MSK (Non-Selective NSAIDs)

Question 1

Examples of drug (Non-Selective NSAIDs)

Answer 1

• Ibuprofen

- Diclofena

Question 2

Mechanism of action (Non-Selective NSAIDs)

Answer 2

• Non-selective inhibition of cyclo-oxygenase (COX 1 and 2) enzymes, decreasing key inflammatory mediator prostaglandin from being synthesised.
• Thereby reduces pain, inflammation and swelling.

Question 3

Indications (Non-Selective NSAIDs)

Answer 3

• Mild to moderate pain relief
• Rheumatic disorders (such as rheumatoid arthritis and osteoarthritis)
• Fever (anti-pyretic effect)

Question 4

Side effects (Non-Selective NSAIDs)

Answer 4

• Gastric and duodenal ulceration (risk increases with duration of therapy and dosage)
• Nausea
• Diarrhoea
• Small increased risk of thrombotic events even when used short term, particularly diclofenac and high dose ibuprofen.
• Avoid in pregnancy particularly 3rd trimester (risk of closure of fetal ductusarteriosus in utero and pulmonary hypertension in newborn)
• Renal impairment
• Hyperkalaemia

Question 5

Important pharmacokinetics/pharmacodynamics (Non-Selective NSAIDs)

Answer 5

• Pain relief starts soon after the first dose, full analgesic effects can take up to one week and anti-inflammatory effects can take up to three weeks.
• Avoid in patients with renal impairment – use lowest dose, for shortest time if unavoidable.
• Caution should be used in the elderly – risk of gastrointenstinal bleeds.

Question 6

Patient information (Non-Selective NSAIDs)

Answer 6

• Risk of stomach bleeds if on long-term use.
• Take with food or milk, to reduce abdominal discomfort and to reduce the risk of bleeding.
• Take only when required.
• In elderly patients a proton pump inhibitor is usually given alongside NSAID drugs