MSK (Selective NSAIDS)

Question 1

Examples of drug (Selective NSAIDS)

Answer 1

• Celecoxib

Question 2

Mechanism of action (Selective NSAIDS)

Answer 2

• Selective inhibitor of COX-2, decreasing key inflammatory mediator prostaglandin from being synthesised.
• Thereby reduces pain, inflammation and swelling.
• The gastrointestinal side effects are mediated via COX-1 inhibition

Question 3

Indications (Selective NSAIDS)

Answer 3

• Pain and inflammation in: osteoarthritis / rheumatoid arthritis / ankylosing spondylitis

Question 4

Side effects (Selective NSAIDS)

Answer 4

• Gastric and duodenal ulceration (Risk increases with duration of therapy and dosage)
• Nausea
• Diarrhoea
• Renal impairment
• Hyperkalaemia

Question 5

Important pharmacokinetics/pharmacodynamics (Selective NSAIDS)

Answer 5

• Less incidence of serious gastrointestnal bleeds (GI) / ulceration compared to non-selective NSAIDs.
• Presumed higher risk of cardiovascular events, compared to non-selective NSAIDs.
• Avoid in patients with renal impairment – use lowest dose, for shortest time if unavoidable.
• Caution should be used in the elderly – risk of GI bleeds.
• Avoid in pregnancy particularly 3rd trimester (risk of closure of fetal ductusarteriosus in utero and pulmonary hypertension in newborn).

Question 6

Patient information (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.