Analgesia - APAP, NSAID, Muscle Relaxant Flashcards Preview

Clinical Pharmacology > Analgesia - APAP, NSAID, Muscle Relaxant > Flashcards

Flashcards in Analgesia - APAP, NSAID, Muscle Relaxant Deck (39)
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1

NSAID Families

1. Carboxylic Acids
2. Propionic Acids
3. Acetic Acid Derivatives
4. Enolic Acids
5. Fenamates
6. Napthylkanones

Paxton: start with Ibuprofen or Naproxen --> enolic acids --> acetic acid

2

NSAIDs MOA?

Inhibit COX1 +/- COX2

1 - regulates most normal cellular processes
2 - expressed during inflammation

Reversibly bind platelets, except ASA

3

What conditions are NSAIDs indicated?

1. Analgesia
2. Antipyretic
3. Dysmenorrhea
4. Anti-inflammatory (rheum conditions)

4

Who are NSAIDs contraindicated in?

Recent CABG
Pregnancy

5

NSAIDs are pregnancy category ___ because?

Category C

- early: miscarriage
- later: fetal renal dysfunction, premature closure of PDA

6

General side effects/ risks of NSAIDs?

1. GI, CV, Renal
2. Caution w/HTN, HF, CKD, asthma
3. May precipitate asthma and anaphylactoid reaction in ASA-sensitive pt (not IgE-mediated)

7

Describe the GI side effects related to NSAIDs?

- Dyspepsia/gastritis & ulceration/perforation*
- INC r/o GI bleed w/anti-plt, EtOH, steroids
- may exacerbate IBD

8

Describe the CV side effects related to NSAIDs?

- r/o thrombosis [BBW INC r/o CV events]
- d/c ALL (except ASA) in AMI pt
- caution w/warfarin
- reversible plt dysfunction --> INC bleeding time
- may interfere w/anti-plt effect of ASA (try other analgesics first)

9

Describe the renal side effects related to NSAIDs?

- DEC efficacy of diuretics (loops/thiazides & ACE/ARB) --> AKI risk
- INC [Li]
- nephrotoxicity: fluid retention, AIN, ATN

10

Who must you avoid NSAIDs in?

Pt with high GI and CV risk

11

Your elderly patient is on diuretics and ACE/ARB. You need to start him on NSAIDs now too. What must you monitor?

Monitor renal function and serum K within 7 days of starting the NSAID

12

Recognize Carboxylic Acids

1. ASA*
2. Salsalate
3. Diflunisal
4. Choline Mag Trisalicylate

13

Recognize Propionic Acids

1. Ibuprofen*
2. Naproxen*
3. Fenoprofen
4. Ketoprofen
5. Flurbiprofen
6. Oxaprozin

14

Recognize Acetic Acid Derivatives

1. Indomethacin*
2. Diclofenac*
3. Ketorolac*
4. Sulindac
5. Etodolac
6. Tolmetin

15

Recognize Enolic Acids

1. Piroxicam (better CV, worse GI)
2. Meloxicam (worse CV, better GI)

16

Which NSAID is safest for breastfeeding women? It also has low GI toxicity.

Ibuprofen

17

Which NSAID is safest in terms of CV toxicity?

Naproxen

18

Which propionic acid has more GI toxicity, ibuprofen or naproxen?

Naproxen

19

Which acetic acid is used for PDA closure? Give it to the baby, but don't give to pregnant women!

Indomethacin (IV for PDA closure)

20

What are two side effects of Indomethacin?

- worst GI toxicity
- high r/o thrombosis

21

Acetaminophen max dose

-1,000 mg/dose
-4g/day

22

Acetaminophen indications

-Antipyresis
-Mild-mod pain --> IV APAP more robust that PO

23

Acetaminophen MOA

-Not clear
-Analgesia: Inhibit NO pathway mediated by certain NTs
-Antipyretic: inhibits endogenous pyrogens

24

Acetaminophen ADRs

-Hepatotoxicity (inc glutathione--> acetylimidoquinone)

->3 drinks/day + APAP
->4g/day (50% unintentional, iatrogenic)
-Additive effect if given with =/> 1 hepatotoxic med (INH, etc)

25

Acetaminophen Hepatotox tx

Acetylcysteine- given within 8-10 hr of OD

26

Acetaminophen and Pregnancy

-Category C
-Occasional use is fine for mild-mod pain

27

Prescribing APAP

-put max tabs/day in sig to help keep patients from going over 4g/day

28

Cyclobrenzapine

-MOA: near identical to amitriptyline

-Indications: SHORT-TERM (2-3 wks) muscle spasms--> has most evidence for efficacy

-Interactions: death with CNS depressants, don't give 14d of MAOI, seizure reported with tramadol

-CI in pts with arrhythmia, AMI, HF

-ADRs: sedation, dizziness, xerostomia quinidine-like effect (QT-prolongation)**

29

Carisoprodol

-MOA: unknown

-Indication: don't use according to MISTER Paxton

-Schedule IV drug

-Interactions: additive sedation with CNS depressants

-ADRs: dizziness/sedation, transient quadriplegia, temporary loss of vision**

30

Baclofen

-Indications: SC injury/MS

-Withdrawal sx or worsening spasticity if not tapered over 2 wks