NSAIDs

Question 1

Name some common NSAIDs

Answer 1

ibuprofen
naproxen
diclofenac - One we have to know
celecoxib

Question 2

How do NSAIDs work?

Answer 2

Non selective COX inhibitor

Question 3

What are the roles of COX 1 and COX2

Answer 3

COX1: Prostaglandin synthesis that leads to:

• Protection of gastric muscosa
• Inhibition of thrombi formation
• Dilation of afferent arteriole in kidney

COX2: prostaglandin 2 synthesis that leads to:

• Pain
• Inflammation

Question 4

In summer what three effects do NSAIDs have?

Answer 4

Anti-inflammatory
Anti-Pyretic
Analgesic

Question 5

What are the contra-inductions of using NSAIDS

Answer 5

Severe renal impairment
Heart Failure 
Hepatic Impairment
Peptic Ulceration
GI bleed
NSAID hypersensitivity

Question 6

What are the main uses of diclofenac

Answer 6

1. Mild to moderate pain: as an when needed (paracetamol preferred if at risk of NSAID side effects)
2. Pain related to inflammation: MSK pain e.g. RA, osteoarthritis and Gout

Question 7

What are the common interactions with NSAIDS/Diclofenac?

Answer 7

Aspirin and Corticosteroids = Increase risk of ulceration
Diuretics and Ace inhibitors = Increase risk of renal impairment and reduce effects of antihypertensives and diuretics
Anticoagulants and SSRIs: Increase risk of GI bleed
Warfarin: Increase risk of bleeds

Question 8

What are the common side effects of NSAIDs?

Answer 8

Gi toxicity (ulceration, nausea and dyspepsia)
NSAID Hypersensitivity (bronchostriction and rash)
Renal Impairment
Increased risk of CV event (MI and stroke)
Fluid retention

Question 9

How is diclofenac excreted?

Answer 9

Metabolised by the liver

Excreted by biliary system and urine