Paper I
2021 May (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Name two selective and two nonselective cyclooxygenase 2 (COX-2) inhibitors. Enumerate four uses of aspirin along with the dose required. Describe the adverse effects and drug interactions of aspirin. (2+2+2)

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Answer

Two selective COX-2 inhibitors: Celecoxib, Etoricoxib Two non-selective COX inhibitors: Aspirin, Ibuprofen

Four uses of aspirin with dose

  • Analgesic-antipyretic: 300–650 mg every 4–6 hours
  • Anti-inflammatory (rheumatic disorders): 3–5 g/day in divided doses
  • Antiplatelet (secondary prevention of MI/stroke): 75–150 mg once daily (low dose)
  • Kawasaki disease: high dose (80–100 mg/kg/day) during acute phase, then low dose

Adverse effects of aspirin

  • Gastric irritation, peptic ulceration, GI bleeding
  • Bronchospasm in aspirin-sensitive asthmatics
  • Reye’s syndrome in children with viral infections
  • Salicylism (tinnitus, vertigo) with chronic high-dose use
  • Bleeding tendency

Drug interactions of aspirin

  • Potentiates warfarin (displaces from protein binding, additive antiplatelet effect) — increased bleeding risk
  • Reduces efficacy of ACE inhibitors and diuretics (inhibits renal prostaglandin-mediated effects)
  • Increases risk of hypoglycaemia with sulfonylureas (protein-binding displacement)
  • Increased methotrexate toxicity (reduces renal clearance)
  • Increased risk of GI bleeding with other NSAIDs/corticosteroids

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