NSAIDs

Question 1

MOA for NSAIDs

Answer 1

• NSAIDs reversibly inhibit cox1 and cox2 enzymes (decreased formation of PG precursors)
• inhibition of cox2 = anti-inflammatory and analgesic
• inhibition of both = antipyretic and analgesic

Question 2

common AEs of NSAIDs

Answer 2

• renal
• CV
• GI (cox1)
• muscle repair (cox2)

Question 3

who should not use NSAIDs?

Answer 3

• hx of GI bleed
• elderly (esp 75+)
• poor kidney fxn

Question 4

aspirin

Answer 4

• NSAID
• PO, rectal
• IRREVERSIBLY inhibits cox1 and cox2
• antithrombotic (blood thinner) bc irreversibly inhibits TXA2 (dec. platelet aggregation)
• low dose = selective for cox1 = cardioprotection
• high dose = analgesia, anti-inflammation

Question 5

common AEs of aspirin

GI Bro took a photo and got a skin rash

Answer 5

• GI, skin rash, photosensitivity, bronchospasm

- AVOID if hx of GI bleed - will make them bleed more; children with recent viral illness (Reye’s syndrome)

Question 6

oral NSAIDs (6)

Answer 6

• Ibuprofen
• Naproxen (Aleve)
• Indomethacin
• Aspirin
• Celecoxib (Celebrex)
• Meloxicam (Mobic)

Question 7

topical NSAIDs (2)

DVF, TSA

Answer 7

• Diclofenac (Voltaren gel, Flector patch)

- Trolamine salicylate (Aspercreme)

Question 8

celecoxib (Celebrex)

Answer 8

• only cox2 selective NSAID on the market
• good option if pt has GI issues, but not good if they have CV issues bc if cox2 inhibition > cox1 inhibition, could be at risk of myocardial infarction or stroke

Question 9

acetaminophen (Tylenol)

Answer 9

• not an NSAID
• inhibits prostaglandin synthesis in CNS
• analgesia, antipyretic, NOT anti-inflammatory
• can be combined w NSAID to reduce NSAID dose and potential AEs
• PO, IV, rectal

Question 10

acetaminophen AEs

Answer 10

• hepatotoxicity (esp with alcohol or high doses)

- watch out for unintentional overdose

Question 11

true or false: acetaminophen is usually safer for the elderly than NSAIDs

Answer 11

true