Anti-inflammatory drugs 2
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Questions and Answers

Which adverse effect is commonly associated with anti-inflammatory drugs?

  • Increased appetite
  • Constipation
  • Fatigue
  • Nausea (correct)

    • What is a notable benefit of celecoxib compared to other NSAIDs?

  • Increased GI bleeding risk
  • Enhanced antipyretic effects
  • Less gastrointestinal bleeding and dyspepsia (correct)
  • Higher risk of ulcers

    • Why should patients at high risk of ulcers and requiring aspirin for cardiovascular prevention avoid using celecoxib?

  • It affects cyclooxygenase in the CNS
  • It increases platelet function
  • It elevates the risk of ulcers (correct)
  • It reduces fever

    • What effect does acetaminophen have on platelet function and bleeding time?

    <p>No effect on platelet function or bleeding time</p> Signup and view all the answers

    Why is acetaminophen not considered an NSAID?

    <p>Due to its strong anti-inflammatory activity on peripheral tissues</p> Signup and view all the answers

    Which population would benefit from using acetaminophen over NSAIDs?

    <p>Patients with gastric complaints/risks with NSAIDs</p> Signup and view all the answers

    How soon can a response to methotrexate be observed after starting treatment?

    <p>Within 3 to 6 weeks</p> Signup and view all the answers

    What is a common adverse effect of methotrexate treatment?

    <p>Mucosal ulceration and nausea</p> Signup and view all the answers

    How does supplementation with folic acid impact the tolerability of methotrexate?

    <p>Improves tolerability and reduces GI and hepatic adverse effects</p> Signup and view all the answers

    What is a potential severe adverse effect of hydroxychloroquine mentioned in the text?

    <p>Ocular toxicity, including irreversible retinal damage</p> Signup and view all the answers

    Which organ system is particularly affected by the adverse effects of methotrexate?

    <p>Liver</p> Signup and view all the answers

    What is the recommended frequency for taking methotrexate in the treatment mentioned?

    <p>Once a week</p> Signup and view all the answers

    What is the role of N-acetylcysteine in cases of overdose?

    <p>An antidote</p> Signup and view all the answers

    Which traditional DMARD is generally preferred for mono-therapy in the treatment of RA?

    <p>Methotrexate</p> Signup and view all the answers

    What is the mechanism of action of methotrexate in the treatment of RA?

    <p>Inhibits purine nucleotide biosynthesis</p> Signup and view all the answers

    In patients with inadequate response to monotherapy, what treatment approach may be needed?

    <p>Addition of a TNF inhibitor or non-TNF biologic agent</p> Signup and view all the answers

    What is the primary reason acetaminophen is recommended for children with viral infections or chickenpox?

    <p>To prevent the risk of Reye syndrome associated with aspirin</p> Signup and view all the answers

    What is the mainstay of treatment in patients with rheumatoid or psoriatic arthritis?

    <p>Methotrexate combined with other traditional DMARDs</p> Signup and view all the answers

    How is acetaminophen metabolized in the liver?

    <p>It is hydroxylated to form N-acetyl-p-benzoquinoneimine (NAPQI)</p> Signup and view all the answers

    Why should traditional DMARDs be started as soon as possible following the diagnosis of RA?

    <p>To prevent progression of the disease</p> Signup and view all the answers

    What happens when there are large doses of acetaminophen consumed?

    <p>Hepatic necrosis can occur due to NAPQI reacting with hepatic proteins</p> Signup and view all the answers

    Why should acetaminophen be avoided in patients with severe hepatic impairment?

    <p>It can deplete glutathione and lead to hepatotoxicity</p> Signup and view all the answers

    How are acetaminophen and its metabolites eliminated from the body?

    <p>Excreted in urine</p> Signup and view all the answers

    What is the mechanism by which NAPQI causes liver damage?

    <p>By reacting with sulfhydryl groups and causing hepatotoxicity</p> Signup and view all the answers

    What is the mechanism of action of leflunomide in treating RA?

    <p>Inhibition of dihydroorotate dehydrogenase (DHODH)</p> Signup and view all the answers

    Which adverse effect is NOT commonly associated with leflunomide use?

    <p>Hypertension</p> Signup and view all the answers

    What is a contraindication for the use of leflunomide?

    <p>Liver disease</p> Signup and view all the answers

    Which drug can leflunomide be used in combination with for patients with suboptimal response to monotherapy?

    <p>Methotrexate</p> Signup and view all the answers

    What is the onset of activity for sulfasalazine in treating RA?

    <p>1-3 months</p> Signup and view all the answers

    Which adverse effect is commonly associated with sulfasalazine use?

    <p>Leukopenia</p> Signup and view all the answers

    What adverse effect can occur due to the inhibition of prostaglandin synthesis by NSAIDs in patients with asthma?

