Analgesia NSAIDs Flashcards
What can cause chronic pain?
osteoarthritis
Neuropathic pain
Cancer pain
Ischaemic pain
How do NSAIDS work?
COX inhibitors block the production of prostaglandins and thromboxane
COX1 causes NSAID dise effects
COX 2 causes NSAID therapeutic effects
What are the common side effects of NSAIDs
GI -melena -haematemesis -ulceration -vomiting, diarrhoea -occurs within the first 2 weeks of therapy Renal blood flow -during hypotension blood flow to the kidneys is limited -occurs when animal dehydrated -water retention and odema Elevation of liver enzymes -liver dysfunction uncommon Hypertension -not reported in dogs but must be considered Block production thromboxane -blood clotting abnormalities
What are the functions of prostaglandins for each body system?
GI -maintain mucosal blood flow -bicarbonate and mucous secretions -epitheliazation Renal -Promote glomerular filtration rate -renin release -sodium excretion
How can you minimise the side effects of NSAIDS?
Do not exceed the dose
do not give two NSAIDs concurrently
do not give NSAIDS and corticosteriods concurrently
Do not give to hypotensive animals/ dehydrated
Warn owners about the risks
Think about individual animal
How to administer NSAIDs to animals with pre-existing GI ulceration?
Administer with gastroprotectants -omeprazole -zantac -suculfrate Consider other drugs Inform owners about the risk
How should you administer NSAIDs to animals with renal disease?
Monitro renal disease carefully and frequently
Do not administer to dogs that are hypotensive
Warn owners
Stop immediately if pet stops eating or drinking and becomes dehydrated
Water must be freely available
what is the gold standard approach to start an animal on NSAID thearpy?
Complete pre-treatment blood tests BIochem Haemotology Blood pressure measurement Urine analysis
When should you re-check a new patient who has recently been started on NSAID?
one to two weeks
Side effects most likely to occur in the first two weeks
-GI signs
-renal 2-3 days after treatment
How should you administer NSAIDs to animals with liver disease?
Reduced liver function may lead to accumulation of drug
Reduced NSAID metabolisim
Increased risk of side effects
May need lower doses or frequency
How should you administer NSAIDs to animals with cardiac disease?
Monitor for hypertension
BP monitoring
Greater risk of reduced renal blood flow in patients receiving diuretics and ACE inhibitors
How should you administer NSAIDs to animals with hypoproteinaemia?
Increased volume free fraction of NSAID in the blood
elevates risk of side effects
When should you monitor the following patients who are being placed onto NSAIDs
High risk of side effects
Mild risk of side effects
Low risk
High-avoid NSAIDS
Medium(concurrent disease in target organ)-recheck monthly
Lower risk- re-check 3-6 months
How and why should NSAID efficacy be monitored?
Ensure that the medication is minimising pain
Assess quality of life
Give owners Specific Outcome Measures to analyse their pets behaviour
Use formal scoring to monitor progress
What should you do if the NSAID is not tolerated or efficacious enough?
Switch to different NSAID greater COX2 selectivity introduce adjuvant therapy e.g (amantadine) Non-pharmalogical therapies Heat therapy cold therapy physio hydro weight management j/d diet gabapentin
