NSAIDs

Question 1

how do NSAIDs work

Answer 1

reduce the production of prostaglandins by inhibiting the enzyme cyclo-oxygenase

note: prostaglandins cause inflammation, pain and fever as part of the healing process. inhibiton of COX-2 enzyme associated with less GI side effects

Question 2

which NSAID has the least side effects

Answer 2

ibuprofen

it has the least side effects but its anti-inflammatory properties are weaker than other NSAIDs*

Question 3

name some examples of NSAIDs

Answer 3

• ibuprofen
• naproxen (good efficacy + low incidence of side-effects- but more than ibuprofen)
• diclofenac (similar efficacy to naproxen)

Question 4

why is indometacin not used often even though it is just as effective if not more effective than naproxen

Answer 4

because indometacin has a high incidence of side-effects including headache, dizziness, and gastro-intestinal disturbances

Question 5

what can happen if you overdose on mefenamic acid (an NSAID)

Answer 5

Mefenamic acid has important consequences in overdosage because it can cause convulsions, which if prolonged or recurrent, require treatment

Question 6

what is meloxicam (an NSAID) used for

Answer 6

short-term relief of pain in osteoarthritis and for long-term treatment of rheumatoid arthritis and ankylosing spondylitis.

Question 7

why are NSAIDs preferred for rheumatoid arthritis and in some cases of advanced osteoarthritis compared to paracetamol

Answer 7

paracetamol will give adequate pain control in osteoarthritis but does not have anti-inflammatory effect needed in rheumatoid arthritis + advanced osteoarthritis

note: osteoarthritis is caused by wear + tear of joints whereas rheumatoid arthritis is an autoimmune disease which attacks joint- inflammation occurs here

Question 8

which NSAID has a long duration of action which permits once-daily administration

what is the disadvantage of this NSAID

Answer 8

piroxicam

disadvantage:

• it has more GI side-effects than most other NSAIDs
• is associated with more frequent serious skin reactions.

Question 9

which NSAID is licensed to treat migraine

Answer 9

Tolfenamic acid

note: Naproxen is used for the treatment of acute migraine in combination with sumatriptan, but is not licensed for this indication

Question 10

which two NSAIDs are selective COX-2 inhibitors so are associated with less GI side effects

Answer 10

Celecoxib and etoricoxib

Question 11

what are Celecoxib and etoricoxib (NSAIDs) used for

Answer 11

• pain in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis
• etoricoxib is also licensed for the relief of pain from acute gout

Question 12

why should NSAIDs be avoided in patients with asthma

Answer 12

because NSAIDs can induce asthma/bronchoconstriction

Question 13

which NSAIDs have the highest risk of GI toxicity

Answer 13

piroxicam, ketoprofen, and ketorolac trometamol

Question 14

which NSAIDs have the lowest risk of GI toxicity

Answer 14

• ibuprofen

- cox-2 inhibitors e.g Celecoxib, etoricoxib

Question 15

why should you avoid EXCESSIVE alcohol intake while taking NSAIDs

Answer 15

Alcohol increases the risk of GI haemorrhage associated with NSAIDs

• you do not need to avoid alcohol in moderate drinking, interaction is more likely in those that drink more than the recommended limit

Question 16

what are the contraindications for NSAIDs

Answer 16

• Active or history of GI: bleeding, ulcers, haemorrhage
• severe heart failure
• history of hypersensitivity to aspirin or any other NSAID (this includes exacerbation of asthma)

Question 17

how can long-term use of NSAIDs affect female fertility

Answer 17

long-term use of some NSAIDs is associated with reduced female fertility - reversible on stopping treatment

Question 18

can you use NSAIDs in renal impairment

Answer 18

in general, MHRA advises to avoid where possible but if necessary, use with caution (risk of fluid retention and further renal impairment, including renal failure).