Clinical 3.1 NSAIDs

Question 1

What are the manifestations of inflammation?

Answer 1

Rubor (redness) 
Calor (heat) 
Dolor (pain) 
Tumour (swelling) 
Loss of function

Question 2

Which COX is constitutive?

Answer 2

COX-1

Question 3

What are the positive effects of NSAIDs?

Answer 3

Analgesia
Antipyretic - inhibits PGE2 which stimulates hypothalamus
Anti-inflammatory
Inhibit smooth muscle contraction

Question 4

What are the negative effects of NSAIDs?

Answer 4

GIT: gastritis and ulceration - reduction in HCO secretion and mucous production
Renal dysfunction
Bronchospasm in aspirin sensitive asthma

Question 5

How can you reduce the side effects of NSAIDs?

Answer 5

Use a COX-2 selective

Question 6

What are the COX-2 selective side effects?

Answer 6

Increased risk of CV events - stroke, AMI

Question 7

What are the important drug interactions

Answer 7

Antihypertensives
Diuretics
Diuretics and antihypertensives and NSAID = triple whammy = AKI
High dose aspirin

Question 8

What occurs in NSAID overdose?

Answer 8

AKI - generally mild except aspirin which has initial respiratory alkalosis with tinnitus followed by metabolic alkalosis, multuple organ failure and death

Question 9

What is the general mechanism of NSAIDs?

Answer 9

The NSAIDs reversibly bind to COX preventing the formation of prostaglandins and thromboxane from the precursor of arachidonic acid