Pharmacology of NSAIDs and Misoprostol
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Questions and Answers

What is an indication for administering aspirin?

  • Reducing inflammation in arthritis
  • Pain relief from headaches
  • Treating systemic lupus erythematosus
  • Prophylactic therapy for myocardial infarction (correct)

    • Which of the following is NOT an adverse effect of NSAIDs?

  • Gastrointestinal bleeding
  • Bronchospasm (correct)
  • Increased risk of myocardial infarction
  • Acute renal failure

    • What is the recommended daily dosage of aspirin for high-risk adults in thromboprevention?

  • 81 mg or 325 mg (correct)
  • 50 mg
  • 400 mg
  • 100 mg

    • What condition can lead to renal toxicity when using NSAIDs?

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

    Which prostaglandin analogue is known to prevent gastrointestinal bleeding in patients taking NSAIDs?

    <p>Misoprostol (Cytotec)</p> Signup and view all the answers

    What is a common symptom of salicylate toxicity?

    <p>Nausea and vomiting</p> Signup and view all the answers

    In what situation might NSAIDs be contraindicated?

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

    Which of the following statements regarding aspirin is true?

    <p>Aspirin is the only NSAID without cardiovascular risk warnings.</p> Signup and view all the answers

    What benefit does aspirin provide after a myocardial infarction (MI)?

    <p>Reduces cardiac death</p> Signup and view all the answers

    Which of the following symptoms is NOT associated with salicylate toxicity?

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

    Which statement accurately describes the use of NSAIDs?

    <p>They can relieve mild to moderate headaches.</p> Signup and view all the answers

    What is a common adverse effect of acetylsalicylic acid?

    <p>Gastric ulcers</p> Signup and view all the answers

    What is the mechanism by which aspirin helps reduce thromboxane A2?

    <p>It irreversibly inhibits COX-1 enzyme.</p> Signup and view all the answers

    When should aspirin be administered for maximum effectiveness during a myocardial infarction?

    <p>At the first sign of an MI</p> Signup and view all the answers

    Which type of NSAID is aspirin classified as?

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

    Which is NOT a recommended dosage guideline for aspirin use?

    <p>High doses for immediate pain relief</p> Signup and view all the answers

    Which condition is most strongly associated with the administration of salicylate therapy during a viral illness?

    <p>Reye's syndrome</p> Signup and view all the answers

    What symptom is NOT typically associated with salicylate toxicity?

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

    What is a key use of Ketorolac (Toradol)?

    <p>Short-term relief of moderate to severe pain</p> Signup and view all the answers

    Which of the following adverse effects is most commonly associated with acetylsalicylic acid (aspirin)?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is one of the key reasons Ketorolac (Toradol) is administered for no longer than 5 days?

    <p>Renal impairment and GI effects</p> Signup and view all the answers

    Which medication is considered a propionic acid derivative?

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

    What is a common action of salicylic acid (aspirin) on the body?

    <p>Inhibits platelet aggregation</p> Signup and view all the answers

    Which of the following represents a common adverse effect of naproxen?

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

    Study Notes

    NSAIDs: Contraindications

    • NSAIDs are contraindicated in patients with a known drug allergy.
    • NSAIDs are contraindicated in combination with glucosamine.
    • NSAIDs are contraindicated in patients with vitamin K deficiency.
    • NSAIDs are contraindicated in patients with peptic ulcer disease.

    NSAIDs: Adverse Effects

    • NSAIDs can cause a range of gastrointestinal effects from heartburn to severe gastrointestinal bleeding.
    • NSAIDs can lead to acute renal failure.
    • NSAIDs can alter hemostasis.
    • NSAIDs can cause hepatotoxicity, skin reactions, tinnitus, and hearing loss.
    • NSAIDs increase the risk of myocardial infarction (MI) and stroke.

    Misoprostol (Cytotec)

    • Misoprostol prevents gastrointestinal bleeding.
    • Misoprostol is a synthetic prostaglandin E1 analogue.
    • The mechanism of action of misoprostol is unclear.
    • Misoprostol inhibits gastric acid secretion.

    NSAIDs and Renal Function

    • Renal function depends on prostaglandins.
    • NSAIDs can disrupt prostaglandin function.
    • NSAIDs can compromise existing renal function.
    • Renal toxicity can occur in patients with dehydration, heart failure, liver dysfunction, or use of diuretics or ACE inhibitors.

    NSAIDs: Black Box Warning

    • There is increased risk of adverse cardiovascular thrombotic events with NSAIDs.
    • This risk includes fatal myocardial infarction (MI) and stroke.
    • Aspirin is the only NSAID without this black box warning.

    Aspirin Dosage

    • The prophylactic dose of aspirin for adults with high risk factors is a daily tablet (81 mg or 325 mg).
    • Aspirin is effective after myocardial infarction (MI).
    • Aspirin is effective in preventing thrombotic events
    • 81- and 325-mg strengths of aspirin are equally beneficial for preventing thrombotic events.

