What are 3 funtions of the COX1 enzyme?
Gastric protection, maintenance of renal function and platelet aggregation.
What are six functions of the COX-2 enzyme?
Inflammation, pain, fever, promotion of colon cancer, maintenance of renal function, vasodilation.
Give one benefit of inhibiting COX-1
Prevention of platelet aggregation
List four benefits of inhibiting COX-2
Suppress inflammation, relieve pain, reduce fever, reduce risk of colorectal cancer.
Inhibiting cyclooxygenase (COX) interferes with the production of what?
Prostaglandins
Name two COX inhibitors that do not suppress inflammation.
Tylenol, and Ketorolac (Torodol)
Give three adverse effects of inhibiting COX-1
Gastric ulceration, renal impairment, bleeding (Except Tylenol)
Name Three adverse effects of selective COX-2 inhibitors other than gastric ulceration and bleeding.
Renal impairment, vasoconstriction, increased risk of MI and stroke
Which COX inhibitor has an irreversible action?
Acetylsalicylic acid (Aspirin)
What syndrome can occur with the administration of aspirin to children who have chickenpox or influenza?
Reye's syndrome
How long does aspirin suppress platelet aggregation?
8 days
Should aspirin be recommended to pregnant Women?
No ... detrimental to mother and fetus
Give four signs of early salicylism.
Tinnitus, dizziness, sweating, headache
List three conditions which increase the risk of hypersensitivity with salicylates.
Asthma, allergic rhinitis, nasal polyps
Acute poisoning with salicylate begins with what breathing pattern.
Hyperventilation
How does ibuprofen (Motrin, Advil) alter the action of aspirin?
Blocks ASA access to COX-1 receptors on platelets, preventing ASA from inhibiting platelet aggregation. Give ibuprofen 2 hours after aspirin.
Which NSAID decreases the risk of MI and Stroke? Which NSAID does not increase the risk of MI and stroke? Which NSAIDs increase the risk of MI and stroke? Which has the highest risk of MI and stroke?
1) aspirin 2) Acetaminophen (Tylenol) 3)First genration NSAIDs (not including aspirin) & Celebrex. 5) Celecoxib (Celebrex).
An allergy to what class of drugs is contraindicated for celecoxib (Celebrex)?
Sulfonamides
Where does inhibition of prostaglandins occur with acetaminophen (Tylenol)?
CNS, no anti-inflammatory effects.
What pathway can create toxic metabolites when metabolizing large amounts of Tylenol?
Minor pathway
What is the maximum recommended dosage of Tylenol per day for nondrinkers? Patients who drink or have liver disease? Patients which malnutrition?
4 g per day. 2 g per day for drinkers or liver disease. 3 g per day for patients with malnutrition
What drug is given for Tylenol toxicity?
Acetylcysteine
Why does alcohol increase the likelihood of Tylenol toxicity?
It induces the minor pathway and alcoholics have depleted glutathione stores.
How long before surgery should NSAIDs be stopped?
1 week or 5 half lives
Which drugs increase the risk of stroke and myocardial infarction?
First-generation COX inhibitors, not including aspirin or acetaminophen second-generation COX inhibitors.
Name two drug categories that should be avoided with triptans and why?
SSRIs, SNRIs or other triptans. Increased risk for serotonin syndrome.
How does 5-HT activation reduce the symptoms of migraines?
Causes vasoconstriction of cranial blood vessels and suppresses release of pro-inflammatory neuropeptides.
What are major contraindication or cautions for the use of sumatriptan (imitrex)?
Cardiovascular and cerebrovascular disorders (May vasospasm)
When should sumatriptan (Imitrex) be taken.
At the first sign of a headache