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Anes. Pharm I Test 3

NSAIDs

QuestionAnswer
What is the mechanism of action of NSAIDs? inhibits cyclooxygenase (COX) and prostaglandin synthesis pathway that is responsible for mediating information about pain to the brain
Both the COX1 and COX2 pathways convert arachidonic acid to __________ which are implicated in pain, inflammation, cell proliferation, and other key biologic responses prostaglandins
What are 4 problems with COX inhibitors? multiple side effects, frequent allergic reactions, some drugs require daily dosing for efficacy, ceiling effects
As a general rule, COX2 inhibitors have fewer complications and reactions, but more specific ________ effects cardiac
At therapeutic doses, COX2 inhibitors lack the ________ effects found with other NSAIDs like COX1 platelet
The risk of acute MI or CVA increases with prolonged use of which drug class? COX 2
Compared with Cox-1 class, Cox-2 drugs have _________ GI effects decreased
People with asthma and nasal polyps have a higher incidence of allergic reaction to which drugs? aspirin and other NSAIDs
How are NSAIDs metabolized? well absorbed from GI tract in oral doses, then metabolized by CP450 in the liver, 2% is excreted unchanged renally
In what patient populations would you use caution in administering NSAIDs? history of GI bleed, renal injuries/failure, liver disease/failure, bleeding disorders, history of MI (esp. acute)
What is regulated by normal Cox-1 pathway function? GI blood flow, renal system, platelet aggregation, and macrophages
What is regulated by normal Cox-2 pathway function? bronchodilation and vasodilation
What are some side effects of NSAID use? GI toxicity, coagulation issues (cox-1), increased risk for MI (cox 1 & 2), hypertension, renal issues, hepatotoxicity, allergy, triggers bronchoconstriction (cox-2) especially in asthma patients, meningitis, slowed bone healing
How do ACE inhibitors or Beta Blockers affect NSAIDs? reduce effectiveness of NSAIDs
How long should a patient be off of aspirin before surgery? 1 week; if taken during this time frame, get an aspirin platelet function assay
Does aspirin cause histamine release? no
What are 4 major side effects of aspirin therapy? GI tract dysfunction, platelet inhibition, hepatic dysfunction, renal dysfunction
Which NSAID is an excellent anti-inflammatory and analgesic with little to no billiary effects and fewer GI effects? Ketorolac (Toradol)
What is the peak onset time for ketorolac? 45 - 60 minutes IM; 20 - 30 minutes IV
What are some side effects of ketorolac? inhibits platelet production and aggregation (however, in anesthesia does not cause with 1 or 2 doses), bronchospasm, renal toxicity (though less so than other NSAIDs)
In what type of surgery would you want to avoid ketorolac administration? spinal surgery
What is the dose of IV acetaminophen for pain relief? 1 gram IVPB over 15 minutes Q 6
What is the dose of IV acetaminophen for hyperpyrexia? 650 mg IVPB over 15 minutes Q 4-6
Created by: Mary Beth