Non Steroidal Anti Inflammatory Drugs (NSAIDs)

Question 1

Prostaglandins

Answer 1

• Evident in all body tissues
• Have the enzyme cyclooxygenase (COX) which help production of prostaglandins
• Majority of NSAIDs will inactivate COX-1 and/or COX-2 isoenzymes

Question 2

COX-1

Answer 2

• A beneficial inflammatory mediator due to it’s homeostatic effects and is present in most tissues

Question 3

COX-2

Answer 3

• Only present in a few organs
• Only produced in certain circumstances (e.g tissue damage/injury)
• Newer agents are more selective to COX-2
• More thorough at providing analgesia without inhibiting functions such as gastrointestinal, renal, ophthalmologic and reproductive function
• Lesser detrimental effects like gastric ulceration

Question 4

Meloxicam

Answer 4

• SQ, PO

- COX-2 selective

Question 5

Carprofen

Answer 5

• IV, IM (dogs), SQ, PO (dogs and cats)

- COX-2 selective

Question 6

Firocoxib

Answer 6

• PO
• Dogs only
• COX-2 selective

Question 7

Uses

Answer 7

• Mild to moderate pain, particularly post op/inflammatory
• E.g. ovariohysterectomy, fracture repairs, dental pain, osteoarthritis, mastitis
• Work well along side opioids

Question 8

Side Effects

Answer 8

• Gastrointestinal (vomiting, diarrhoea, ulcerations)
• Renal toxicity (due to inhibition of prostaglandin involving maintaining renal blood flow)
• Coagulopathies (rare)
• Idiosyncratic liver toxicity (very rare)

Question 9

Contraindications

Answer 9

• Dehydrated/hypotensive
• Renal/liver disease
• Gastrointestinal disorders
• Anaesthetised patients
• Patients receiving cardiac or hypertensive meds
• Coagulopathic patients
• Patients on corticosteroids

Question 10

Important Considerations

Answer 10

• When giving PO make sure patient is eating
• Discontinue use if vomiting/diarrhoea occurs
• Ensure normothermia and adequate perfusion occurs
• All NSAIDs take 30-60mins to reach therapeutic levels regardless of route administered