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COX catalyzes what from what?
synthesis of prostaglandins from arachidonic acid
Where are is COX-1 found?
- gastric mucosa- mucosal integrity
- platelets- aggregation
- renal parenchyma- function
COX-2 is a ____ _______ enzyme. It mediates __________, ____, _____, and ___________. its' released in response to ____, _______, ____
- pain inducing
- inflammation, pain, fever, carcinogensis
- Injury, illness, diet
T or F: NSAIDS are one the most widely used drugs in the US?
What are 4 properties of NSAIDS?
- platelet inhibition
What is the mechanism of action for NSAIDS:
T or F: NSAIDS have a ceiling effect, but can decrease narcotic use up to 50%
T or F: NSAIDS are well absorbed from the GI tract?
Have limited first pass hepatic excretion?
Are highly protein bound?
have a low pK? (3-5)
T for all
Low pK of NSAIDS make them good for _____ and ____________ areas.
Hepatocellular injury is most severe with what NSAID?
Asthma exacerbation usually caused by which NSAID?
Aspirin- due to allergy
Ketoralac can inhibit what?
NSAIDS are __________ with opioids
What systems see the adverse fx of NSAIDS?
Which NSAIDS are nonspecific, inhibiting both COX-1 and COX-2? INAAK
when should you stop taking aspirin before surgery? Why?
- 7-10 days
- allow platelets recovery, normal coag (fx last life of platelet)
ASA causes ____________ acetylation of COX enzyme. It is _______ ___________ by the GI tract. It can be _________ to prevent GI side fx, and can cause _______ __________
- rapidly absorbed
- platelet dysfunction
What are the clinical uses for ASA?
- analgesic (low intensity pain)
- antiplt function (even at low does)
what are the side effects of ASA?
- GI, prolonged bleeding time- PT, aspirin induced asthma
- CNS tox
- minimal renal
- hemorrhage with labor
- Reye's syndrome
What are the uses for Acetominophen?
- analgesic (mild to mod pain)
- NOT antiinflammatory
- *** alternate for aspirin in pt's with GI problems and Peds (no Reye's or plt fx)
A sickle cell patient can take __________ safely.
what are the side effects of Tylenol and what is the max dose?
- renal and hepatic
- 4g/24 hours
Ketorolac is a _________ analgesic. it also has ________ antiinflammatory fx. what is the dose? What are the side effects?
- 30mg /6 hr up to 72 hours (can give up to 60)
- 0.5mg/kg for kids (q 6 hrs)
- bleeding fx, bone growth inhibition. not for vasc cases
what two nsaids are used for gout?
Which COX-2 inhibitor, still used today, is very potent?
Cox-2 production ________ with increased saturated fat intake. High Cox-2 seen with what dz states?
- Alz, cancer, kidney dz, osteoporosis, rheumatic and osteoarthritis