NSAIDs Flashcards
What are the 2 effects of NSAIDs?
Analgesic
Antinflammatory
NSAIDs- MOA
NSAIDs reduce the production of prostaglandins by inhibiting COX enzymes
NSAIDs selectivity
Vary in their selectivity for inhibiting different types of cyclo-oxygenase;
- Non-selective COX-1/COX-2 inhibitors
- Selective COX-2 inhibitors
Which type of NSAID is associated with less gastro-intestinal intolerance.
selective inhibition of cyclo-oxygenase-2 (COX-2)
Non-selective COX-1/COX-2 inhibitors
Aspirin
Diclofenac
Ibuprofen
Indometacin
Mefenamic acid
Meloxicam
Naproxen
Piroxicam
Phenybutazone
Tiaprofenamic acid
Selective COX-2 inhibitors
Celecoxib
Etorocoxib
Parecoxib
NSAIDs - side effects
Hypersensitivity
Photosensitivity (topical)
Nephrotoxicity
Sodium + fluid retention
GI events
CV events
High risk - GI side effects
Piroxicam
Ketoprofen
Ketorolac
Medium risk - GI side effects
Indometacin
Diclofenac
Naproxen
Low risk - GI side effects
Ibuprofen
Lowest risk - GI side effects
Selective COX-2 inhibitors
High risk - CV side effects
Selective COX-2 inhibitors
Ibuprofen 2.4g
Diclofenac
Low risk - CV side effects
Naproxen
Ibuprofen 1.2g
Side effects - GI events
All NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly.
Offer PPI
Hypersensitivity reactions -
C/I if history of hypersensitivity to NSAIDs or aspirin
- Bronchospasms
- Rash
- Angioedema
- Hives
- Rhinitis
Photosensitivty
Topical preparations
Esp ketoprofen
Sodium + fluid retention
Caution in:
- Renal impairment
- Liver impairment
- Congestive HF
- Hypertension
Nephrotoxicity
Caution in renal impairment
Reduce eGFR and are renally cleared
Temporarily stop on sick days = AKI
Renal impairment
- Avoid in renal impairment (risk of fluid retention and further impairment)
Pregnancy
- Avoid in pregnancy - caution in breastfeeding
Pregnancy MHRA
use of systemic NSAIDs from week 20 of pregnancy onwards may be associated with an increased risk of:
- oligohydramnios resulting from fetal renal dysfunction—this may occur shortly after treatment initiation, although usually reversible upon discontinuation;
- constriction of the ductus arteriosus—most reported cases resolved after treatment cessation
Paracetamol vs NSAIDs
In single doses non-steroidal anti-inflammatory drugs (NSAIDs) have analgesic activity comparable to that of paracetamol, but paracetamol is often preferred, particularly in the elderly.
NSAIDs - interactions
Asthmatics
Low dose aspirin
Alcohol
NSAIDs + low-dose aspirin →
increase GI bleed risk (use only if necessary)
NSAIDs + alcohol →
increase GI bleed risk
* Use stomach protection (Usually a PPI)
NSAIDs + asthma →
Bronchospasms
NSAIDs + MTX/lithium →
Reduces clearance
NSAIDs + ciprofloxacin →
Increases risk of seixures
NSAIDs + blood thinner →
Increases risk of bleeding
NSAIDs + drugs which cause hyperkalaemia →
hyperkalaemia
NSAIDs + drugs which cause renal failure →
AKI
Interactions - increased risk of AKI
ACEi
Diuretics
Ciclosporin
Tacrolimus
Interactions - increased risk of bleedin
Warfarin
- Displaced by NSAID = high free drug concentrations
NOACs
Antiplatelets
Low dose aspirin
Heparin
SSRI
Venlafaxine
Steroid
Interactions - increased risk of hyperkalaemia
Potassium sparing diuretics
