Pharmacology of Acetaminophen and NSAIDs
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Questions and Answers

What is the primary site of elimination for NSAIDs?

  • Lungs
  • Liver
  • GI tract
  • Kidneys (correct)

    • What is the minimum duration of activity for naproxen sodium?

  • 12 hours (correct)
  • 6 hours
  • 24 hours
  • 8 hours

    • Which of the following increases the chance of severe stomach bleeding when taking NSAIDs?

  • Taking vitamin supplements
  • Age 40 or older
  • Taking antihistamine drugs
  • Age 60 or older (correct)

    • What can be taken with NSAIDs to alleviate stomach upset?

    <p>Food, milk, or antacids</p> Signup and view all the answers

    What is a common adverse effect of NSAIDs, especially in children?

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

    Which of the following medications may increase the risk of stomach bleeding when taken with NSAIDs?

    <p>Blood thinning (anticoagulant) or steroid drug</p> Signup and view all the answers

    What should be done with enteric coated or sustained release NSAID preparations?

    <p>Neither crush nor chew them</p> Signup and view all the answers

    What is the mechanism of pain relief for NSAIDs?

    <p>Central and peripheral inhibition of cyclooxygenase (COX) and subsequent inhibition of prostaglandin synthesis</p> Signup and view all the answers

    What is the effect of ibuprofen on cardiovascular risk?

    <p>Significant increase in cardiovascular risk</p> Signup and view all the answers

    Which NSAID is considered the preferred, safer option?

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

    What is the mechanism of action of salicylates?

    <p>Inhibition of prostaglandin synthesis from arachidonic acid by inhibiting both COX1 and COX2</p> Signup and view all the answers

    How does urinary pH affect the elimination of salicylic acid?

    <p>Unchanged drug is eliminated more at alkaline pH</p> Signup and view all the answers

    What is the potential interaction between NSAIDs and bisphosphonates?

    <p>Increased risk of esophageal ulceration</p> Signup and view all the answers

    Why should aspirin be taken at least 30 minutes before or 8 hours after ibuprofen?

    <p>To avoid decreased antiplatelet effect of aspirin</p> Signup and view all the answers

    What is the maximum analgesic dosage for self-medication with aspirin?

    <p>4 g/day</p> Signup and view all the answers

    What is the indication of aspirin for high-risk patients?

    <p>Prevention of thromboembolic events</p> Signup and view all the answers

    What is the potential interaction between NSAIDs and digoxin?

    <p>Renal clearance of digoxin inhibited</p> Signup and view all the answers

    How does salicylic acid bind to albumin?

    <p>Concentration-dependent binding</p> Signup and view all the answers

    Why should caution be exercised when using NSAIDs with antihypertensive agents?

    <p>The exact reason is not specified in the content</p> Signup and view all the answers

    What is the potential interaction between NSAIDs and anticoagulants?

    <p>The exact interaction is not specified in the content</p> Signup and view all the answers

    What is the effect of salicylates on pain receptors?

    <p>Decreases the sensitivity of pain receptors</p> Signup and view all the answers

    What is the recommended alternative to ibuprofen when taking aspirin?

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

    What is the potential consequence of concurrent use of NSAIDs and bisphosphonates?

    <p>Increased risk of esophageal ulceration</p> Signup and view all the answers

    What should be monitored when using NSAIDs with digoxin?

    <p>Digoxin levels</p> Signup and view all the answers

    NSAIDs are contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency.

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

    The combination of NSAIDs and bisphosphonates increases the risk of gastrointestinal ulcers.

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

    Taking NSAIDs with antacids can reduce stomach upset.

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

    Concurrent use of NSAIDs and alcohol does not increase the risk of gastrointestinal bleeding.

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

    The risk of severe stomach bleeding when taking NSAIDs is higher for people who have had stomach ulcers or bleeding problems.

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

    NSAIDs can be taken with bisphosphonates without any risk of interaction.

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

    NSAIDs decrease the efficacy of digoxin.

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

    The risk of severe stomach bleeding when taking NSAIDs is higher for people who drink 3 or more alcoholic drinks every day.

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

    The concurrent use of NSAIDs and antihypertensive agents can reduce the efficacy of antihypertensive agents.

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

    NSAIDs can increase the risk of digoxin toxicity.

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

    The concurrent use of NSAIDs and anticoagulants does not increase the risk of bleeding.

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

    Caution should be exercised when using NSAIDs with antihypertensive agents due to the potential for decreased blood pressure control.

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

    NSAIDs can reduce the risk of myocardial infarction and stroke.

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

    NSAIDs can increase the risk of bleeding when taken with anticoagulants.

