NSAIDS- Non-Steroidal Anti-Inflamatory Drugs

NSAIDS
Prototype Non-Steroidal Anti-inflammatory Drugs

Mechanism of Action

COX-1-Selective NSAIDs

COX-2-Selective NSAIDs

Side Effects and Adverse Reactions Associated With NSAIDs

Drug Interactions Associated With NSAIDs

Acetaminophen (Tylenol, Paracetamol)

• Classification: antipyretic, non-opioid analgesic, non-steroidal anti-inflammatory drug
  
  
  
• Indications: mild to moderate pain, inflammation, and hyperpyrexia (fever)
  
  
  
• Availability: found in over 200 products; may be used in conjunction with opioid analgesics to potentiate pain relief
  
  
  
• Doses: 325 mg (regular strength), 500 mg (extra strength), and 650 mg (extended release)
  
  
  
• Route: enteral, parenteral, and intravenous
  
  
  
• Forms: tablet, liquid, elixir, suppository, suspension, and infusion
  
  
  
• Combination products: propoxyphene napsylate (Darvocet-N 100), oxycodone and acetaminophen (Percocet)
  
  
  
• Maximum pediatric dose: 10-15 mg/kg every 5 hours for children, and 10-15 mg/kg every 6 hours for newborns
  
  
  
• Toxic dose: 150 mg/kg
  
  
  
• Antidote: N-acetylcysteine (Mucomyst)
  
  
  

What is Allopurinol?

• Treats gouty arthritis
  
• Colchicine may cause hematuria
  
  
• Reduces uric acid levels
  
  
  

About Ibuprofen

Indications for Use of Ibuprofen

• Analgesic: Relieves mild to moderate pain, both acute and chronic
  
  
• Antipyretic: Fever reduction
  
  
• Antiinflammatory: Reduces inflammation associated with arthritis and injury
  
  
  

Common Analgesic Uses

• Dysmenorrhea
  
  
• Headache and migraine
  
  
• Postoperative dental pain
  
  
• Dysmenorrhea
  
  
• Headache and migraine
  
  
• Spondylitis
  
  
• Osteoarthritis, rheumatoid arthritis and soft tissue disorders
  
  
  

Side Effects/Adverse Reactions

• Thrombocytopenia
  
  
• Rashes
  
  
• Headache
  
  
• Blurred vision
  
  
• Dizziness
  
  
• Fluid retention/edema
  
  
• Toxic amblyopia (rare)
  
  
• Undetected gastric damage with prolonged use, especially in heavy doses
  
  
  

Contraindications

• Abnormal bleeding, evidenced by hematemesis, melena, or other signs
  
  
• Severe gastrointestinal disturbances such as intense gastric pain or vomiting
  
  
• Pregnancy: Pregnancy category C. Promoted to category D at ≥ 30 weeks’ gestation (increases risk of premature closure of the fetal ductus arteriosus in the heart)
  
  
• Infants less than 6 months old
  
  
• Ulcer or certain gastrointestinal diseases
  
  
  

Signs of Ibuprofen Toxicity

• Seizures
  
  
• Apnea
  
  
• Hypertension
  
  
• Renal and hepatic dysfunction
  
  
• Increased risk of myocardial infraction (Bushra & Aslam, 2010)
  
  
  

Indications for Use of Aspirin

• Prophylaxis of thrombolytic events and myocardial infarction
  
  
• Low-dose daily therapy for patients with heart failure
  
  
• Rheumatoid arthritis: provides inflammation relief
  
  
• Causes irreversible inhibition of the isoenzyme cyclooxygenase-1
  
  
  

Signs of Aspirin Toxicity

• Tinnitus and hearing loss
  
  
• Hyperventilation
  
  
• Behavioral changes
  
  
  
  

Contraindications of NSAID Use

• Anticoagulants
  
  
• Renal disease
  
  
• Rhinitis
  
  
• Peptic ulcer disease
  
  
• Pregnancy
  
  
  

Renal Disease and NSAID Use

• Use of NSAIDS is contraindicated in patients with renal disease\
  
  
• Renal transplants are required for serious cases
  
  
• Azathioprine (Imuran) is used to reduce the risk of rejection
  
  
• Leukopenia is a severe adverse reaction of Imuran
  
  
• Immunosuppressant therapy agents may need to be discontinued if the WBC count drops below 3,000
  
  
• Multiple sclerosis: Immunosuppressant therapy is performed through the drug glatiramer acetate (Copaxone)
  
  
  

The Connection Between Ulcers and NSAIDS

• Long-term use of NSAIDS may compromise the integrity of a gastric mucosa and increase the risk of developing an ulcer
  
  
• Misoprostol (Cytotec) may be used to reduce the risk of ulcers in patients on long-term NSAID therapy.