Term
| To what category does asa belong? |
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Definition
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Term
To what category do the following belong: Magnesium choline salicylate (Trilisate)
Salsalate (Disalcid)
Diflunisal (Dolobid)? |
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Definition
| nonacetylated salicylates |
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Term
What is A weak acid rapidly absorbed from stomach and small intestine
Leads to damage of gastric mucosal barrier? |
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Definition
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Term
| Acetylsalicylic acid is hydrolyzed to what compound, which is the active form of aspirin? |
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Definition
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Term
What medication is Highly protein bound and is
Conjugated and renally eliminated by 1st order kinetics with therapeutic doses < 650mg? |
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Definition
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Term
| Regarding asa, Metabolic pathway saturated when what level of doses given? this leads to what order kinetics, long half-life (15 hrs), and toxic serum levels? |
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Definition
| high doses, zero order kinetics |
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Term
What med is a Nonselective inhibitor of cyclooxygenase (COX) enzymes 1 and 2 that has the following properties:
Anti-inflammatory
Analgesic
Antipyretic? |
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Definition
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Term
| Does asa inhibit platelet function reversibly or irreversibly? |
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Definition
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Term
What medication involves Inhibition of COX-1 prevents synthesis of thromboxane A2 by platelets, preventing clot formation?
Single dose effect lasts 8-10 day life of platelet. |
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Definition
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Term
| Do Nonacetylated salicylates and nonselective NSAIDs have reversible or irreversible effects? |
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Definition
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Term
What med involves the following ade: Gastritis and gastric bleeding,
Increase in bleeding time,
Airway hypersensitivity
(10% of asthmatics have history;
Cross reactivity with other NSAIDs) |
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Definition
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Term
| Do Nonacetylated salicylates have an irreversible effect on platelets? |
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Definition
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Term
| What type of poisoning involves Tinnitis, nausea and vomiting, hyperventilation, hypokalemia, metabolic acidosis, dizziness, agitation, hallucinations? |
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Definition
| Salicylism (salicylate poisoning) |
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Term
| Salicylism, bleeding, and reye's syndrome are involved w/what med? |
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Definition
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Term
What syndrome involves: Hepatic encephalopathy and liver failure in young children;
Associated with aspirin use to treat febrile viral infection? |
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Definition
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Term
| What nsaid should not be given to children for fevers due to chicken pox or uri's? |
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Definition
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Term
| What med is Rarely used for arthritis or pain and is Primarily for prophylaxis (prevention) of myocardial infarction or stroke? |
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Definition
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Term
What med in a Low dose of 81mg irreversibly inhibits platelets and in
Higher doses only increase risk of GI bleeding? |
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Definition
| asa: Primarily for prophylaxis (prevention) of myocardial infarction or stroke |
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Term
What drug involves Adverse effects higher than OTC NSAIDs and
Risk of accumulation and salicylate toxicity? |
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Definition
| asa: rarely used for arthritis or pain |
|
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Term
| What are the 2 major classes of NSAIDS? |
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Definition
Nonselective (traditional) NSAIDs.
Selective COX-2 inhibitors |
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Term
| What drug class involves the following MOA: Inhibition of COX-1 and/or COX-2 enzymes to prevent prostaglandin synthesis? |
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Definition
|
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Term
Is COX 1 or 2 Continuously expressed (constitutive) and widely distributed in most organ systems including GI tract and
Needed for production of thromboxanes for clotting |
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Definition
|
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Term
is cox 1 or 2 Primarily induced at sites of inflammation and neoplasms and
Continuously active in kidney, intestine, uterus, brain? |
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Definition
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Term
Which drug class involves adverse effects of Dyspepsia,
Ulceration, bleeding, perforation?
