inhibitors
• Diclotenac 150mg daily
• Ibuproten 2.4g daily

Question 11

NSAIDs associated with lowerrisk of
cardiovascular events

Answer 11

• Naproxen 1g daily
  Very low risk
• low dose ibuprofen 1.2g daily or less

Question 12

Which patients are at increased risk of GI toxicity with NSAIDs

Answer 12

• elderly
• PMHx of peptic/GI ulceration
• Alcohol consumption
• More than 1 NSAID at a time

Question 13

Which NSAIDs are associated with GI events

Answer 13

All
some to a varying degree

Question 14

NSAIDs associated with highest risk of
GI events

Answer 14

• piroxicam
• ketoprofen
• ketorolac

Question 15

Which NSAID has an intermediate risk of GI toxicity

Answer 15

• indometacin
• diclofenac
• naproxen

Question 16

Which NSAID has an lowest risk of GI toxicity

Answer 16

• ibuprofen (high dose is toxic)
• Selective COX-2 inhibitors

Question 17

NSAIDs + aspirin

Answer 17

Increased risk of GI effects

Question 18

How else can pt reduce symptoms of GI toxicities with NSAIDs

Answer 18

• take with milk/food

Question 19

Which NSAID should be stopped in UTI occurs?

Answer 19

Tiaprofenic acid