Aspirin, and NSAIDS.txt

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Aspirin, and NSAIDS.txt
2013-10-31 22:33:04

pharm fall 2013
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  1. Indications of ASA
    short or long term symptomatic tx mild to mod pain, inflammation, fever, RA, OA, gout

    Reduces risk of TIAs or stroke in pts with TIAs caused by fibrin platelet emboli

    Reduces risk of MI, acute ischemic strokes and TIAs

    Reduces risk of death or nonfatal MI with previous infarction or unstable angina

    May reduce risk of barretts disease
  2. unlabeled use of ASA
    prevent cataracts

    toxemia in pregnancy

    decreases risk of colorectal cancer

    antiplatelet aggregation
  3. NSAIDS indications
    • OA
    • RA
    • Mild to moderate pain; dental extractions, minor surgery, soft tissue injury
    • primary dysmenorrhea
  4. Unlabeled use of NSAIDS
    tendinitis, bursitis, and migraine
  5. GI bleed may occur with ASA and NSAID without ______?
    prodromal symtoms
  6. Long term use of NSAIDs and salicylates may decrease what disease?

    but not if taking for cardioprotective effects
  7. NSAIDS may be associated with increased risk of?
    • MI
    • stroke
    • adverse cardiovascular events
  8. salicylates and NSAIDs reduce inflammation by
    inhibiting the production of prostaglandins, prostacyclin, and thromboxane in both CNS and peripheral tissue
  9. Salicylates and NSAIDS reduce pain by
    • anti-inflammatory process
    • due to decrease in prostaglandin levels= reduction of inflammation
  10. ASA and antipyretic effects
    blocks interleukin-1 on the hypothalamus which is responsible for temp control.

    causes vasodilation of superficial blood vessel, which dissipates heat
  11. NSAIDs antiplatelet MOA
    block COX-1 and the production of thromboxane

    have reversible inactivation of COX, only good for duration of drug activity. - this is why ASA is used for prevention of MI and stroke
  12. Platelet activation is stimulated by thromboxane which causes _____ and ______?
    aggregation and the clotting cascade
  13. ASA and antiplatelet MOA
    • causes irreversible inactivation of COX
    • decreasing thromboxane for the 8-10 days life of platelet
  14. NSAIDS are under study for decreasing risk of what diseases
    • alzheimers
    • may decrease parkinsons disease
    • reduces risk of colon cancer

    inverse link between NSAIDS and breast cancer
  15. ADRS of ASA  and NSAIDS
    Inhibition of prostaglandins causes more gastric acid production and increased risk of gastric mucosal damage

    damaged kidneys rely on prostaglandins for vasodilation, inhibition decreases blood flow to kidneys
  16. Long term use of NSAIDs and Celecoxib (COX-2 inhibitor) can cause
    renal papillary necrosis, renal insufficiency, acute renal failure, and other renal injuires.

    Pts with impaired renal fx, HF, liver dysfunction; elderly, taking diuretics, ACEIs, and ARBs are at greater risk for this reaction, D/C med and function usually returns to normal.
  17. Patient moderate to severe pain and/or inflammation what is DOC?

    Unless what?
    COX-2 selective NSAID

    unless patient is at risk for HTN and renal disorder.
  18. High doses of NSAIDs may want to consider adding ____ or _____?
    PPI or misoprostol
  19. Cardinal points of tx
    first line tx
    second line tx

    Goal of tx are to ____, _____, and _____.
    • acetaminophen
    • NSAIDs

    limit inflammatory disease process, protect the joint, and relieve pain
  20. First line for moderate pain
  21. Women of child bearing age should not be given _______?
    misoprostol unless appropriate contraception is used.  It can cause baby to be aborted.

    Get a beta HCG before using
  22. All drugs have generic except _____?
    this drug also has _______ properties?

    sulfonamide properties- do not use in patients with sulfa allergy

    This drug has low Gi adverse effects

    This drug should be used cautiously in patients with heart disease
  23. DOC OA
    mild OA- tylenol

    • If tylenol not effective start on NSAID
    • NSAIDs are more effective for OA of knee or hip

    COXZ -2 in elderly for long term tx because of decreased GI effects.
  24. Indomethacin has high risk for adverse reactions such as
    • headache
    • CNS
    • hyperkalemia
    • aggravates epilepsy and parkinsonism

    *short term use only
  25. Patient variables with NSAIDS and ASA use
    medical conditions- renal, hepatic, and cardiovascular diseases- many adverse effects related to NSAID use and these conditions!!!



