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Name the 6 NSAID groups
1. Salicylates
2. Pyrazolones
3. Indoleacetic Acids
4. Propionic Acids
5. Oxicams
6. Fenamates
How is aspirin a unique NSAID?
- acetylates cyclooxygenase irreversibly, NOT reversibly like the other NSAIDs.
What are the 4 main uses of NSAIDs?
1. anti-inflammatory
2. analgesic
3. antipyretic
4. antiplatelet
Name 4 slow-acting anti-rheumatic drugs (SARDS).
1. methotrexate
2. gold salts
3. penicillamine
4. hydroxychloroquine
- OTC analgesic and antipyretic with weak anti-inflammatory properties
- blocks prostaglandin synthesis in CNS, less effect in peripheral tissues
- no effect on platelet function
- CAN be given to gout patients taking probenecid
N-acetylcysteine (Mucomyst)
Given to counteract acetominaphen hepatotoxicity.
How are COX1 and COX2 different?
COX1 is ubiquitous and constitutive, while COX2 is released in response to inflammatory stimuli.
3-4x more potent than aspirin as an analgesic and anti-inflammatory agent, but no antipyretic properties
Aspirin and other salicylates
- anti-inflammatory, analgesic, antipyretic
- uncouples oxphos, so increases CO2 and increases respiration
- increases gastic acid, lowers protective mucus secretion
- inhibits thromboxane production in platelets, leads to poor platelet aggregation
- prostaglandins maintain renal blood flow, so aspirin can lead to interstitial nephritis, edema, hyperkalemia
- DOC in rhematoid arthritis
- facilitates closure of patent ductus arteriosus
What is Reye's syndrome?
Fatal, fulminating hepatitis with cerebral edema. Caused by giving aspirin to kids who are susceptible.
What is salicylism?
- Salicylate toxicity leading to nausea, vomiting, hyperventilation, headache, mental confusion, dizziness, tinnitus
- increasing urinary pH helps eliminate salicylate
Proprionic acid and derivatives
- ibuprofen, naproxen, fenoprofen, ketoprofen, flurbiprofen, oxaprozin
- anti-inflammatory, analgesic, antipyretic effects, used in the chronic treatment of rheumatoid and osteoarthritis due to lighter GI effects
- reversible COX inhibitors
- almost totally bound to serum albumin
Indoleacetic acids
- indomethacin, sulindac, etodolac
- generally not used to lower fever
- potent anti-inflammatory, but not well-tolerated by rheumatoid arthritis pts
- used in acute gouty arthritis, ankylosing spondylitis and to close a patent ductus arteriosus
- an oxicam derivative, mxn unknown
- used to treat rheumatoid arthritis, ankylosing spondylitis, osteoarthritis
- powerful anti-inflammatory with high associated toxicities
- used in short-term treatment of acute gout and acute rheumatoid arthritis
- causes agranulocytosis and aplastic anemia
What is gout?
Associated with high blood levels of uric acid. Characterized by attacks of arthritis and urinary calculi, which are caused by deposits of sodium urate crystals in joints, cartilage and kidneys. Uric acid is the end product of purine metabolism.
How do you treat acute gout vs. chronic gout?
Phenylbutazone (NSAID)
Indomethacin (NSAID)
Colchicine (inhibits neutrophil migration)

Probenecid (renal proc of uric acid)
Allopurinol (blocks steps in uric acid synthesis)
Colchicine (inhibits neutrophil migration)
Sulfinpyrazone (renal proc of uric acid)

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