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

    Salicylates are not effective in treating mild to moderate pain from musculoskeletal conditions.

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

    Aspirin is not indicated for the prevention of thromboembolic events in high-risk patients.

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

    Concomitant use of NSAIDs and bisphosphonates increases the risk of gastrointestinal ulceration.

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

    Acetaminophen is not a recommended alternative to ibuprofen when taking aspirin.

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

    Monitoring of free phenytoin levels is not necessary when using ibuprofen concomitantly.

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

    The renal clearance of digoxin is increased by NSAIDs.

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

    Aspirin should be taken at least 30 minutes before or 2 hours after ibuprofen.

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

    NSAIDs do not interact with antihypertensive agents.

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

    The interaction between NSAIDs and anticoagulants is not clinically significant.

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

    NSAIDs do not increase the risk of gastrointestinal bleeding when used with alcohol.

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

    What is the potential interaction between NSAIDs and bisphosphonates?

    <p>Concurrent use of NSAIDs and bisphosphonates increases the risk of gastrointestinal ulcers.</p> Signup and view all the answers

    What is the potential consequence of concurrent use of NSAIDs and antihypertensive agents?

    <p>The concurrent use of NSAIDs and antihypertensive agents can reduce the efficacy of antihypertensive agents.</p> Signup and view all the answers

    What is the effect of NSAIDs on digoxin?

    <p>NSAIDs can increase the risk of digoxin toxicity.</p> Signup and view all the answers

    What is the potential interaction between NSAIDs and anticoagulants?

    <p>NSAIDs can increase the risk of bleeding when taken with anticoagulants.</p> Signup and view all the answers

    What is the potential consequence of concurrent use of NSAIDs and alcohol?

    <p>The concurrent use of NSAIDs and alcohol increases the risk of gastrointestinal bleeding.</p> Signup and view all the answers

    What is the potential interaction between acetaminophen and warfarin?

    <p>Increased risk of bleeding (elevations in INR).</p> Signup and view all the answers

    What is the potential interaction between acetaminophen and alcohol?

    <p>Increased risk of hepatotoxicity.</p> Signup and view all the answers

    What is the potential interaction between aspirin and valproic acid?

    <p>Displacement from protein binding sites and inhibition of valproic acid metabolism.</p> Signup and view all the answers

    What is the cardiovascular risk associated with nonselective NSAIDs, and how does it vary?

    <p>The cardiovascular risk of nonselective NSAIDs depends on dose and duration.</p> Signup and view all the answers

    Why is naproxen considered the preferred, safer option compared to ibuprofen?

    <p>Naproxen has not been associated with a significant increase in cardiovascular risk, whereas ibuprofen has.</p> Signup and view all the answers

    What is the effect of salicylates on pain receptors, and how do they reduce pain?

    <p>Salicylates reduce the sensitivity of pain receptors to pain impulses at sites of inflammation and trauma by decreasing prostaglandin synthesis.</p> Signup and view all the answers

    What is the potential interaction between NSAIDs and antihypertensive agents, and why is caution necessary?

    <p>The concurrent use of NSAIDs and antihypertensive agents can reduce the efficacy of antihypertensive agents, leading to decreased blood pressure control.</p> Signup and view all the answers

    How do NSAIDs interact with digoxin, and what should be monitored?

    <p>NSAIDs can increase the risk of digoxin toxicity, and digoxin levels should be monitored.</p> Signup and view all the answers

    What is the effect of concurrent use of NSAIDs and anticoagulants, and what is the risk?

    <p>The concurrent use of NSAIDs and anticoagulants increases the risk of bleeding.</p> Signup and view all the answers

    What is the effect of concurrent use of NSAIDs and bisphosphonates, and what is the risk?

    <p>The concurrent use of NSAIDs and bisphosphonates increases the risk of gastrointestinal ulceration.</p> Signup and view all the answers

    What is the effect of concurrent use of NSAIDs and alcohol, and what is the risk?

    <p>The concurrent use of NSAIDs and alcohol increases the risk of gastrointestinal bleeding.</p> Signup and view all the answers

    What is the primary mechanism of action for NSAIDs in relieving pain?

    <p>inhibition of cyclooxygenase (COX) and subsequent inhibition of prostaglandin synthesis</p> Signup and view all the answers

    What is the potential consequence of concurrent use of NSAIDs and bisphosphonates?

    <p>increased risk of gastrointestinal ulcers</p> Signup and view all the answers

    How do NSAIDs interact with antihypertensive agents?

    <p>NSAIDs can reduce the efficacy of antihypertensive agents, leading to decreased blood pressure control</p> Signup and view all the answers

    What is the effect of NSAIDs on digoxin levels?