  26. non pharmalogic treatment of OA
    walking can improve status

    weight loss can reduce strain on joints
  27. RICE
    • rest
    • ice
    • compression
    • elevation
  28. cornerstone of non-pharmolgical tx of mild to moderate pain
    RICE for 24-48 hours
  29. Muscle injuries, do not use NSAIDS for how long?
    24 hours due to effect on platelets

    Ibuprofen then usually given for 1-2 weeks
  30. dysmenorrhea begin NSAIDS when
    24-72 hours before menses

    duration for 2-3 days
  31. What is used to reduce MI and stroke
    • aspirin 325 every other day
    • or aspirin 81 mg daily

    Do not use with NSAIDS decreases cardioprotective effects of Aspirin
  32. Tx for RA

    Rice 24-48 hours of exacerbaton
  33. Leg muscle injury with bleeding use
    ibuprofen for limited time of 1-2 weeks
  34. Monitoring of all drugs for
    gi distress, renal and hepatic fx.

    subjective report of pain relief
  35. Monitoring of Salicylates
    vertigo, tinnitus, or impaired hearing

    serum concentration can be measured
  36. Monitoring of NSAIDS
    short term- acute minor pain relief within an hour

    Long term- baseline CBC with diff, creatinine, UA, K. and LFTs. Baseline and 3 months the every 3-6 months

    follow up with pt weekly for pain relief or early side effects

    pain relief in RA may take up to 2 weeks

    gi bleeding can occur at any time.  monitor cbc, pt, ua, and stool for occult blood.
  37. pain relief in RA using NSAIDS may take how long
    2 weeks
  38. NSAIDs can cause what in elderly
    confusion and renal clearance may be diminished
  39. Be careful with diclofenac in elderly, watch for
    • increasing HTN
    • edema
    • other signs of CHF
  40. Pregnancy and lactation with NSAIDS and Salicylates
    Not recommended, stop prior to delivery r/t increased risk of bleeding.

    • Category C- ibuprofen, naproxen, celecoxib
    • Category D- ASA esp in 3rd trimester
    • Category D- NSAIDS
    • ASA and NSAIDS are excreted in breast milk
  41. Patient education and salicylates and NSAID
    all can cause serious gi bleed, report symptoms and stop drug

    • take med with food or milk
    • may take antacids
    • no ETOH
    • take around the clock for best serum concentration
    • Do not take more than one drug at a time from these classes
  42. Patient education and aspirin
    discard med if have vinegar like odor

    -stop taking 5-10 days before surgery (talk with dr first)

    - can cause asthma exacerbation
  43. Patient education and NSAIDS
    notify provider of SOB, wheezing, dizziness, GI distress, pruritis, or skin rash.

    -stop taking 3 days before surgery (discuss with provider first)
  44. ASA is contradicted with
    asthma and hypersensitivity which can cause bronchospasm, generalized uticaria, and angioedema.

    • children under 16
    • pregnancy in 3rd trimester
  45. Foods that contain salicylates
    Foods that contain salicylates include- curry, paprika, licorice, prunes, raisins, tea, and gherkins.
  46. Long acting aspirin is available and should not be used for _____ or ______?
    fever or short term pain
  47. ASA overdosage is what?
    life threatning
  48. Black box warning of NSAIDS
    for patients with CV disease, GI adverse events, bleeding, ulceration, and perforation
  49. NSAIDS can have ophthalmic effects of
    ophthalmic effects of blurred or diminished vison, scotomata, changes in color vision, corneal deposits, and retinal disturbances.

    Photosensitivity may occur
  50. NSAIDs increase what drugs
    • aminoglycosides
    • anticoagulants (especially celbrex)
    • cyclosporines
    • hydantoin
    • lithium
    • methotrexate
    • ASA
  51. NSAIDS decrease what drugs
    • ACE inhibitors
    • B blockers
    • loop diuretics
    • lithium
  52. ASA decreases what drugs
    NSAIDS, ACEI, BB, loop diuretics, probenecid, sulfinpyrazone, spironolactone
  53. ASA increases what drugs
    • anticoagulants
    • heparin
    • barbonic anhydrase inhibitors
    • NTG
    • valproic acid
    • methotrexate
    • insulin
  54. Fluconazole increases levels of
  55. Salicylates decrease ______ but increase ______?
    • NSAIDS
    • tramadol