    <p>Shift toward leukotriene production</p> Signup and view all the answers

    Which symptom is characteristic of mild salicylate toxicity, also known as salicylism?

    <p>Marked hyperventilation</p> Signup and view all the answers

    What is a common symptom of hypersensitivity reactions experienced by approximately 15% of patients taking aspirin?

    <p>Urticaria</p> Signup and view all the answers

    In patients with severe hypersensitivity to aspirin, what is the recommended action regarding NSAIDs?

    <p>Avoid using NSAIDs</p> Signup and view all the answers

    Which phenomenon can occur when aspirin displaces highly protein-bound drugs like warfarin or phenytoin?

    <p>Increased concentration of free salicylate</p> Signup and view all the answers

    What symptom may manifest in severe salicylate intoxication from large doses of salicylate administration?

    <p>Restlessness and delirium</p> Signup and view all the answers

    What is the primary reason acetaminophen is preferred over aspirin for children with viral infections or chickenpox?

    <p>Acetaminophen has a lower risk of causing Reye syndrome</p> Signup and view all the answers

    Which metabolite of acetaminophen can react with sulfhydryl groups and cause liver damage?

    <p>N-acetyl-p-benzoquinoneimine</p> Signup and view all the answers

    In patients with hepatic disease or a history of alcoholism, what are they at a higher risk of when taking acetaminophen?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What happens when NAPQI reacts with the sulfhydryl groups in the liver at normal therapeutic doses of acetaminophen?

    <p>Glutathione depletion</p> Signup and view all the answers

    Why should acetaminophen be avoided in patients with severe hepatic impairment?

    <p>It can exacerbate liver injury</p> Signup and view all the answers

    How are acetaminophen and its metabolites primarily eliminated from the body?

    <p>Via the kidneys in urine</p> Signup and view all the answers

    Which type of NSAID has been associated with an increased risk for cardiovascular events by decreasing PGI2 production mediated by COX-2?

    <p>Diclofenac</p> Signup and view all the answers

    Why is the use of NSAIDs other than aspirin discouraged in patients with established cardiovascular disease?

    <p>They increase TXA2 production.</p> Signup and view all the answers

    Which NSAID is suggested to be the least harmful for patients with cardiovascular disease when NSAID treatment cannot be avoided?

    <p>Naproxen</p> Signup and view all the answers

    What is the primary reason for the cardiovascular protective effect seen with low doses of aspirin?

    <p>Decrease in TXA2 production</p> Signup and view all the answers

    Which enzyme do NSAIDs inhibit that leads to the suppression of prostaglandin synthesis?

    <p>Cyclooxygenases</p> Signup and view all the answers

    Inhibition of which molecule's production by COX-2 has been associated with an increased risk for cardiovascular events?

    <p>PGI2</p> Signup and view all the answers

    What is the primary role of traditional DMARDs in the treatment of rheumatoid arthritis?

    <p>Prevent further joint destruction</p> Signup and view all the answers

    Which of the following best describes the mechanism of action of methotrexate in treating rheumatoid arthritis?

    <p>Inhibits purine nucleotide biosynthesis</p> Signup and view all the answers

    In patients with inadequate response to methotrexate monotherapy, what treatment approach may be needed?

    <p>Use of TNF inhibitor or non-TNF biologic agent</p> Signup and view all the answers

    What is the mainstay of treatment for patients with rheumatoid or psoriatic arthritis?

    <p>Traditional DMARDs like methotrexate</p> Signup and view all the answers

    What is the recommended initial choice of drug for mono-therapy in treating rheumatoid arthritis?

    <p>Methotrexate</p> Signup and view all the answers

    Which statement best describes the role of NSAIDs in combination therapies for rheumatoid arthritis?

    <p>Mainly used for their anti-inflammatory actions</p> Signup and view all the answers

    How does leflunomide exert its immune-modulatory effects in the treatment of RA?

    <p>Acting on dihydroorotate dehydrogenase</p> Signup and view all the answers

    What is a common adverse effect associated with leflunomide use?

    <p>Hypokalemia</p> Signup and view all the answers

    Why is leflunomide not recommended in patients with liver disease?

    <p>It can be hepatotoxic</p> Signup and view all the answers

    Which enzyme does leflunomide inhibit that is necessary for pyrimidine synthesis?

    <p>Dihydroorotate dehydrogenase</p> Signup and view all the answers

    What monitoring parameters are recommended for patients on leflunomide therapy?

    <p>Liver enzymes</p> Signup and view all the answers

    What is an adverse effect commonly associated with sulfasalazine use in the treatment of RA?