    <p>NSAIDs can increase the risk of digoxin toxicity</p> Signup and view all the answers

    How do NSAIDs interact with anticoagulants?

    <p>NSAIDs can increase the risk of bleeding when taken with anticoagulants</p> Signup and view all the answers

    What is the effect of concurrent use of NSAIDs and alcohol on the risk of gastrointestinal bleeding?

    <p>The risk of gastrointestinal bleeding is higher when taking NSAIDs with 3 or more alcoholic drinks per day</p> Signup and view all the answers

    What is the potential interaction between NSAIDs and antihypertensive agents?

    <p>NSAIDs can decrease the efficacy of antihypertensive agents, leading to decreased blood pressure control</p> Signup and view all the answers

    What is the effect of NSAIDs on the risk of gastrointestinal bleeding?

    <p>The risk of gastrointestinal bleeding is higher in certain populations, such as those with a history of stomach ulcers or bleeding problems</p> Signup and view all the answers

    Acetaminophen is potentially _______________________ in doses exceeding 4 g/day, especially with chronic use.

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

    NSAIDs relieve pain through central and peripheral inhibition of _______________________ and subsequent inhibition of prostaglandin synthesis.

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

    The combination of NSAIDs and _______________________ increases the risk of gastrointestinal ulcers.

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

    Concurrent use of NSAIDs and _______________________ can reduce the efficacy of antihypertensive agents.

    <p>antihypertensive agents</p> Signup and view all the answers

    NSAIDs can increase the risk of _______________________ when taken with anticoagulants.

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

    The risk of severe stomach bleeding when taking NSAIDs is higher for people who drink 3 or more _______________________ drinks every day.

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

    NSAIDs may cause severe _______________________ bleeding.

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

    The chance of severe stomach bleeding is higher if you are age 60 or _______________________.

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

    The cardiovascular risk of nonselective ______ is depend on dose and duration.

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

    ______ is considered the preferred, safer option among NSAIDs.

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

    The concurrent use of NSAIDs and ______ increases the risk of gastrointestinal ulcers.

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

    NSAIDs can ______ the risk of digoxin toxicity.

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

    Salicylates are absorbed by passive diffusion of the non-ionized drug in the ______ and small intestine.

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

    The concurrent use of NSAIDs and ______ agents can reduce the efficacy of antihypertensive agents.

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

    The concurrent use of NSAIDs and ______ can reduce the efficacy of antihypertensive agents.

    <p>antihypertensive agents</p> Signup and view all the answers

    NSAIDs can increase the risk of ______ when taken with anticoagulants.

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

    NSAIDs can ______ the risk of bleeding when taken with anticoagulants.

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

    The risk of severe stomach bleeding when taking NSAIDs is higher for people who drink ______ or more alcoholic drinks every day.

    <p>3</p> Signup and view all the answers

    The risk of severe stomach bleeding when taking NSAIDs is higher for people who ______ 3 or more alcoholic drinks every day.

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

    NSAIDs can increase the risk of ______ toxicity when taken with digoxin.

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

    Concurrent use of NSAIDs and ______ does not increase the risk of gastrointestinal bleeding.

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

    Acetaminophen is recommended to minimize ______ intake when using acetaminophen.

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

    The concurrent use of NSAIDs and ______ increases the risk of gastrointestinal ulceration.

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

    The concurrent use of aspirin and ______ increases the risk of hepatotoxicity.

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

    Match the following NSAID interactions with their potential consequences:

    <p>NSAIDs and anticoagulants = Increased risk of bleeding NSAIDs and antihypertensive agents = Reduced efficacy of antihypertensive agents NSAIDs and bisphosphonates = Increased risk of gastrointestinal ulceration NSAIDs and digoxin = Increased risk of digoxin toxicity</p> Signup and view all the answers

    Match the following NSAID combinations with their effects:

    <p>NSAIDs and alcohol = Increased risk of gastrointestinal bleeding NSAIDs and bisphosphonates = Increased risk of gastrointestinal ulceration NSAIDs and antihypertensive agents = Decreased blood pressure control NSAIDs and digoxin = Decreased efficacy of digoxin</p> Signup and view all the answers

    Match the following NSAID interactions with their risks:

    <p>NSAIDs and anticoagulants = Risk of bleeding NSAIDs and bisphosphonates = Risk of gastrointestinal ulceration NSAIDs and antihypertensive agents = Risk of decreased blood pressure control NSAIDs and alcohol = Risk of gastrointestinal bleeding</p> Signup and view all the answers

    Match the following NSAID effects with their consequences:

