NSAID Flashcards
Non-selective COX-1/COX-2 inhibitors
- Aspirin
- Diclofenac
- Ibuprofen
- Indometacin
- Mefenamic acid
- Meloxicam
- Naproxen
- Piroxicam
- Phenybutazone
- Tiaprofenamic acid
Selective COX-2 inhibitors
Celecoxib
Etorocoxib
Parecoxib
Indometacin
GI disturbances
Headache
Dizziness
Driving
Mefenamic acid
Haemolytic anaemia/diarrhoea
Naproxen
Choice drug for inflammation
Piroxicam
High risk of GI side effects - gastric protection necessary
Serious skin reactions
Phenybutazone
Haematological SE
Tiaprofenamic acid
Severe cystitis
Side effects
- Hypersensitivity
- Photosensitivity (topical)
- Nephrotoxicity
- Sodium + fluid retention
Hypersensitivity
C/I if history of hypersensitivity to NSAIDs or aspirin
- Bronchospasms
- Rash
- Angioedema
- Hives
- Rhinitis
Photosensitivty
Topical preparations
Esp ketoprofen
Nephrotoxicity
Caution in renal impairment
Reduce eGFR and are renally cleared
Temporarily stop on sick days = AKI
Sodium + fluid retention
Caution in:
- Renal impairment
- Liver impairment
- Congestive HF
- Hypertension
Asthma + NSAIDs
Caution
May worsen asthma - bronchospasm
C/I in history of asthma attack with NSAID.
GI Toxicity
NSAIDs commonly cause stomach irritation
Take with or after food
- GI bleed
- GI ulcers
- GI perforation
High risk
Ketoprofen
Ketorolac
Piroxicam
Medium risk
Naproxen
Diclofenac
Indometacin
Low risk
Ibuprofen
Lowest risk
COX-2 selective “coxibs)
C/I
Active GI bleeding/ulcers
History of NSAID-induced ulcer/bleeding
1 episode with piroxicam/ketoprofen/ketorolac
> 2 episodes with other non-selective NSAIDs
NSAID + Cardiovascular
Small increased risk of thrombotic events
C/I in severe HF
Highest risk:
- High dose ibuprofen (2.4g faily)
- Dexibuprofen
- Diclofenac
- Acelcofenac
Pregnancy
AVOID esp in 3rd trimester
- Delays laour
- Pulmonary hypotension in newborn
- Premature closure of foetal ductus ateriosis
Interactions - increased risk of AKI
ACEi
Diuretics
Ciclosporin
Tacrolimus
Interactions - increased risk of bleeding
Warfarin
- Displaced by NSAID = high free drug concentrations
NOACs
Antiplatelets
Low dose aspirin
Heparin
SSRI
Venlafaxine
Steroid
