NSAIDS

Question 1

What is the mechanism of action of NSAIDs

Answer 1

Reduction in production of prostaglandins via inhibition of COX-1 and COX-2

Inhibition of COX 2 is associated with less GI intolerance but greater CV disease

Question 2

What are the warning signs of NSAIDs- report to doctor immediately

Answer 2

Black stools or coffee ground vomit suggests chronic GI bleeding

Iron deficiency anaemia due to GI bleeding (fatigue, dizziness, pale skin, SOB)

Progressive unintentional weight loss or difficulty swallowing

Pregnancy and breastfeeding (contraindicated)

Oedema (swollen ankles or feet)

Unexplained recent dyspepsia

Worsening of asthma

Question 3

What are the monitoring requirements necessary in NSAIDs

Answer 3

Blood pressure (especially after dose changes)

Renal function

Liver function

Haemoglobin in those with risk factors of GI bleeding

Question 4

What are the drug interactions in NSAIDS

Answer 4

Increased convulsion risk when given with quinolones

Enhanced anticoagulant effect of coumarins and phenindione

Enhanced sulfonylurea effect

Increased bleeding risk with dabigatran, heparins, SSRIs, venlafaxine, anti-platelets

Increased risk of nephrotoxicity when given with ciclosporin, tacrolimus, diuretics (antagonises diuretic effect)

Increased side effect profile with other NSAIDs

NSAIDs antagonise the hypotensive effect of beta-blockers, calcium channel blockers, ACE inhibitor, angiotensin II antagonists, alpha blockers, nitrates

Question 5

What are the other points you should be aware of for NSAIDS

Answer 5

patients prescribed NSAIDs for osteoarthritis or rheumatoid arthritis or patients over 45 given NSAIDs for lower back pain should be co-prescribed GI protection (e.g. PPI)

Taken with or just after food

Question 6

Rank the NSAIDS in order of gastrointestinal events

Answer 6

Highest:
Piroxicam
Ketoprofen

Immediate:
Indometacin
Diclofenanc
NAproxen

Lowest:
Ibuprofen