Introduction Non-steroidal anti-inflammatory drugs (NSAIDS) have the following effects anti-inflammatory antipyretic analgesic antiplatelet Mechanism inhibit the COX (cyclooxygenase) enzymes ultimately inhibiting the synthesis and release of prostaglandins COX enzymes catalyze the formation of prostaglandins and thromboxane from arachidonic acid There are two different COX enzymes targeted COX inhibitors target both COX-1 and COX-2 COX-2 specific inhibitors target COX-2 alone and do not affect COX-1 function Indications pain heterotopic ossfication prophylaxis Contraindications severe renal disease gastric ulcers COX Inhibitors NSAIDS inhibit both COX-1 and COX-2 Aspirin (ASA) salicylate that irreversibly binds a serine COX enzyme residue half life >1 week binds to COX and blocks active site inhibits thromboxane A2 blocking platelet aggregation ibuprofen reversible competitive COX inhibitor indomethacin acts on the lipoxygenase side of the arachidonic metabolic pathway inhibibits leukotriene inflammatory mediators COX-2 Specific Inhibitors Introduction selectively target COX-2 enzymes and do not affect COX-1 function examples celecoxib (Celebrex) rofecoxib (Vioxx) Benefits selective inhibition of COX-2 results in anti-inflammatory action without disrupting the beneficial effects of COX-1 (maintaining gastric mucosa, regulating renal blood flow, influencing platelet aggregation) can be used in the perioperative period because they do not affect platelet function no more efficacious in treating osteoarthritis than non-specific COX inhibitors Side effects cardiac toxicity Side Effects Renal dysfunction Gastrointestinal side effects pain and dyspepsia peptic ulcer perforation, bleeding, or obstruction 2% to 4% occurence in chronic users risk factors concurrent anticoagulant use (most important) age >60 years history of previous gastrointestinal disorder Delayed fracture healing animal fracture models have shown decreased endochondral ossification in the absence of a COX-2 enzyme delayed union and nonunion due to inhibition of chondrogenic differentiation of mesenchymal stem cells inhibit callus formation by inhibiting endochondral ossification secondary bone healing more likely to be effected than primary bone healing Increased risk with prolonged use, large doses, and adult patients no effect demonstrated in pediatric fracture healing Platelet dysfunction Cardiac Toxicity Corticosteroids (Systemic) Steroid Dose Pack efficacy side effects Corticosteroid Intra-articular-Injections Efficacy Side Effects Local flare Fat atrophy Skin pigmentation changes Facial flushing
QUESTIONS 1 of 9 1 2 3 4 5 6 7 8 9 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.142) Which of the following side effects is most strongly associated with the use of NSAIDs? QID: 4777 Type & Select Correct Answer 1 Hepatic dysfunction 3% (151/5082) 2 Renal impairment 94% (4774/5082) 3 Prolonged QTc 1% (45/5082) 4 Seizures 0% (9/5082) 5 Hematuria 2% (78/5082) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ11.47) Which of the following is true regarding the COX-2 enzyme? QID: 3470 Type & Select Correct Answer 1 It regulates normal cellular processes and is the primarily constitutive form of the COX enzymes 7% (162/2193) 2 It decreases prostaglandin production in bone in the presence of certain osteotropic factors 17% (369/2193) 3 It is thought to be necessary for normal endochondral ossification during fracture healing 59% (1295/2193) 4 Inhibition of COX-2 has been definitively shown to impede bone healing in human clinical studies 12% (259/2193) 5 Pharmocologic COX-2 inhibition commonly leads to more gastric irritation than COX-1 inhibition 5% (99/2193) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ10.21) Which of the following is NOT a described complication of corticosteroid injections? QID: 3109 Type & Select Correct Answer 1 Local flare in surrounding tissues 7% (166/2515) 2 Apoptosis of myocytes 50% (1269/2515) 3 Skin pigmentation changes 2% (50/2515) 4 Fat atrophy 4% (96/2515) 5 Facial flushing 37% (925/2515) L 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ10.76) All the following medications binds reversibly to the enzyme COX-1 EXCEPT QID: 3164 Type & Select Correct Answer 1 Meloxicam 13% (427/3346) 2 Diclofenac 3% (87/3346) 3 Indomethacin 3% (111/3346) 4 Naproxen sodium 2% (67/3346) 5 Aspirin 79% (2644/3346) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.206) Arachidonic acid is directly metabolized by which of the following substances? QID: 867 Type & Select Correct Answer 1 Carbonic anhydrase 5% (130/2373) 2 HMG-CoA reductase 7% (155/2373) 3 1-lipoxygenase 5% (124/2373) 4 Cyclooxygenase 78% (1844/2373) 5 Thromboxane synthetase 5% (110/2373) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ05.49) A 45-year-old man is placed on indomethacin for heterotopic ossification prophylaxis following surgery for an acetabular fracture. What is the most likely side effect of this medication? QID: 85 Type & Select Correct Answer 1 Renal failure 9% (75/816) 2 Hepatitis 0% (4/816) 3 Peripheral neuropathy 1% (9/816) 4 Deep vein thrombosis 1% (5/816) 5 Gastrointestinal ulceration 88% (721/816) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos ISTA: New Early-Career Webinar Series 2020 Development of Ibuprofen-Loaded UHMWPE for Orthopaedics Applications: Evaluation of Mechanical and Biological Properties - Izabelle De Mello Gindri Basic Science - Anti-inflammatory Medications B 2/25/2021 23 views 0.0 (0) Basic Science⎪Anti-inflammatory Medications Basic Science - Anti-inflammatory Medications Listen Now 16:59 min 7/21/2020 173 plays 4.0 (1)