NSAIDs and Acetaminophen Review (Aspirin, Ibuprofen, Celecoxib, Acetaminophen)

A set of Question-and-Answer style flashcards covering aspirin, NSAIDs, COX-2 inhibitors, acetaminophen, their mechanisms, risks, interactions, pregnancy considerations, overdose treatments, and pharmacologic vs therapeutic classifications.

What does ASA stand for?

Aspirin.

Why should patients with a history of peptic ulcer disease (PUD) avoid NSAIDs?

Increased risk of GI ulcers and bleeding due to reduced protective prostaglandins from COX inhibition.

Why is ibuprofen a concern after CABG?

Risk of further thrombotic events in the heart.

In early pregnancy, which NSAID can be used and which should be avoided?

Ibuprofen can be used in the first two trimesters; aspirin (salicylates) should be avoided.

What is the prototype COX-2 selective NSAID?

Celecoxib.

Compared with nonselective NSAIDs, what is a key GI difference with celecoxib?

Lower risk of GI bleeding and ulcers.

Which NSAIDs are associated with increased thrombotic risk (MI/stroke)?

Ibuprofen and celecoxib (COX-2 inhibitors).

Which drug reduces the risk of MI and stroke?

Aspirin (salicylates).

What is the mechanism difference between NSAIDs and acetaminophen?

NSAIDs inhibit COX enzymes and reduce inflammation; acetaminophen acts centrally to reduce fever and pain with minimal anti-inflammatory effect.

What is a safety advantage of acetaminophen regarding GI side effects?

There is essentially no risk of GI bleeding or ulcers.

What is the major overdose safety concern with acetaminophen and its antidote?

Hepatotoxicity; antidote is N-acetylcysteine (acetylcysteine).

What factors increase risk of acetaminophen hepatotoxicity?

Chronic alcohol use and chronic kidney disease.

To which pharmacologic class does acetaminophen belong?

Nonopioid analgesic and antipyretic; not an NSAID.

What are the onset and duration for celecoxib?

Onset about 3 hours; duration about 12 hours.

Where is celecoxib primarily excreted?

Predominantly in bile with some renal excretion.

How do NSAIDs affect antihypertensive therapy?

Ibuprofen and celecoxib can reduce the effectiveness of antihypertensives; aspirin generally does not.

Why is celecoxib distribution affected by low albumin?

Celecoxib is highly protein-bound (~97%); low albumin increases free, active drug.

What does SJS stand for and why is it mentioned?

Steven-Johnson syndrome; a potentially life-threatening drug-induced skin reaction.

What is the difference between pharmacologic class and therapeutic class?

Pharmacologic class describes mechanism of action; therapeutic class describes clinical effect/indication.

What is a standard overdose treatment approach for NSAID overdose like ibuprofen?

Gastric lavage with activated charcoal to bind the drug and promote elimination.

How does caffeine interact with acetaminophen?

Caffeine inhibits metabolism, enhancing acetaminophen's analgesic effect.

What is the NSAID generation progression?

First-generation nonselective NSAIDs; second-generation COX-2 selective NSAIDs (e.g., celecoxib).