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243 FINAL > Pain: Pharm - NSAIDS > Flashcards

Pain: Pharm - NSAIDS Flashcards

1
Q

Pain - NSAIDs

What are NSAIDs used for?

A
  • Analgesic, antipyretic, anti‐inflammatory
  • Used for mild – moderate pain (≤ 4‐6/10)
  • Have been shown to be more effective that
    acetaminophen at full doses
  • No clinically significant difference in efficacy
  • Initial choice: empiric with consideration of patient
    factors
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2
Q

Pain - NSAIDs

What is the MOA of NSAIDs?

A

Cyclooxygenase inhibitors → block PG synthesis

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3
Q

Pain - NSAIDs

Slide 43: MOA of NSAIDs

A

Look at slide 43 picture - MOA of NSAIDs

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4
Q

Pain - NSAIDs

Does all NSAIDs have similar pharmacokinetics (PK)?

A

Yes

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5
Q

Pain - NSAIDs

What are the pharmacokinetics (PK) similarities in all NSAIDs?

A

◦ Rapid & extensive absorption

◦ Highly protein bound

◦ Metabolized by the liver – variable half life

◦ Excreted in urine or bile

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6
Q

Pain - NSAIDs

Does all NSAIDs have similar efficacy?

A

Yes: At equivalent doses

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7
Q

Pain - NSAIDs

What are the 3 common groups of NSAIDs OTC?

A
  1. ASA (Aspirin, Coated Aspirin, Entrophen, generics)
  2. Ibuprofen (Advil, Advil Liqui‐Gels, Motrin, generics)
  3. Naproxen (Aleve, generics)
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8
Q

Pain - NSAIDs

Dosing for ASA?

A

◦ 325‐650mg q4h

◦ 500mg‐1g q6h

◦ Pediatric ‐ avoid

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9
Q

Pain - NSAIDs

Dosing for Ibuprofen?

A

◦ 200–400 mg q4–6h PRN PO

◦ Maximum dose for self‐care: 1200 mg/day

◦ Maximum dose: 2400 mg/day

◦ Pediatric – 10mg/kg/dose

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10
Q

Pain - NSAIDs

Dosing for Naproxen?

A

◦ 220–440 mg Q8–12H PRN PO

◦ Maximum dose for self‐care: 440 mg/day

◦ Use in children 12 years and older

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11
Q

Pain - NSAIDs

What are the adverse Effects in the CNS system?

A

Headaches, tinnitus, and dizziness

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12
Q

Pain - NSAIDs

What are the adverse Effects in the CVS system?

A

Fluid retention, hypertension, edema and rarely, myocardial infarction and congestive heart failure

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13
Q

Pain - NSAIDs

What are the adverse Effects in the GI system?

A

Abdominal pain, dyspepsia, nausea, vomiting & ulcers/bleeding

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14
Q

Pain - NSAIDs

What are the adverse Effects in the Heme system?

A

Rare thrombocytopenia, neutropenia, or even aplastic anemia.

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15
Q

Pain - NSAIDs

What are the adverse Effects in the Hepatic system?

A

Abnormal LFT & rarely liver failure

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16
Q

Pain - NSAIDs

What are the adverse Effects in the Pulm system?

A

Bronchospasm

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17
Q

Pain - NSAIDs

What are the adverse Effects in the Skin system?

A

Rashes & puritus (includes anaphylactoid reactions, SJS & TEN)

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18
Q

Pain - NSAIDs

What are the adverse Effects in the Renel system?

A

Renal insufficiency, renal failure, hyperkalemia, and proteinuria

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19
Q

Pain - NSAIDs

Risk Factors for Serious Adverse Events

Slide 48 - table

A

Look at table on slide 48

20
Q

Pain - NSAIDs

Caution:

A 
◦ Renal dysfunction, solitary kidney CVD/CHF, HTN, 
   asthma, history of Peptic Ulcer Disease (PUD) or 
   Gastrointestinal bleeding (GIB)

◦ Avoid in severe hepatic failure – hepatorenal
syndrome

◦ Pregnancy – 1st trimester  miscarriage & 3rd trimester
premature closure of ductus arteriosus

21
Q

Pain - NSAIDs

Contraindications:

A

◦ ASA sensitive Asthma or hypersensitivity to
NSAID/ASA (bronchospasm, rhinitis, urticaria)

◦ Peri‐op pain post CABG

coronary artery bypass grafting - improved blood flow to heart

22
Q

Pain - NSAIDs

PK - clearance of renally eliminated drugs (Lithium,
digoxin, aminoglycosides, vancomycin)

increase or decrease?

