NSAID DRUGS Flashcards
What are the 3 principle classes of drugs used for pain relief?
- Non-narcotics - Paracetamol
- Narcotics - opioid
- Non-steroidal anti-inflammatory (NSAIDs)
- Neuropathic agents
What other aspects of the medical history would you require from the patient before prescribing a NSAID?
- Asthma
- Co-morbidities - heart failure, Renal disease, hepatic cirrhosis
- Allergies
How does aspirin differ from other NSAIDs? What additional effects does it have in CVD & what is the mechanism of its action?
The only NSAID to IRREVERSIBLY inhibit cyclooxygenease activity by acetylation.
Has an anti-thrombotic effect a_t low dos_e> reduce risk of CVD & MI
What other aspects of the medical history would you require from the patient before prescribing a NSAID?
Asthma
Co-morbidities - heart failure, Renal disease, hepatic cirrhosis
Allergies
what should be done if NSAIDS r used for those with high risk of GI events?
PPI or misprostol should be given as well to prevent NSAIDS-induces ULCERS
NSAIDS
- LIST ONLY therapeutic uses?
- contraindications?
Appreciate the mechanism of action of NSAID as:
asanalgesics, anti-inflammatory and antipyretics
Anti-inflammatory
COX inhbition diminshes formation of PG (which act as inflammatory mediators) & inhibit inflammation in osteoarthritis, gout, RA
ANALGESICS
PGE2 sensitizes nerve-endings to the action of bradykinin & hisimine.
mild to moderate pain (less effective than opiates)
ANTIPYRETIC
inhibits PGE2 form hypothalamus
List therapeutic uses of NSAIDS as:
asanalgesics, anti-inflammatory and antipyretics
Myalgia
Gout
arthritis
headache
Dysmenorrhea
fever
my girlfriend arthie had dysmenorhhea & fever
LIST the major ADRs associated with NSAIDs
long term use in elderly> bc ability to clear drug is less
- GI> stomach pain, heartburn, nausea, ulceration, Gi bleed, dyspepsia
- Increaed bleeding risk (vascular)
- kidney
- Heart
- asthma attack
- Hypersensitivty
Why ADR in GI?
how to offset it?
Gastric COX-1 PGE2 >> inhibits gastric section, stimulate synthesis of protective mucous in somtach and intestine.
increased acid secretion, no mucous, increased GI bleeding risk and ulcers
agents w/ high selectivity for COX1 have higher risk of GI RISK!
give PPI of misoprostol
Why ADR in renal? outcomes?
PG responsible for proper BF
less BF, less GFR, more Na and water retention> HYPERTENSION RISK & EDEMA
mainaly in those whose renal function is already compromised!
list syndromes u can get as an ADR from NSAIDS
( there r 2 s’s in th word NSAIDS)
- Steven Johnsen syndrome
- Reyers syndrome
other ADR?
Hypersensitivity
- Skin rashes > Stevens Johnson syndrome*
- Bronchial asthma
Reyes Syndrome (paediatric)
• Rare serious brain/liver injury – usually in viral infections treated with aspirin risk of damage.
* Can occur with other drug groups - not just NSAIDs
Nsaids & interaction with ASTHMA?
nsaid inhbit COX> Pg
BUT DO NOT INHIBIT THE ACTION OF LEUKOTRINES!
so inhibtion of PG can cause a shift to making more LEUKOTRINES> increases exacerbation in asthma!!
what is steven johnsons syndrome?
NSAIDs in combination for treating pain?
what about Nsaids combination with other drugs in general?
NSAIDs given in combination increase risk of ADRs
es: NSAIDs + low dose Aspirin – Compete for COX-1 binding sites - may interfere with cardioprotective action of Aspirin
