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51 Cards in this Set
- Front
- Back
The enzyme cyclooxygenase is responsible for the synthesis of what substance?
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Prostanoids (prostaglandins & related compounds)
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Name three adverse effects resulting from the inhibition of prostaglandins.
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Gastric erosion & ulceration, bleeding tendencies, renal impairment
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To what chemical family does aspirin belong?
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salicylates
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What is a common name for aspirin?
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Acetylsaicyclic acid
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What abbreviation might you see for aspirin? Note: Abbreviations for medications are strongly discouraged by JCAHO.
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ASA
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Name two sites of absorption of aspirin. How does the use of the rectal route affect the rate and extent of absorption?
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Small intestine
Rectal route – absorbed slowly and blood levels are lower than with oral dosing |
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What is the term used for toxicity aspirin?
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salicylism
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Name five known and usual therapeutic uses for aspirin.
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Suppression of inflammation, analgesia, reduction of fever, dysmenorrheal, suppression of platelet aggregation
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For what types of pain is aspirin most effective?
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Rheumatoid arthritis, osteoarthritis & juvenile arthritis
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Why is aspirin not recommended in children?
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o Reye’s syndrome & use of aspirin by children who have influenza or chickenpox
o ASA should be avoided by children & teenagers suspected of having influenza or chickenpox |
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What effect will aspirin have on normal body temperature?
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Will not lower normal body temperature
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Why is aspirin particularly effective in treating dysmenorrhea?
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Inhibiting prostaglandin synthesis in uterine smooth muscle which relieves cramping
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What would be considered a "low dose" of aspirin to reduce the risk of stroke and MI?
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75 – 81 mg/day
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How likely is aspirin to cause adverse effects when administered short term in analgesic or antipyretic doses?
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Rarely causes serious adverse effects
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When is aspirin toxicity more common?
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When treating inflammatory disorders which require high-dose long-term treatment
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What are the most common gastrointestinal side effects of aspirin?
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Gastric distress, heartburn & nausea
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Although in most cases the amount of blood lost due to GI irritation is insignificant, what may result with chronic aspirin use?
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Cumulative blood loss can result in anemia
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What life threatening adverse effect may occur with long term, high dose therapy?
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Gastric ulceration, perforation & bleeding
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Name 5 factors that might place a person at greater risk of ulceration when taking aspirin.
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o Advanced age
o A history of peptic ulcer disease o Previous intolerance to aspirin or other NSAIDs o Cigarette smoking o History of alcohol abuse |
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When should aspirin be discontinued prior to surgery? Why?
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In order to minimize blood loss during parturition and elective surgery high dose aspirin should be discontinued at least 1 week before surgery
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When may salicylism begin to develop?
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When ASA levels climb just slightly above therapeutic
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Name four overt signs of salicylism.
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Tinnitus, sweating, headache, dizziness
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What action is taken if salicylism develops?
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ASA should be withheld until symptoms subside, therapy should then resume but w/ a small reduction in dosage
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According to recommendations from the CDC (Centers for Disease Control) when should aspirin and other NSAIDs be avoided in children and teenagers?
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Suspected of having influenza or chickenpox
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Why is aspirin classified by the FDA (Food and Drug Administration) as Pregnancy Risk Category D?
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Anemia, postpartum hemorrhage, can prolong labor
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What signs and symptoms might a patient exhibit if having a hypersensitivity reaction to aspirin?
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Profuse watery rhinorrhea and may progress to generalized urticaria, bronchospasm, laryngeal edema & shock
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If taken with aspirin, what drug can increase the risk of gastric bleeding?
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Warfarin & Heparin
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If a person is taking low dose aspirin for prevention of MI or stroke and then uses ibuprofen anytime he has pain, what could be the effect?
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Can reduce the antiplatelet effects of aspirin
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What age patient is at greatest risk for a lethal overdose of aspirin?
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children
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Why did the pharmaceutical industry first produce NSAIDs?
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Wanted to produce drugs with actions similar to Aspirin, Cause reversible inhibition
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What medical conditions does aspirin protect against that might actually be increased with some NSAIDs
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MI & Stroke
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Name two common brand names for ibuprofen
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Advil & Motrin
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Name three actions of Ibuprofen.
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Treat fever, mild to moderate pain & arthritis
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How significant are the side effects of GI bleeding and inhibition of platelet aggregation with ibuprofen?
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less than aspirin
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Identify the five doses of standard tablets for ibuprofen
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o Standard tablets (100, 200, 400, 600 & 800 mg)
o Chewable tablets (50 and 100 mg) o Capsules (200 mg) o A 20 mg/mL oral suspension o A 40 mg/mL oral suspension |
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Name four brand names for naproxen or naproxen sodium.
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Aleve, Anaprox, Naprelan, Naprosyn
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What are the approximate half-lives of naproxen or naproxen sodium? How does that affect the frequency of administration?
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12-17, has a prolonged half-life and cam ne administered less frequently
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How well tolerated are naproxen and naproxen sodium?
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Better tolerated
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How frequently is it recommended that naproxen or naproxen sodium to be given?
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Rheumatoid arthritis – twice daily, mild to moderate pain – q6-8h
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Name two ways acetaminophen is like aspirin and one way it is not like aspirin.
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- Like: analgesic & antipyretic properties
- Unlike: devoid of clinically useful anti-inflammatory and antiheumatic actions |
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Why is acetaminophen effective in treating fever and pain but not in reducing inflammation
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By decreasing prostaglandin synthesis in the CNS it is able to reduce fever/pain but the inability of acetaminophen to inhibit prostaglandin synthesis outside the CNS may explain the absence of anti-inflammatory effects
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Briefly summarize the relationship of the major and minor pathways of metabolism to toxic metabolites and liver damage.
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- Major pathway – acetaminophen undergoes conjugation w/ glucuronic acid & other compounds to form nontoxic metabolites
- Minor pathway – acetaminophen is oxidized by a cytochrome P450-containing enzyme into a highly reactive & toxic compound. - All of the drug is converted to nontoxic compounds via the major pathway |
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How common are adverse effects to acetaminophen at therapeutic doses.
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Extremely rare, does not cause gastric ulceration or renal impairment and doesn’t inhibit platelet aggregation
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What is the benefit of using acetaminophen instead of aspirin for children?
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Lack of association w/ Reye’s syndrome, preferred for use by children suspected of having chickenpox & influenza
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What serious adverse effect is a greater risk when large doses are combined with alcohol consumption?
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Liver injury
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What is the maximum daily dose of acetaminophen recommended by some authorities if a person drinks alcohol on a regular basis?
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Low therapeutic doses
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Even though acetaminophen does not decrease platelet aggregation, what is the suspected reason there is an increased risk of bleeding when combined with warfarin?
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Acetaminophen may inhibit warfarin metabolism, which would cause warfarin levels to rise
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Name two populations of patients where acetaminophen is preferred over aspirin and NSAIDs.
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Patients w/ peptic ulcer disease & patients who have experienced aspirin hypersensitivity reactions
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How does acetaminophen rank among other causes of acute liver failure in the United States?
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Leading cause of acute liver failure, accounting for 50% of all cases
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Name a specific antidote to acetaminophen overdose.
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Hepatic necrosis
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What is significant about the fact that many over the counter products and prescription drugs include acetaminophen?
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- It creates a significant risk of overdose
- Patients who don’t carefully read the labels may well take 2 or more products that contain acetaminophen, thereby exceeding the safe dosage |