Pain & Inflammation Part 1.2

Which statement accurately describes the absorption, distribution, metabolism, and excretion of aspirin?

• It is poorly absorbed from the stomach and excreted primarily by the liver.

• It is absorbed from the large intestine, minimally bound to plasma proteins, and excreted in feces.

• It is well absorbed from the stomach and upper small intestine, widely distributed, 50-80% bound to plasma proteins, metabolized in the liver, and excreted by the kidneys (with excretion increased by urine alkalinization).

• It is primarily absorbed through topical application and metabolized in the muscles.

What is the specific mechanism of action of aspirin?

• It reversibly inhibits cyclooxygenase (COX) enzyme.

• It selectively inhibits COX-2.

• It primarily blocks phospholipase A2 (PLA2).

• It irreversibly inhibits cyclooxygenase (COX) enzyme and thromboxane A2 (TXA2).

What dose range of aspirin is used for its anti-platelet/anticoagulant effect for cardiovascular problems?

• 300-600 mg every 6-8 hours.

• 150-300 mg for periodic use.

• In grams for anti-inflammatory effects.

• Low doses (75-150 mg).

What dose range of aspirin provides pain relief and fever reduction by inhibiting prostaglandin synthesis and resetting the hypothalamic thermostat?

• 300-600 mg every 6-8 hours, or 50-100 mg for periodic use.

• Low doses (75-150 mg).

• High doses (in grams).

• Any dose, as its primary effect is anti-inflammatory.

What dose of aspirin is typically needed for its anti-inflammatory effects in conditions like osteoarthritis (OA), rheumatoid arthritis (RA), and rheumatic fever?

• Low doses (75-150 mg).

• 300-600 mg every 6-8 hours.

• Higher doses (in grams, specifically 150-300 mg for periodic use).

• It has no significant anti-inflammatory effect.

Besides inhibiting prostaglandin synthesis, what other anti-inflammatory actions does aspirin have?

• It destabilizes lysosomes and promotes migration of inflammatory cells.

• It primarily blocks COX-2 selectively.

• It stabilizes lysosomes and inhibits migration of inflammatory cells.

• It increases the production of superoxide radicals.

Which of the following are listed as common adverse effects of aspirin?

• Agranulocytosis and aplastic anemia.

• Renal tubular necrosis and hepatic encephalopathy.

• Headache, tinnitus, dizziness, blurred vision, irritability, hyperventilation, and abdominal pain (gastrointestinal irritation).

• Premature closure of the patent ductus arteriosus (PDA).

Which of the following are listed as serious adverse effects of aspirin?

• Diarrhea and abdominal pain (only).

• Renal insufficiency, hyperkalemia, proteinuria, liver function abnormalities (increased AST, ALP), and Reye's syndrome.

• Severe migraine and fluid retention (only).

• Bronchoconstriction and increased vascular permeability.

Aspirin is contraindicated in children with chickenpox or influenza B virus infection due to the significant risk of developing what severe condition?

• Metabolic acidosis.

• Agranulocytosis.

• Liver function abnormalities (increased AST, ALP) without further complication.

• Reye's syndrome (a highly lethal hepatoencephalopathy).

Which of the following drug interactions involving aspirin is highlighted as a concern due to increased toxicity?

• Avoid concurrent use with oral anticoagulants (e.g., warfarin, heparin) and oral hypoglycemics (e.g., metformin) as aspirin can displace them from protein binding.

• It enhances the uricosuric effect of drugs like sulfinpyrazone and probenecid.

• Barbiturates decrease aspirin's analgesic effect.

• Concurrent use with N-acetylcysteine (NAC) enhances aspirin metabolism.