A

decrease

23
Q

Pain - NSAIDs

PD - renal toxicity with ACE‐I & other nephrotoxic drugs
(cyclosporine, methotrexate)

increase or decrease?

A

increase

24
Q

Pain - NSAIDs

PD - effectiveness of antihypertensives

increase or decrease?

A

decrease

25
Q

Pain - NSAIDs

PD - with other potassium sparing drugs (ACE‐I,
spironolactone)

What happen?

A

hyperkalemia

26
Q

Pain - NSAIDs

PD - antiplatelet effect of low dose ASA

increase or decrease?

A

decrease

27
Q

Pain - NSAIDs

PD - risk of bleeding antiplatelet & anticoagulants

increase or decrease?

A

increase

28
Q

Pain - NSAIDs

PD - risk GI AE with smoking, systemic corticosteroids,
LD ASA

increase or decrease?

A

increase

29
Q

Pain - NSAIDs

NSAID monitoring

Slide 51 ???

A 
monitor for
= abdominal discomfort
- hematemesis/melena
- bo
- renal fx and fluid retention
- pain and function
30
Q

Pain - Topical NSAIDs

Can be used to treat ________ conditions.

A

acute musculoskeletal

31
Q

Pain - Topical NSAIDs

Plasma concentrations usually < __% compared to oral administration

A

5%

32
Q

Pain - Topical NSAIDs

Not recommended to use ___ and ___ concurrently

A

topical

oral

33
Q

Pain - Topical NSAIDs

According to Cochrane review 2010:

Adults use Topical NSAIDs to treat _____

A

acute pain from strains, sprains, sports or overuse injuries

34
Q

Pain - Topical NSAIDs

According to Cochrane review 2010:

Most compared NSAID to _____

A

placebo

35
Q

Pain - Topical NSAIDs

According to Cochrane review 2010:

NNT = _____, for for 50% pain relief over a week

A

4.5

36
Q

Pain - Topical NSAIDs

According to Cochrane review 2010:

Few systemic SE or withdrawals due to SE, local SE: 6%

A

Slide 52, sorry don’t know how to put this statement as Q/A!

37
Q

Pain - Topical NSAIDs

Diclofenac 1.16% or 2.32% gel, 1.5% lotion applied TID‐QID (Voltaren Emulgel®)
◦ SE: Skin irritation, hypersensitivity, GI toxicity in
clinical trials

A

Slide 52, sorry don’t know how to put this statement as Q/A!

38
Q

Pain - Topical Analgesics

External analgesics include ___, ___, ___, ___

A

methyl salicylate
menthol
camphor
capsaicin

39
Q

Pain - Topical Analgesics

How often to apply Topical Analgesics?

A

Applied 1‐3x /day

40
Q

Pain - Topical Analgesics

Limited efficacy but may be useful during rehabilitation as ___ or ___ rubs or as accompaniments to massage therapy

Limited evidence for ___

A

cooling

heating

arnica montana (reduce bruising?)

41
Q

Pain - Topical Analgesics

External analgesics should not be applied to acute injuries if there is ___ or if the ___ are open or covered by dressings, since this can further irritate the wound area.

A

bleeding

wounds

42
Q

Pain - Topical Analgesics

External analgesics should not be used concurrently with ___, as burns may result

A

thermotherapy devices

43
Q

Pain - Topical Analgesics

Health Canada Feb 2017: risk of serious skin burns with OTCs containing ___

A

menthol

44
Q

Pain - Muscle Relaxants

Muscle Relaxants is intended to provide pain relief for?

A

when muscle spasm is a component of an acute injury

  • Not recommended first line due to lack of efficacy
45
Q

Pain - Muscle Relaxants

List 2 examples of Muscle Relaxants:

A

methocarbamol

chlorzoxazone

46
Q

Pain - Analgesic Use in Pregnancy and
Breastfeeding

Pregnancy recommendations: (2)

A

◦ Drug of Choice = acetaminophen

◦ Restrict NSAIDs to 2nd trimester (increased risk of
ductus arteriosus after this)

47
Q

Pain - Analgesic Use in Pregnancy and
Breastfeeding

Breastfeeding recommendations: (2)

A

◦ Both NSAIDs and acetaminophen can be used safely

◦ Codeine is CYP2D6 substrate. If mother is ultra‐rapid
metabolizer, can lead to toxic levels in infant when
used while breastfeeding. Avoid If possible
◦ Monitor infant for lethargy, respiratory distress,
poor feeding

243 FINAL (24 decks)

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