NSAIDs

Question 1

NSAIDs: Prescribed for

Answer 1

Pain relief, inflammation, temperature reduction

Question 2

NSAIDs: Examples

Answer 2

Ibuprofen, diclofenac, naproxen

Question 3

NSAIDs: Mode of action

Answer 3

Inhibits the activity of cyclooxygenases (COX-1 and COX-2), thereby inhibiting prostaglandin synthesis

Question 4

NSAIDs: Contraindication

Answer 4

Peptic ulceration, history of gastrointestinal bleeding or hypersensitivity to aspirin, IBD

Question 5

NSAIDs: Caution

Answer 5

Asthma, cardiac impairment, impaired renal function

Question 6

NSAIDs: Important coadministration

Answer 6

Coadministration with warfarin increases bleeding risk.

• Concomitant use of NSAIDs with high doses of nutrients and herbs with antiplatelet activity e.g., vitamin E, garlic and turmeric, may increase the risk of bleeding

Question 7

NSAIDs: Side effects

Answer 7

• Inhibit prostaglandins that play a vital role in gastric mucosal defence, increasing the risk of gastric bleeding and ulceration.
• Block renal prostaglandins that normally dilate vessels in the kidneys. This can lead to reduced blood flow and oxygen supply causing acute kidney damage

Question 8

NSAIDs: Selective COX-2 Inhibitors

Answer 8

NSAIDS that selectively inhibit COX-2 allow COX-1-i production of prostaglandins that have important gastro-protective effects. However, they are associated with an increased risk of cardio-vascular events in those with heart disease

Question 9

NSAIDs: Alternative options

Answer 9

• Willow bark (Salix alba) reduces inflammation and fever and has analgesic properties.
• Willow bark does not have antiplatelet activity and can be safely used alongside NSAIDs where pain is more severe.
• Turmeric (curcumin), ginger and boswellia are also COX inhibitors.
• Ensure an anti-inflammatory / alkalising diet incorporating a range of fruit and vegetables rich in flavonoids and chlorophyll.
• Quercetin inhibits LOX and COX pathways and down-regulates NF-kB. Food sources include onions, asparagus, apples, berries