    <p>Increased risk of cardiovascular events = Ibuprofen Increased risk of gastrointestinal bleeding = Concurrent use of NSAIDs and alcohol Decreased efficacy of antihypertensive agents = Concurrent use of NSAIDs and antihypertensive agents Increased risk of digoxin toxicity = Concurrent use of NSAIDs and digoxin</p> Signup and view all the answers

    Match the following NSAID properties with their characteristics:

    <p>Naproxen = Considered a safer option for cardiovascular risk Ibuprofen = Associated with increased cardiovascular risk Aspirin = Indicated for prevention of thromboembolic events in high-risk patients Salicylates = Inhibit prostaglandin synthesis from arachidonic acid</p> Signup and view all the answers

    Match the following NSAID interactions with their management:

    <p>NSAIDs and bisphosphonates = Monitor for gastrointestinal ulceration NSAIDs and anticoagulants = Monitor for bleeding risk NSAIDs and antihypertensive agents = Monitor for decreased blood pressure control NSAIDs and digoxin = Monitor for digoxin toxicity</p> Signup and view all the answers

    Match the following NSAID effects with their indications:

    <p>Prevention of thromboembolic events in high-risk patients = Aspirin Treatment of mild to moderate pain from musculoskeletal conditions = Salicylates Increased risk of cardiovascular events = Ibuprofen Decreased efficacy of digoxin = Concurrent use of NSAIDs and digoxin</p> Signup and view all the answers

    Match the following NSAID interactions with their importance:

    <p>NSAIDs and anticoagulants = Clinically significant NSAIDs and bisphosphonates = Clinically significant NSAIDs and antihypertensive agents = Important for blood pressure control NSAIDs and digoxin = Important for digoxin toxicity monitoring</p> Signup and view all the answers

    Match the following statements with the correct effect of NSAIDs on other medications:

    <p>Increases the risk of bleeding = NSAIDs and Anticoagulants Decreases the efficacy = NSAIDs and Digoxin Increases the risk of gastrointestinal ulceration = NSAIDs and Bisphosphonates Decreases the efficacy of blood pressure control = NSAIDs and Antihypertensive Agents</p> Signup and view all the answers

    Match the following statements with the correct interaction between NSAIDs and other substances:

    <p>Increases the risk of gastrointestinal bleeding = NSAIDs and Alcohol Increases the risk of bleeding = NSAIDs and Anticoagulants Decreases the efficacy of blood pressure control = NSAIDs and Antihypertensive Agents Increases the risk of gastrointestinal ulceration = NSAIDs and Bisphosphonates</p> Signup and view all the answers

    Match the following statements with the correct effect of NSAIDs on gastrointestinal health:

    <p>Causes severe stomach bleeding = Taking NSAIDs with antacids Reduces the risk of gastrointestinal bleeding = Concurrent use of NSAIDs and anticoagulants Increases the risk of gastrointestinal bleeding = Taking NSAIDs with alcohol Decreases the risk of gastrointestinal bleeding = Taking NSAIDs with bisphosphonates</p> Signup and view all the answers

    Match the following statements with the correct effect of NSAIDs on cardiovascular health:

    <p>Increases the risk of myocardial infarction and stroke = NSAIDs and Anticoagulants Decreases the risk of myocardial infarction and stroke = NSAIDs and Antihypertensive Agents Increases the risk of digoxin toxicity = NSAIDs and Digoxin Has no effect on cardiovascular risk = NSAIDs generally</p> Signup and view all the answers

    Match the following statements with the correct effect of NSAIDs on other medications:

    <p>Increases the risk of bleeding = NSAIDs and Anticoagulants Decreases the efficacy of blood pressure control = NSAIDs and Antihypertensive Agents Increases the risk of gastrointestinal ulceration = NSAIDs and Bisphosphonates Has no effect on digoxin levels = NSAIDs and Digoxin</p> Signup and view all the answers

    Match the following statements with the correct effect of NSAIDs on gastrointestinal health:

    <p>Increases the risk of gastrointestinal bleeding = Taking NSAIDs with alcohol Decreases the risk of gastrointestinal bleeding = Taking NSAIDs with bisphosphonates Causes severe stomach bleeding = Taking NSAIDs with antacids Reduces the risk of gastrointestinal bleeding = Concurrent use of NSAIDs and anticoagulants</p> Signup and view all the answers

    Match the following statements with the correct interaction between NSAIDs and other substances:

    <p>Increases the risk of gastrointestinal bleeding = NSAIDs and Bisphosphonates Decreases the efficacy of blood pressure control = NSAIDs and Antihypertensive Agents Increases the risk of bleeding = NSAIDs and Anticoagulants Has no effect on gastrointestinal health = NSAIDs and Digoxin</p> Signup and view all the answers

    Match the following statements with the correct effect of NSAIDs on cardiovascular health:

    <p>Increases the risk of digoxin toxicity = NSAIDs and Digoxin Decreases the risk of myocardial infarction and stroke = NSAIDs and Anticoagulants Has no effect on cardiovascular risk = NSAIDs and Antihypertensive Agents Increases the risk of myocardial infarction and stroke = NSAIDs and Bisphosphonates</p> Signup and view all the answers

    Match the following drug interactions with their potential effects:

    <p>NSAIDs and Anticoagulants = Increased risk of bleeding NSAIDs and Antihypertensive Agents = Reduced efficacy of antihypertensive agents NSAIDs and Bisphosphonates = Increased risk of gastrointestinal ulceration NSAIDs and Digoxin = Increased risk of digoxin toxicity</p> Signup and view all the answers

    Match the following drug interactions with their potential effects:

    <p>Aspirin and Warfarin = Elevations in INR Acetaminophen and Warfarin = Increased risk of hepatotoxicity NSAIDs and Antihypertensive Agents = Decreased blood pressure control Acetaminophen and Alcohol = Increased risk of hepatotoxicity</p> Signup and view all the answers

    Match the following drug interactions with their management/preventive measures:

    <p>Acetaminophen and Warfarin = Monitor INR for several weeks when acetaminophen is added or discontinued Aspirin and Valproic Acid = Avoid concurrent use; use naproxen instead of aspirin NSAIDs and Anticoagulants = Avoid concurrent use if possible; consider use of gastroprotective agents NSAIDs and Bisphosphonates = Avoid concurrent use if possible</p> Signup and view all the answers

    Match the following drug interactions with their potential effects:

    <p>NSAIDs and Digoxin = Increased risk of digoxin toxicity NSAIDs and Antihypertensive Agents = Reduced efficacy of antihypertensive agents NSAIDs and Bisphosphonates = Increased risk of gastrointestinal ulceration NSAIDs and Alcohol = Increased risk of gastroduodenal bleeding</p> Signup and view all the answers

    Match the following drug interactions with their potential effects:

    <p>Aspirin and Valproic Acid = Displacement from protein binding sites and inhibition of valproic acid metabolism NSAIDs and Anticoagulants = Increased risk of bleeding Acetaminophen and Warfarin = Elevations in INR NSAIDs and Bisphosphonates = Increased risk of gastrointestinal ulceration</p> Signup and view all the answers

    Match the following drug interactions with their management/preventive measures:

    <p>NSAIDs and Anticoagulants = Avoid concurrent use if possible; consider use of gastroprotective agents NSAIDs and Antihypertensive Agents = Monitor blood pressure and adjust antihypertensive agents as needed NSAIDs and Bisphosphonates = Avoid concurrent use if possible Acetaminophen and Warfarin = Monitor INR for several weeks when acetaminophen is added or discontinued</p> Signup and view all the answers

    Match the following drug interactions with their potential effects:

    <p>Acetaminophen and Warfarin = Increased risk of hepatotoxicity NSAIDs and Anticoagulants = Increased risk of bleeding NSAIDs and Bisphosphonates = Increased risk of gastrointestinal ulceration NSAIDs and Digoxin = Increased risk of digoxin toxicity</p> Signup and view all the answers

    Match the following drug interactions with their potential effects:

    <p>NSAIDs and Antihypertensive Agents = Decreased blood pressure control NSAIDs and Bisphosphonates = Increased risk of gastrointestinal ulceration NSAIDs and Digoxin = Increased risk of digoxin toxicity NSAIDs and Alcohol = Increased risk of gastroduodenal bleeding</p> Signup and view all the answers

    Study Notes

    Acetaminophen

    • Potentially hepatotoxic in doses exceeding 4 g/day, especially with chronic use
    • Patients with glucose-6-phosphate dehydrogenase deficiency should use caution when taking acetaminophen

    Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

    • Relieve pain through central and peripheral inhibition of cyclooxygenase (COX) and subsequent inhibition of prostaglandin synthesis
    • Rapidly absorbed from the GI tract with high bioavailability
    • Extensively metabolized, mainly by glucuronidation, to inactive compounds in the liver
    • Elimination occurs primarily through the kidneys
    • Onset of activity for naproxen sodium and standard ibuprofen is about 30 minutes
    • Duration of activity for naproxen sodium is up to 12 hours and 6-8 hours for ibuprofen
    • Analgesic, antipyretic, and anti-inflammatory activity
    • Useful in managing mild moderate pain of non-visceral origin