    <p>Anorexia</p> Signup and view all the answers

    What is a potential risk associated with adding aspirin to celecoxib therapy?

    <p>Increased GI bleeding</p> Signup and view all the answers

    Why should patients who have had anaphylactoid reactions to aspirin be cautious when using celecoxib?

    <p>Celecoxib may cause similar effects as aspirin</p> Signup and view all the answers

    How does fluconazole impact the serum levels of celecoxib?

    <p>Increases serum levels</p> Signup and view all the answers

    Why is acetaminophen considered useful for patients with gastric complaints concerning NSAIDs?

    <p>It has weak anti-inflammatory activity</p> Signup and view all the answers

    What is a distinguishing feature of acetaminophen compared to traditional NSAIDs?

    <p>Weak anti-inflammatory activity</p> Signup and view all the answers

    What differentiates the therapeutic use of acetaminophen from traditional NSAIDs?

    <p>Treatment of fever and pain relief</p> Signup and view all the answers

    What is a distinguishing feature of the metabolism of celecoxib as mentioned in the text?

    <p>Requires dose adjustment in renal impairment</p> Signup and view all the answers

    What is the main reason for avoiding NSAIDs like celecoxib in the third trimester of pregnancy?

    <p>Potential closure of the ductus arteriosus in the fetus</p> Signup and view all the answers

    What makes Celecoxib different from aspirin in terms of COX enzyme inhibition?

    <p>Aspirin has irreversible inhibition of COX-1</p> Signup and view all the answers

    What is a significant advantage of Celecoxib over traditional NSAIDs for pain management?

    <p>Minimal effect on renal function</p> Signup and view all the answers

    Why should Celecoxib dosage be adjusted in patients with moderate hepatic impairment?

    <p>Impaired metabolism leading to drug accumulation</p> Signup and view all the answers

    What distinguishes the excretion route of Celecoxib metabolites as mentioned in the text?

    <p>Excreted via biliary excretion</p> Signup and view all the answers

    What is the potential consequence of large doses of acetaminophen leading to depletion of available glutathione in the liver?

    <p>Hepatic necrosis</p> Signup and view all the answers

    Which patient population is specifically mentioned to be at higher risk of acetaminophen-induced hepatotoxicity?

    <p>Patients with hepatic disease or a history of alcoholism</p> Signup and view all the answers

    What is the primary reason for avoiding acetaminophen in patients with severe hepatic impairment?

    <p>Depleted glutathione levels</p> Signup and view all the answers

    Which metabolite of acetaminophen is responsible for causing liver damage by reacting with sulfhydryl groups?

    <p>N-acetyl-pbenzoquinoneimine (NAPQI)</p> Signup and view all the answers

    In cases of acetaminophen overdose, what substance reacts with NAPQI to form a nontoxic product?

    <p>Glutathione</p> Signup and view all the answers

    Which part of the body is particularly affected by large doses of acetaminophen that lead to hepatic necrosis?

    <p>Liver</p> Signup and view all the answers

    What is the primary mechanism of action of methotrexate in the treatment of rheumatoid arthritis?

    <p>Inhibition of purine nucleotide biosynthesis</p> Signup and view all the answers

    What is the mainstay of treatment for patients with rheumatoid or psoriatic arthritis?

    <p>Methotrexate</p> Signup and view all the answers

    What is the mechanism of action of leflunomide in the treatment of rheumatoid arthritis?

    <p>Inhibition of dihydroorotate dehydrogenase (DHODH)</p> Signup and view all the answers

    In patients with suboptimal response to methotrexate monotherapy, what other agents can be added?

    <p>TNF inhibitors</p> Signup and view all the answers

    What is a common adverse effect of leflunomide therapy in patients with rheumatoid arthritis?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is a common adverse effect associated with traditional Disease-Modifying Antirheumatic Drugs?

    <p>Renal toxicity</p> Signup and view all the answers

    Why is leflunomide contraindicated in pregnancy?

    <p>It can lead to fetal harm and birth defects</p> Signup and view all the answers

    Why is mono-therapy with methotrexate generally preferred over other traditional DMARDs?

    <p>Increased safety and efficacy</p> Signup and view all the answers

    Which adverse effect is NOT commonly associated with leflunomide use in rheumatoid arthritis?

    <p>Weight gain</p> Signup and view all the answers

    What is the primary reason for initiating treatment with traditional DMARDs as soon as possible after diagnosing rheumatoid arthritis?

    <p>To reduce joint destruction</p> Signup and view all the answers

    What monitoring parameters are recommended for patients on leflunomide therapy?

    <p>Liver enzymes</p> Signup and view all the answers

    What is the onset of activity for sulfasalazine in treating rheumatoid arthritis?

    <p>1 to 3 months</p> Signup and view all the answers

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