W7 Exam NSAIDs, Osteo, Autoimmune/Inflamm DXs (kelliwilson1 PHARM muscuolskeletal), (Droopyhalo NSG 6005 WEEK 7 Pharmacology), (Shiphie_Philipose MU NURS 615: Advanced Pharm - Chapter 25 Study Guide)

W7 Exam NSAIDs, Osteo, Autoimmune/Inflamm DXs (kelliwilson1 PHARM muscuolskeletal), (Droopyhalo NSG 6005 WEEK 7 Pharmacology), (Shiphie_Philipose MU NURS 615: Advanced Pharm - Chapter 25 Study Guide)

Aspirin (exotrin) ASA
What should you remember? - ANS-1. Most POTENT inhibitor of prostaglandin synthesis
2. Inhibit platelet aggregation 7-10 days (life span)
3. Reye's syndrome (children) chickenpox, influenza, & other viral disorders
4. hypersensitivity prevalent in those with asthma, nasal polyposis, chronic uritcaria
5. tinnitus and dizziness with elevated bl levels
6. caution liver and renal insufficiency
7. NO PREGNANCY cat D (used in infertility and toximia)
8. NO BFing
9. GI ulcer risk↑
10. LOTS of interactions
Acetaminophen (tylenol) APAP
What should you remember? - ANS-1. MAX 3 g/day
2. reduce fever by direct act hypothalamus=(vaso dil, sweating)
3. ETOH limit ≤2 g/day, hepatotoxicity and hepatic failure reported even with therapeutic doses
4. minimal inhibition of protaglandidn synthesis=clinically insignificant antirheumatic or anti-inflammatory
effects
5. NO platelet aggregation, NO affect on prothrombin response, No production of GI ulcer
6. PREG cat B
7. Poisoning=
n/v, confusion, drowsiness, confusion, liver TTP, ↓ BP,
cardiac arrythmias, jaundice, acute hepatic or renal
failure, all occur in ≤ 24 hours
8. Death d/t liver necrosis and renal failure may occur
9. TX gastric lavage withing 4 hours
Ibuprofen (motrin)
What should you remember? - ANS-1. take with food, stay upright 15-30 min
2. block production prostaglandins (↓ BF kidney)
3. 3 or more doses/day, 5 x's/wk = rebound HA & pain
4. reversibly inhibit platelet aggregation, less and of shorter duration than aspirin
5. Preg Cat C...D ≥ 30 wk gestation
6. Do NOT combo with other NSAIDs
7. LABs: LFTs, Renal Fx, CBC
8. 2nd line TX arthritis
Naproxen Sodium (aleve)
What should you know? - ANS-1. may cause GI upset, bl, ulceration, perforation
2. take with food or milk to minimize GI upset
3. Max dose 1g/day
4. BLACK BOX: increased risk serious CV thrombotic event, MI, stroke, which can be fatal
5. Preg Cat C, enters Breastmilk
6. LABs: LFTs, Renal Fx, CBC
Indomethacin (indocen)
CLASS
Indication
BLACK BOX - ANS-NSAIDs
Indication: acute gouty arthritis, acute bursitis/tendonitis/ severe/mod osteoarthritis, rheumatoid arthritis
≡IV form is used as alternative to surgery for closure of patent ductus arteriosus in neonates
≡manage preterm labor
BLACK BOX: increased risk serious CV thrombotic event, MI, stroke, which can be fatal
may increase risk of GI irritation, inflammation, ulceration, bl and perforation
Preg Cat C
Indomethacin (indocen)
Routes
AE
Monitor - ANS-Routes: IV and oral and PR
AE: HA, diziness, depression, fatigue, malaise, somnolence, vertigo, dyspepsia, epigastric pain, heartburn,
indigestion, n/v/c/d, abd pain/cramps/distress, rectal irritation (suppository), tenesmus (suppository)
Monitor: BP and opthalmic eval
COX 1&2
Celecoxib (celebrex)
CLASS
Indication
BLACK BOX - ANS-NSAID
Indication: OA, ankylosing spondylitis, JIA, RA, acute pain, TX primary dysmenorrhea
BLACK BOX: increased risk serious CV thrombotic event, MI, stroke, which can be fatal
may increase risk of GI irritation, inflammation, ulceration, bl and perforation
Contraindicated for TX perioperative pain in the setting of coronary artery bypass graft surgery (GABG)
Preg Cat C
Celecoxib (celebrex)
Routes
AE
Monitor - ANS-Routes:
AE: peripheral edema, dizziness, fever, HA, insomnia, rash, abd pain, n/v/d, dyspepsia, flatulence,
arthralgia, back pain, cough, nasopharyngitis, pharyngitis, rhinitis, sinusitis, URI...less common angina,
chest pain see Black Box
Monitor:LFTs
COX 2
Celecoxib (celebrex)
Drug Interactions - ANS-NO ETOH
Avoid use with herbs possessin anticoagulation antiplatelet properties:
Ginkgo biloba, garlic, gomsemg. gomger + many more
↓ effects of ACEI, angiotensin II receptor blocker, antiplatelet, BBs, Codeine
↓ levels of Celebrex: bile acid sequestrants, P450 inducers
Which of the following is primary COX 1?
1. ASA
2. Motrin
3. Aleve
4. Indocin
5. Celebrex - ANS-ASA
Which of the following is primary Cox 2?
1. ASA
2. Motrin
3. Aleve
4. Indocin
5. Celebrex - ANS-celebrex 

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