NSAIDs Flashcards
Name examples of non-selective NSAIDs.
aspirin, diclofenac, ibuprofen, naproxen, mefenamic acid, indomethacin, ketoprofen, piroxicam.
Name examples of selective NSAIDs.
celecoxib, etoricoxib, meloxicam
What are the indications of NSAIDs?
pain and inflammation (general), pain and inflammation in rheumatic disease/osteoarthritis/rheumatoid arthritis/ankylosing spondylitis/musculoskeletal disorders/systemic juvenile idiopathic arthritis/soft-tissue injuries, postoperative pain, fever in ear, nose or throat infection, acute gout, closure of ductus arteriosus, pyrexia with discomfort, symptomatic ductus arteriosus, dysmenorrhoea/menorrhagia.
What are the contraindications of NSAIDs?
active GI bleeding, active GI ulceration, history of GI bleeding related to NSAID use, history of GI perforation related to NSAID use, history of recurrent GI haemorrhage, history of recurrent GI ulceration, cerebrovascular disease (diclofenac, etoricoxib), ischaemic heart disease (diclofenac, etoricoxib), mild to severe heart failure (diclofenac, etoricoxib), severe heart failure, peripheral arterial disease (diclofenac, etoricoxib), inflammatory bowel disease (etoricoxib, mefenamic acid, piroxicam), uncontrolled hypertension (etoricoxib).
What is the mechanism of action of non-selective NSAIDs?
Non-selective NSAIDs inhibit both the cyclooxygenase COX-1 and COX-2 enzymes. These enzymes are crucial for producing prostaglandins, which have a role in the inflammatory response pathway. When tissue trauma occurs, arachidonic acid is released from membrane phospholipids. COX converts this to prostaglandins and thromboxanes which sensitise nociceptors that are involved in the pain pathway. NSAIDs inhibit COX from producing prostaglandins and thromboxanes.
What is the mechanism of action of selective NSAIDs?
The same as for non-selective, except they only target the COX-2 enzyme. COX-2 is mainly generated in inflamed tissue, therefore by acting on COX-2 only, side effects associated with inhibiting COX-1 such as GI irritation/bleeding/perforation etc. are reduced.
What are the common/very common side effects of NSAIDs?
abdominal pain, anorexia, constipation, diarrhoea, dizziness, drowsiness, dyspepsia, flatulence, headache, heartburn, indigestion, nausea, rashes, vomiting.
What are the monitoring requirements of etoricoxib?
monitor blood pressure before treatment, during treatment and 2 weeks after treatment.
What are the monitoring requirements of indometacin?
with oral use, during prolonged therapy it is advisable to conduct ophthalmic and blood examinations.
What is the patient/carer advice for NSAIDs that cause dizziness/drowsiness?
advise that dizziness/drowsiness may impair driving, skilled tasks, operating machinery etc.
