NSAIDs

Question 1

What are the two types of NSAIDs?

Answer 1

• Non-selective

- Selective

Question 2

What are the non-selective NSAIDs?

Answer 2

• Ibuprofen
• Diclofenac
• Naproxen

Question 3

What is an example of a selective NSAID?

Answer 3

Parecoxib

Question 4

What is the main advantage of selective NSAIDs?

Answer 4

Target inflammatory cells and less likely to cause GI irritation

Question 5

How do NSAIDs work?

Answer 5

Block production of prostaglandins from arachidonic acid by inhibiting COX-1 and COX-2
Prostaglandins are mediators of inflammation and pain

Question 6

What are the routes of administration of NSAIDs?

Answer 6

• PO

- IV

Question 7

What are the indications for NSAIDs?

Answer 7

• Mild to moderate pain, e.g. dental pain, dysmenorrhoea
• Inflammatory pain, particularly MSK pain
• Dental pain
• Dysmenorrhoea
• Back pain and soft tissue disorders

Question 8

What are the cautions and contraindications for NSAIDs?

Answer 8

• Asthma
• Active gastric ulceration or bleeding
• NSAID hypersensitivity
• Renal impairment
• Severe heart failure and liver failure
• Pregnancy and breastfeeding - avoid in 3rd trimester

Question 9

What mnemonic can be used to remember some contraindications for use of NSAIDs?

Answer 9

NSAID

Question 10

What does the mnemonic NSAID stand for?

Answer 10

• Nursing a baby (pregnant/breastfeeding)
• Severe bleeding
• Asthma
• Issues with renal function
• Drug allergy

Question 11

What drugs can NSAIDs interact with to cause increased risk of GI ulceration?

Answer 11

• Corticosteroids

- Aspirin

Question 12

What drugs can NSAIDs interact with to cause increased risk of GI bleeding?

Answer 12

• Anti-coagulants
• Other NSAIDs
• SSRIs
• Venlafaxine

Question 13

What drugs can NSAIDs interact with to cause increased risk of renal impairment?

Answer 13

Nephrotoxic drugs e.g. aminoglycosides, ACEi, ARBs

Question 14

What drugs can NSAIDs interact with to cause increased risk of lithium toxicity?

Answer 14

Lithium

Question 15

What monitoring should patients have prior to starting NSAIDs?

Answer 15

U+Es

Question 16

What are some possible side-effects of NSAIDs?

Answer 16

• Headaches
• Dizziness
• Nausea
• GI irritation/ulceration/bleeding
• Renal impairment
• Diarrhoea
• Bronchospasm

Question 17

Who can NSAIDs cause bronchospasm in?

Answer 17

Asthmatics

Question 18

Why can NSAIDs cause renal impairment?

Answer 18

They reduce renal blood flow

Question 19

What are all NSAIDs associated with an increased risk of?

Answer 19

Thrombotic events, regardless of baseline cardiovascular risk factors or duration of NSAID treatment

Question 20

What counselling is required with NSAIDs?

Answer 20

• Reducing GI effects
• Allergic reaction
• Alcohol

Question 21

How can the GI effects of NSAIDs be reduced?

Answer 21

• Take drug with food to minimise indigestion

- In long-term NSAID use, PPI should be taken to protect gastric mucosa

Question 22

What should the patient be told regarding allergic reactions with NSAIDs?

Answer 22

If swelling of the face, eyes, lips, or tongue develops, or if breathing difficulties occur, stop taking the drug and call an ambulance immediately

Question 23

What should the patient be told regarding alcohol with NSAIDs?

Answer 23

Alcohol increases the risk of GI bleeding, and therefore is not recommended for moderate drinks to use NSAIDs, and those who exceed recommended daily limits of alcohol should exercise greater caution