Risk increases with dose and duration of treatment, alcohol use, steroid use. |
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Definition
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Term
What drug class involves adverse effects including Sodium and water retention
(Can exacerbate heart failure and hypertension),
Acute tubular necrosis,
Prostaglandins necessary for autonomic control of blood flow to glomerulus,
Risk with dehydration, hypovolemia, ACE inhibitors and ARBs? |
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Definition
|
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Term
| what is the most common adr of nsaids? |
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Definition
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Term
What drug class involves the following adr's: Reversible platelet inhibition;
CNS: dizziness, drowsiness, confusion;
Thrombosis associated with COX-2 selective agents
[Rofecoxib (Vioxx) and valdecoxib (Bextra) removed from market recently] |
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Definition
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Term
How high is the risk of gi toxicity with Ibuprofen (Motrin, Advil, etc),
Naproxen (Alleve, Naprosyn), and
Ketaprofen (Orudis)? |
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Definition
|
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Term
| How high is the risk for gi toxicity with Diclofenac (Voltaren)? |
|
Definition
|
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Term
| How high is the risk of gi toxicity w/Nabumetone (Relafen)? |
|
Definition
|
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Term
How high is the risk of gi toxicity w/
Meloxicam (Mobic)? |
|
Definition
|
|
Term
How high is the risk of gi toxicity w/
Celecoxib (Celebrex)? |
|
Definition
|
|
Term
How high is the risk of gi toxicity w/
Salsalate (Disalcid)? |
|
Definition
|
|
Term
| How high is the risk of gi toxicity w/Indomethacin (Indocin)? |
|
Definition
|
|
Term
How high is the risk of gi toxicity w/
Piroxicam (Feldene)? |
|
Definition
|
|
Term
How high is the risk of gi toxicity w/
Flurbiprofen (Ansaid)? |
|
Definition
|
|
Term
How high is the risk of gi toxicity w/
Fenoprofen (Nalfon)? |
|
Definition
|
|
Term
How high is the risk of gi toxicity w/
Oxaproxin (Daypro)? |
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Definition
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Term
| What adr is reduced when you Add H2 antagonists (ie ranitidine) or proton pump inhibitors (ie omeprazole) to NSAID therapy? |
|
Definition
| gi toxicity; 80% with ulcers are healed with PPI versus 60% with H2 blocker |
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Term
| What adr is reduced by substitutin celecoxib (celebrex) ( but should avoid pt w/cardiovascular disease)? |
|
Definition
| reduce gi toxicity secondary to nsaids |
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Term
| What adr is reduced when you Add misoprostol (Cytotec), a prostaglandin analog that helps protect gastric mucosa? |
|
Definition
reduce gi toxicity- Arthrotec = diclofenac + misoprostol,
Poor tolerance due to diarrhea and cramping,
Contraindicated in pregnancy |
|
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Term
| What drug interactions occur w/nsaids? |
|
Definition
ibuprofen.
Celecoxib. other antiplatelet drugs. diuretics. ace inhibitors. angiotensin receptor blockers. methotrexate. |
|
|
Term
| what nsaids drug interaction involves inhibition of antiplatelet effect? |
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Definition
|
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Term
| What drug interaction w/nsaids involves loss of potential gi protective effect? |
|
Definition
|
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Term
| What increases risk of bleeding w/nsaids? |
|
Definition
| other antiplatelet drugs such as clopidogrel (plavix) |
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Term
| nsaids antagonizes diuresis and Na+ loss of what drug? |
|
Definition
|
|
Term
| nsaids antagonizeds renal effects of what drug? |
|
Definition
|
|
Term
| nsaids antagonizes renal effects of what drug? |
|
Definition
| angiotensin receptor blockers |
|
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Term
| nsaids may increase serum concentration and toxicity of what drug? |
|
Definition
|
|
Term
| what are 4 uses for nsaids? |
|
Definition
| pain relief, incl ha. fever, inflammatory conditions such as arthritis. primary dysmenorrhea. |
|
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Term
| what dose of nsaids are comparable to 650 mg of T for pain? |
|
Definition
| low doses (ibuprofen 200 mg; naproxen 250 mg) |
|
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Term
| what doses of nsaids are comparable to acetaminophen/codeine combinations for pain? |
|
Definition
| moderate doses (OTC: Ibuprofen 400mg, naproxen 500mg) |
|
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Term
| What doses of nsaids are used for for anti-inflammatory effect? |
|
Definition
| high doses (OTC: ibuprofen 1800-2400 mg/day, naproxen 1000 mg/day) |
|
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Term
| OTC only for what dose of ibuprofen and naproxen? |
|
Definition
| ibuprofen: 200 mg; naproxen 250 mg strengths |
|
|
Term
| What is the Only parenteral NSAID – given IV or IM? |
|
Definition
|
|
Term
| What nsaid is indicated for pain relief; Higher dose (30mg) comparable to morphine? |
|
Definition
|
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Term
| For how many days can you use ketorolac (toradol)? |
|
Definition
| Cannot use > 5 days: GI ulceration and bleeding |
|
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Term
| In what dosage is ketorolac (toradol) indicated for osteoarthritis or RA? |
|
Definition
| Not indicated for osteoarthritis or rheumatoid arthritis |
|
|
Term
| What drug for OA relieves mild pain, but inferior to NSAIDs for moderate to severe pain? |
|
Definition
|
|
Term
| What drug for OA may be as effective as oral NSAIDs and avoids systemic toxicity? |
|
Definition
topical nsaids- Ibuprofen 10% or ketoprofen 5% compounded by pharmacist.