    Aspirin: Uses

    • Aspirin is used for headaches, neuralgia, myalgia, and arthralgia.
    • Aspirin is used for inflammation such as arthritis, pleurisy, and pericarditis.
    • Aspirin is used for systemic lupus to provide antirheumatic effects.
    • Aspirin is used to reduce fever (antipyretic).

    Inflammation

    • Inflammation is a protective response to injury to tissues.
    • The signs and symptoms of inflammation include pain, fever, loss of function, redness, and swelling.
    • Endogenous compounds including proteins of the complement system, histamine, serotonin, bradykinin, leukotrienes, and prostaglandins contribute to inflammation.

    Nonsteroidal Antiinflammatory Drugs (NSAIDs)

    • NSAIDs are a chemically diverse group of drugs.
    • NSAIDs have analgesic, antiinflammatory, antipyretic, and aspirin-platelet inhibition properties.

    Uses of NSAIDs

    • NSAIDs are used to relieve mild to moderate headaches.
    • NSAIDs are used to relieve muscle pain (myalgia).
    • NSAIDs are used to alleviate postoperative pain.

    Properties of NSAIDs

    • NSAIDs share antipyretic, analgesic, and antiinflammatory properties.

    Salicylates

    • Salicylates include Aspirin, Diflunisal, Salsalate, and Choline salicylate.

    Acetic Acid Derivatives

    • Acetic acid derivatives include Diclofenac Sodium (Voltaren), Indomethacin (Indocin), and Ketorolac (Toradol).

    Propionic Acid Derivatives

    • Propionic acid derivatives include Fenoprofen (Nalfon), Flurbiprofen (Ansaid), Ibuprofen (Motrin, Advil), Ketoprofen (Orudis KT), and Naproxen (Naprosyn, Aleve).

    Aspirin Benefits

    • Aspirin reduces cardiac death after myocardial infarction (MI).
    • Aspirin should be administer at the first sign of myocardial infarction (MI).
    • Aspirin is one of the first drugs given in the emergency department if no contraindications exist.

    NSAIDs: Mechanism of Action

    • NSAIDs inhibit the leukotriene pathway, prostaglandin pathway, or both.
    • NSAIDs block the chemical activity of enzyme COX.
    • COX-1 plays a role in maintaining GI mucosa.
    • COX-2 is another type of COX enzyme.

    Aspirin Mechanism

    • Aspirin is an irreversible inhibitor of COX-1 receptors in platelets.
    • As an irreversible inhibitor, aspirin reduces the formation of thromboxane A2, which promotes platelet aggregation.
    • Other NSAIDs lack the antiplatelet effects of aspirin.

    Aspirin: Reye's Syndrome

    • Reye's syndrome is a potentially life-threatening condition involving progressive neurologic deficits.
    • Reye's syndrome is triggered by viral illnesses such as influenza.
    • Reye's syndrome is triggered by salicylate therapy itself in the presence of a viral illness.
    • Survivors of Reye's syndrome may or may not have permanent neurologic damage.

    Salicylates

    • Salicylic acid (aspirin) inhibits platelet aggregation.
    • Salicylic acid has an antithrombotic effect and is used in the treatment of myocardial infarction (MI) and other thromboembolic disorders.
    • Salicylates can cause Reye's syndrome.

    Salicylates - Tylenol

    • Overdose of salicylates can cause salicylism.
    • Signs of Salicylism include increased heart rate, hyperventilation, drowsiness, tinnitus, hearing loss, dimness of vision, headache, dizziness, and mental confusion.
    • Acetylcysteine (Mucomyst) is an antidote for salicylate overdose.

    Acetic Acid Derivatives: Indomethacin

    • Indomethacin has uses for rheumatoid arthritis, osteoarthritis, acute bursitis or tendonitis, ankylosing spondylitis, acute gouty arthritis, pericarditis, and treatment of preterm labor.
    • Indomethacin is available for oral, rectal, and intravenous use.
    • The biggest adverse effect of indomethacin is nausea and vomiting.

    Acetic Acid Derivatives: Ketorolac

    • Ketorolac (Toradol) has antiinflammatory activity.
    • Ketorolac has powerful analgesic effects comparable to morphine.
    • Ketorolac is indicated for short-term use (up to 5 days) for moderate to severe acute pain.
    • Ketorolac can cause renal impairment, edema, gastrointestinal pain, dyspepsia, and nausea.

    Propionic Acid Derivatives

    • Ibuprofen is the most commonly used NSAID.
    • Naproxen is the second most commonly used NSAID.
    • Naproxen has a better adverse effect profile than ibuprofen.
    • Naproxen has fewer drug interactions with ACE inhibitors.

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    Description

    This quiz covers the contraindications and adverse effects associated with nonsteroidal anti-inflammatory drugs (NSAIDs), as well as the role of misoprostol in preventing gastrointestinal bleeding. It emphasizes the importance of renal function and associated risks when using these medications. Test your knowledge on these vital pharmacological aspects now!

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