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enzyme required to produce cascade of events that occur during inflammation cyclo-oxygenase (COX)
synthesized continuously and is present at all times in all tissues and cells COX 1
synthesized mainly in response to pain and inflammation COX 2
mainly COX 1 selective NSAIDs asa, ketoprofen, ansaid, Indocin, feldene, sulindac
slightly COX 1 selective NSAIDs ibuprofen, naproxen, diclofenac
slightly COX 2 selective NSAIDs etodolac (Lodine), Relafen, Mobic (meloxicam)
COX 2 selective NSAIDs Celebrex, vioxx, bextra (both removed from the market d/t increased risk for cardiovascular events
more readily absorbed than naproxen and is used when rapid analgesia is desire naproxen sodium
should not be used in pts with chronic alcoholism tylenol
diclofenac produced in combination with cytoprotective agent misoprostol arthrotec
NSAIDs are pregnancy category B ketoprofen, ibuprofen, diclofenac, indomethacin, medlomen, feldene, sulindac but should be avoided in last trimester
NSAIDs that are pregnancy category C lodine, ansaid, toradol, Relafen, daypro
if used in pregnancy, agents that inhibit prostaglandin synthesis may cause closure of the ductus arteriosus
a single dose of Tylenol; 150 mg/kg in children or 7.5-10 grams may be toxic dose of tylenol
dose of Tylenol that is usually fatal 25 grams
obtain a serum Tylenol assay 4 hours after ingestion, if level is > ?, 90% will have hepatic damage 300mg/m:
antidote for Tylenol toxicity n-acetylcysteine (Mucomyst)
if Tylenol is taken in large doses or regularly the store of ? become depleted and may create hepatic necrosis glutathione, a hepatic conjugate; glucuronidation, the metabolic pathway
NSAID that shows no difference in overall safety and efficacy between older and younger patients Relafen (nambumetone)
if pt with RA would benefit from NSAID but are at increased risk for GI effects recommendations for tx are: low dose prednisone instead of NSAID, nonacetylated salicylate, Celebrex, use NSAID in combo with gastroprotective agent, use low dose aspirin if antiplatelet therapy is indicated
acetaminophen max dose 4 grams
Tylenol provides little benefit when ? is the cause of pain peripheral inflammation
nsaids indicated for gout Indocin, sulindac, ketoprofen
max dose of ibuprofen for mild-moderate pain: 2400mg/day; for oa or ra: 3200mg/day
max dose of naprosyn mild-mod pain: 1250mg/day oa ra: 1500mg/day
propionic acid group short acting ibuprofen, ketoprofen
acetic acid group short acting diclofenac (volatren), indomethacin
fenamic acid group short acting meclofenamate
pyrrolizine carboxylic acid group short acting toradol
pyranocarboxylic acid group short acting etodolac (lodine)
propionic acid group intermediate naproxen, naproxen sodium
acetic acid group intermediate sulindac
propionic acid group long-acting ketoprogen er, oxaprozin (daypro)
oxicams long-acting meloxicam (Mobic), piroxicam (feldene)
naphthylalkanone long acting nabumetone (Relafen)
Created by: heatherbrown2020