Diclofenac 1% topical gel (Voltaren Gel) |
|
|
Term
| What drug for oa relieves pain by inhibiting substance P – 50% experience local burning sensation which diminishes over time? |
|
Definition
| topical capsaicin cream (otc); 50% experience local burning sensation which diminishes over time |
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Term
| What drug for oa results of trials still controversial – overall appears to reduce pain with chronic use with little adverse reaction? |
|
Definition
| Glucosamine sulfate +/- chondroitin |
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Term
| What tx option for oa is combined w/local anesthetic and injected into affected jts? |
|
Definition
| glucocorticoid injections |
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Term
| What injections for oa are common, though probably noet effective? |
|
Definition
| hyaluronic acid injections |
|
|
Term
| Tramadol (ultram) adn opioids are other tx options for what disorder? |
|
Definition
|
|
Term
| What are 4 non-drug tx for ra? |
|
Definition
| jt protection. energy conservation. passive exercise. heat. |
|
|
Term
| What is short-term drug tx for ra? |
|
Definition
| nsaids (no disease modifying activity), and corticosteroids (local injections, low-dose systemic therapy (predinsone 10mg)) |
|
|
Term
| Do DMARDS have slow or rapid onset? |
|
Definition
| slow onset of effect (3-6 mos) |
|
|
Term
| Why might pts on dmards require regular evaluation? |
|
Definition
|
|
Term
| What are 2 drugs for *mild* arthritis? |
|
Definition
| hydroxychloroquine (plaquenil) adn sulfasalazine (azulfidine) |
|
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Term
| What is the least toxic of all dmards? |
|
Definition
| hydroxychloroquine (plaquenil) |
|
|
Term
| Which dmards involves hemolytic anemia if g6pd deficiency? |
|
Definition
| hydroxychloroquine (plaquenil), sulfasalazine (azulfidine) |
|
|
Term
| What non-biologic dmard involves potential retinal damage in the elderly? |
|
Definition
| hydroxychloroquine (plaquenil) |
|
|
Term
| What are adr's of sulfasalazine (azulfidine)? |
|
Definition
| nausea, rash, hemolytic anemia if g6pd deficiency, rare-leukopenia, hepatitis |
|
|
Term
| What is teh DMARD of choice by most rheumatologists? |
|
Definition
|
|
Term
| Is the response rate to methotrexate fast or slow? high or low? |
|
Definition
| rapid and high response rate |
|
|
Term
| How is methotrexate administered? |
|
Definition
| low oral doses once weekly |
|
|
Term
| The following are adr's of what dmard: Elevated liver enzymes in 15% (discontinue if 2x normal upper limit), nausea, vomiting? |
|
Definition
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Term
| The following are adrs of what dmard: Dose-related toxicity: bone marrow suppression and stomatitis? |
|
Definition
|
|
Term
| The following are adrs of what dmard: teratogenic: pregnancy category x? |
|
Definition
|
|
Term
| How is methotrexate excreted? |
|
Definition
| renally- avoid if clcr<30 ml/min |
|
|
Term
| What supplement might be necessary for dmard? |
|
Definition
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