    Adverse Effects of NSAIDs

    • Most frequent adverse effects involve the GI tract and include dyspepsia, heartburn, nausea, anorexia, and epigastric pain
    • Increased risk of severe stomach bleeding, especially in:
      • Those aged 60 or older
      • Those with a history of stomach ulcers or bleeding problems
      • Those taking blood thinning (anticoagulant) or steroid drugs
      • Those taking other drugs containing prescription or nonprescription NSAIDs
      • Those who consume 3 or more alcoholic drinks daily
      • Those who take more or for a longer time than directed

    Cardiovascular Risk of NSAIDs

    • Associated with increased risk for myocardial infarction, heart failure, hypertension, and stroke
    • Cardiovascular risk depends on dose and duration
    • Ibuprofen has been associated with a significant increase in cardiovascular risk, whereas naproxen has not

    Salicylates

    • Inhibit prostaglandin synthesis from arachidonic acid by inhibiting both isoforms of the COX enzyme (COX1 and COX2)
    • Reduce the sensitivity of pain receptors to the initiation of pain impulses at sites of inflammation and trauma
    • Absorbed by passive diffusion of the non-ionized drug in the stomach and small intestine
    • Factors affecting absorption include dosage form, gastric pH, gastric emptying time, dissolution rate, and the presence of antacids or food

    Pharmacokinetics of Salicylates

    • Protein binding is concentration dependent
    • At concentrations lower than 100 mg/mL, approximately 90% of salicylic acid is bound to albumin
    • At concentrations greater than 400 mg/mL, approximately 75% is bound
    • Salicylic acid is largely eliminated through the kidney
    • Urine pH determines the amount of unchanged drug that is eliminated

    Therapeutic Uses of Salicylates

    • Effective in treating mild moderate pain from musculoskeletal conditions and fever
    • Indicated for prevention of thromboembolic events (e.g., myocardial infarction and stroke) in high-risk patients

    Clinically Important Drug-Drug Interactions

    • Ibuprofen decreases the antiplatelet effect of aspirin
    • Ibuprofen displaces phenytoin from protein binding sites
    • NSAIDs increase the risk of GI or esophageal ulceration with bisphosphonates
    • NSAIDs inhibit the renal clearance of digoxin

    Acetaminophen

    • Potentially hepatotoxic in doses exceeding 4 g/day, especially with chronic use
    • Patients with glucose-6-phosphate dehydrogenase deficiency should use caution when taking acetaminophen

    Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

    • Relieve pain through central and peripheral inhibition of cyclooxygenase (COX) and subsequent inhibition of prostaglandin synthesis
    • Rapidly absorbed from the GI tract with high bioavailability
    • Extensively metabolized, mainly by glucuronidation, to inactive compounds in the liver
    • Elimination occurs primarily through the kidneys
    • Onset of activity for naproxen sodium and standard ibuprofen is about 30 minutes
    • Duration of activity for naproxen sodium is up to 12 hours and 6-8 hours for ibuprofen
    • Analgesic, antipyretic, and anti-inflammatory activity
    • Useful in managing mild moderate pain of non-visceral origin

    Adverse Effects of NSAIDs

    • Most frequent adverse effects involve the GI tract and include dyspepsia, heartburn, nausea, anorexia, and epigastric pain
    • Increased risk of severe stomach bleeding, especially in:
      • Those aged 60 or older
      • Those with a history of stomach ulcers or bleeding problems
      • Those taking blood thinning (anticoagulant) or steroid drugs
      • Those taking other drugs containing prescription or nonprescription NSAIDs
      • Those who consume 3 or more alcoholic drinks daily
      • Those who take more or for a longer time than directed

    Cardiovascular Risk of NSAIDs

    • Associated with increased risk for myocardial infarction, heart failure, hypertension, and stroke
    • Cardiovascular risk depends on dose and duration
    • Ibuprofen has been associated with a significant increase in cardiovascular risk, whereas naproxen has not

    Salicylates

    • Inhibit prostaglandin synthesis from arachidonic acid by inhibiting both isoforms of the COX enzyme (COX1 and COX2)
    • Reduce the sensitivity of pain receptors to the initiation of pain impulses at sites of inflammation and trauma
    • Absorbed by passive diffusion of the non-ionized drug in the stomach and small intestine
    • Factors affecting absorption include dosage form, gastric pH, gastric emptying time, dissolution rate, and the presence of antacids or food

    Pharmacokinetics of Salicylates

    • Protein binding is concentration dependent
    • At concentrations lower than 100 mg/mL, approximately 90% of salicylic acid is bound to albumin
    • At concentrations greater than 400 mg/mL, approximately 75% is bound
    • Salicylic acid is largely eliminated through the kidney
    • Urine pH determines the amount of unchanged drug that is eliminated

    Therapeutic Uses of Salicylates

    • Effective in treating mild moderate pain from musculoskeletal conditions and fever
    • Indicated for prevention of thromboembolic events (e.g., myocardial infarction and stroke) in high-risk patients

    Clinically Important Drug-Drug Interactions

    • Ibuprofen decreases the antiplatelet effect of aspirin
    • Ibuprofen displaces phenytoin from protein binding sites
    • NSAIDs increase the risk of GI or esophageal ulceration with bisphosphonates
    • NSAIDs inhibit the renal clearance of digoxin

    Acetaminophen

    • Can be hepatotoxic in doses exceeding 4 g/day, especially with chronic use.
    • Patients with glucose-6-phosphate dehydrogenase deficiency should use caution when taking acetaminophen.

    Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

    • Relieve pain through central and peripheral inhibition of cyclooxygenase (COX) and subsequent inhibition of prostaglandin synthesis.
    • Are rapidly absorbed from the GI tract with high bioavailability.
    • Are extensively metabolized, mainly by glucuronidation, to inactive compounds in the liver.
    • Are eliminated primarily through the kidneys.
    • Have analgesic, antipyretic, and anti-inflammatory activity.
    • Are useful in managing mild to moderate pain of non-visceral origin.

    NSAIDs Adverse Effects

    • Most frequent adverse effects involve the GI tract and include dyspepsia, heartburn, nausea, anorexia, and epigastric pain.
    • May be taken with food, milk, or antacids if upset stomach occurs.
    • Can cause severe stomach bleeding, especially in:
      • Patients aged 60 or older.
      • Those with a history of stomach ulcers or bleeding problems.
      • Those taking blood thinning or steroid drugs.
      • Those taking other drugs containing NSAIDs.
      • Those who consume 3 or more alcoholic drinks daily.

    NSAIDs Cardiovascular Risk

    • Are associated with increased risk of myocardial infarction, heart failure, hypertension, and stroke.
    • Cardiovascular risk depends on dose and duration.
    • Ibuprofen is associated with a significant increase in cardiovascular risk, while naproxen is considered the preferred, safer option.

    Salicylates

    • Inhibit prostaglandin synthesis from arachidonic acid by inhibiting both isoforms of the COX enzyme.
    • Reduce the sensitivity of pain receptors to the initiation of pain impulses at sites of inflammation and trauma.
    • Are absorbed by passive diffusion of the non-ionized drug in the stomach and small intestine.
    • Are effective in treating mild to moderate pain from musculoskeletal conditions and fever.

    Salicylates Pharmacokinetics

    • Protein binding is concentration dependent.
    • Are largely eliminated through the kidney.
    • Urine pH determines the amount of unchanged drug that is eliminated.

    Salicylates Clinical Use

    • Aspirin is also indicated for prevention of thromboembolic events (e.g., myocardial infarction and stroke) in high-risk patients.
    • The maximum analgesic dosage for self-medication with aspirin is 4 g/day.

    Clinically Important Drug-Drug Interactions

    • Acetaminophen and alcohol: avoid concurrent use if possible; minimize alcohol intake when using acetaminophen.
    • Acetaminophen and warfarin: monitor INR for several weeks when acetaminophen is added or discontinued in patients on warfarin.
    • Aspirin and valproic acid: avoid concurrent use; use naproxen instead of aspirin.
    • Aspirin and NSAIDs: avoid concurrent use if possible; consider use of gastroprotective agents (e.g., PPIs).

    Acetaminophen

    • Can be hepatotoxic in doses exceeding 4 g/day, especially with chronic use.
    • Patients with glucose-6-phosphate dehydrogenase deficiency should use caution when taking acetaminophen.

    Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

    • Relieve pain through central and peripheral inhibition of cyclooxygenase (COX) and subsequent inhibition of prostaglandin synthesis.
    • Are rapidly absorbed from the GI tract with high bioavailability.
    • Are extensively metabolized, mainly by glucuronidation, to inactive compounds in the liver.
    • Are eliminated primarily through the kidneys.
    • Have analgesic, antipyretic, and anti-inflammatory activity.
    • Are useful in managing mild to moderate pain of non-visceral origin.

    NSAIDs Adverse Effects

    • Most frequent adverse effects involve the GI tract and include dyspepsia, heartburn, nausea, anorexia, and epigastric pain.
    • May be taken with food, milk, or antacids if upset stomach occurs.
    • Can cause severe stomach bleeding, especially in:
      • Patients aged 60 or older.
      • Those with a history of stomach ulcers or bleeding problems.
      • Those taking blood thinning or steroid drugs.
      • Those taking other drugs containing NSAIDs.
      • Those who consume 3 or more alcoholic drinks daily.

