NSAIDS

Question 1

1. What are three results of the COX-1 enzyme?

Answer 1

Gastric protection, maintenance of renal function, and platelet aggregation

Question 2

2. What are six results of the COX-2 enzyme?

Answer 2

Inflammation, pain, fever, promotion of colon cancer, maintenance of renal function, vasodilation

Question 3

3. Give one benefit of inhibiting COX-1.

Answer 3

Prevention of platelet aggregation

Question 4

4. List four benefits of inhibiting

COX-2.

Answer 4

Suppress inflammation, relieve pain, reduce fever, reduce risk of colorectal cancer

Question 5

5. Inhibiting cyclooxygenase (COX) interferes with the production of what?

Answer 5

Prostaglandins

Question 6

6. Name two COX inhibitors that do not suppress inflammation.

Answer 6

Acetaminophen (Tylenol), ketorolac (Toradol)

Question 7

7. Give four adverse effects of inhibiting COX-1.

Answer 7

Gastric ulceration, renal impairment, bleeding, increased risk of MI & stroke (except ASA & Tylenol)

Question 8

8. Name three adverse effects of selective COX-2 inhibitors other than gastric ulceration with bleeding.

Answer 8

Renal impairment, vasoconstriction, increased risk of MI & stroke

Question 9

9. Which COX inhibitor has an irreversible action?

Answer 9

Acetylsalicylic acid (Aspirin)

Question 10

10. What syndrome can occur with the administration of aspirin to children who have chickenpox or influenza?

Answer 10

Reye’s syndrome

Question 11

11. How long does aspirin suppress platelet aggregation?

Answer 11

8 days

Question 12

12. Should aspirin be recommended to pregnant women?

Answer 12

No – detrimental to mother and fetus

Question 13

13. Give four signs of early salicylism.

Answer 13

Tinnitus, dizziness, sweating, headache

Question 14

14. List three conditions which increase the risk of hypersensitivity with salicylates.

Answer 14

Asthma, allergic rhinitis, nasal polyps

Question 15

15. Acute poisoning with salicylates begins with hyperventilation or hypoventilation?

Answer 15

Hyperventilation

Question 16

16. How does ibuprofen (Motrin, Advil) alter the action of aspirin?

Answer 16

Blocks ASA access to COX-1 receptors. on platelets, preventing ASA from inhibiting platelet aggregation. Give ibuprofen 2 hrs after aspirin.

Question 17

17. An allergy to what class of drugs is a contraindication for celecoxib (Celebrex)?

Answer 17

Sulfonamides

Question 18

18. Where does inhibition of prostaglandins occur with acetaminophen (Tylenol)?

Answer 18

CNS, no anti-inflammatory effects.

Question 19

19. What pathway can create toxic metabolites when metabolizing large amounts of Tylenol?

Answer 19

Minor pathway

Question 20

20. What is the maximum recommended dosage of Tylenol per day for nondrinkers? Patients who drink or have liver disease? Patients with malnutrition?

Answer 20

4 g per day. 2 g per day for drinkers or liver disease. 3 g per day for patients with malnutrition.

Question 21

21. What drug is given for Tylenol toxicity?

Answer 21

Acetylcysteine

Question 22

22. Why does alcohol increase the likelihood of Tylenol toxicity?

Answer 22

It induces the minor pathway & alcoholics have depleted glutathione stores.

Question 23

23. How long before surgery should NSAIDs be stopped?

Answer 23

1 week or 5 half-lives.

Question 24

24. Which drugs increase the risk of stroke and myocardial infarction?

Answer 24

COX-1 inhibitors, not including aspirin or acetaminophen.

COX-2 inhibitors

Question 25

25. What serotonin receptors are activated by sumatriptan (Imitrex)?

Answer 25

5-HT (serotonin)1B/1D receptors

Question 26

26. How does 5-HT activation reduce the symptoms of migraines?

Answer 26

Causes vasoconstriction of cranial blood vessels and suppresses release of pro-inflammatory neuropeptides.

Question 27

27. What are major contraindications or cautions for the use of sumatriptan (Imitrex)?

Answer 27

Cardiovascular and cerebrovascular disorders. (May cause vasospasm.)

Question 28

28. When should sumatriptan (Imitrex) be taken?

Answer 28

At the first sign of a headache.

Question 29

29. What restrictions are placed on patients receiving intra-articular injections with glucocorticoids? How long may the pain from the injection last?

Answer 29

Restrict movement for 1-2 days. Pain should only last 1-2 days.

Question 30

30. What disease process is a contraindication for glucocorticoids? What vaccines?

Answer 30

Systemic fungal infections. | Live virus vaccines.