    NSAIDs Cardiovascular Risk

    • Are associated with increased risk of myocardial infarction, heart failure, hypertension, and stroke.
    • Cardiovascular risk depends on dose and duration.
    • Ibuprofen is associated with a significant increase in cardiovascular risk, while naproxen is considered the preferred, safer option.

    Salicylates

    • Inhibit prostaglandin synthesis from arachidonic acid by inhibiting both isoforms of the COX enzyme.
    • Reduce the sensitivity of pain receptors to the initiation of pain impulses at sites of inflammation and trauma.
    • Are absorbed by passive diffusion of the non-ionized drug in the stomach and small intestine.
    • Are effective in treating mild to moderate pain from musculoskeletal conditions and fever.

    Salicylates Pharmacokinetics

    • Protein binding is concentration dependent.
    • Are largely eliminated through the kidney.
    • Urine pH determines the amount of unchanged drug that is eliminated.

    Salicylates Clinical Use

    • Aspirin is also indicated for prevention of thromboembolic events (e.g., myocardial infarction and stroke) in high-risk patients.
    • The maximum analgesic dosage for self-medication with aspirin is 4 g/day.

    Clinically Important Drug-Drug Interactions

    • Acetaminophen and alcohol: avoid concurrent use if possible; minimize alcohol intake when using acetaminophen.
    • Acetaminophen and warfarin: monitor INR for several weeks when acetaminophen is added or discontinued in patients on warfarin.
    • Aspirin and valproic acid: avoid concurrent use; use naproxen instead of aspirin.
    • Aspirin and NSAIDs: avoid concurrent use if possible; consider use of gastroprotective agents (e.g., PPIs).

    Acetaminophen

    • Can be hepatotoxic in doses exceeding 4 g/day, especially with chronic use.
    • Patients with glucose-6-phosphate dehydrogenase deficiency should use caution when taking acetaminophen.

    Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

    • Relieve pain through central and peripheral inhibition of cyclooxygenase (COX) and subsequent inhibition of prostaglandin synthesis.
    • Are rapidly absorbed from the GI tract with high bioavailability.
    • Are extensively metabolized, mainly by glucuronidation, to inactive compounds in the liver.
    • Are eliminated primarily through the kidneys.
    • Have analgesic, antipyretic, and anti-inflammatory activity.
    • Are useful in managing mild to moderate pain of non-visceral origin.

    NSAIDs Adverse Effects

    • Most frequent adverse effects involve the GI tract and include dyspepsia, heartburn, nausea, anorexia, and epigastric pain.
    • May be taken with food, milk, or antacids if upset stomach occurs.
    • Can cause severe stomach bleeding, especially in:
      • Patients aged 60 or older.
      • Those with a history of stomach ulcers or bleeding problems.
      • Those taking blood thinning or steroid drugs.
      • Those taking other drugs containing NSAIDs.
      • Those who consume 3 or more alcoholic drinks daily.

    NSAIDs Cardiovascular Risk

    • Are associated with increased risk of myocardial infarction, heart failure, hypertension, and stroke.
    • Cardiovascular risk depends on dose and duration.
    • Ibuprofen is associated with a significant increase in cardiovascular risk, while naproxen is considered the preferred, safer option.

    Salicylates

    • Inhibit prostaglandin synthesis from arachidonic acid by inhibiting both isoforms of the COX enzyme.
    • Reduce the sensitivity of pain receptors to the initiation of pain impulses at sites of inflammation and trauma.
    • Are absorbed by passive diffusion of the non-ionized drug in the stomach and small intestine.
    • Are effective in treating mild to moderate pain from musculoskeletal conditions and fever.

    Salicylates Pharmacokinetics

    • Protein binding is concentration dependent.
    • Are largely eliminated through the kidney.
    • Urine pH determines the amount of unchanged drug that is eliminated.

    Salicylates Clinical Use

    • Aspirin is also indicated for prevention of thromboembolic events (e.g., myocardial infarction and stroke) in high-risk patients.
    • The maximum analgesic dosage for self-medication with aspirin is 4 g/day.

    Clinically Important Drug-Drug Interactions

    • Acetaminophen and alcohol: avoid concurrent use if possible; minimize alcohol intake when using acetaminophen.
    • Acetaminophen and warfarin: monitor INR for several weeks when acetaminophen is added or discontinued in patients on warfarin.
    • Aspirin and valproic acid: avoid concurrent use; use naproxen instead of aspirin.
    • Aspirin and NSAIDs: avoid concurrent use if possible; consider use of gastroprotective agents (e.g., PPIs).

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    Description

    This quiz covers the potential hepatotoxicity of acetaminophen and precautions for patients with glucose-6-phosphate dehydrogenase deficiency. It also discusses the mechanism of pain relief of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs).

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