NSAIDS

Question 1

NSAIDS

Answer 1

ibuprofen (Motrin, Advil)
naproxen (Aleve, Naprosyn)
indomethacin (Indocin)
aspirin
celecoxib (Celebrex)
meloxicam (Mobic)
diclofenac (Voltaren)
trolamine salicylate (Aspercreme)

Question 2

NSAIDS INDICATION

Answer 2

IBUPROFEN, NAPROXEN, INDOMETHACIN: analgesia (pain), antipyretic (fever), anti-inflammatory

ASPIRIN, CELECOXIB, MELOXICAM, DICLOFENAC, TROLAMINE SALICYLATE: analgesia (pain), antipyretic (fever), anti-inflammatory, antithrombotic (blood-thinner)

Question 3

NSAIDS ROA

Answer 3

IBUPROFEN, NAPROXEN, INDOMETHACIN, CELECOXIB, MELOXICAM, DICLOFENAC, TROLAMINE SALICYLATE: PO, topical (more local/less risk), IM, IV

ASPIRIN: PO, rectal

Question 4

NSAIDS MOA

Answer 4

reversibly inhibits COX-1 and COX-2 enzyme to decrease prostaglandin formation

Question 5

NSAIDS AE

Answer 5

IBUPROFEN, NAPROXEN, INDOMETHACIN, CELECOXIB, MELOXICAM, DICLOFENAC, TROLAMINE SALICYLATE: GI, N/V, dyspepsia, ulcers, GI bleeding, increased BP, nephrotoxicity, CV risk

ASPIRIN: dyspepsia, ulcers, GI bleeding, GI N/V, bleeding/bruising // Rare AE: skin rash, photosensitivity, bronchospasm, Raye Syndrome in children

Question 6

NSAIDS PT SPECIFIC CONSIDERATIONS:

Answer 6

inhibiting COX-2 may impact muscle fiber repair –> impacts injury recovery and resistance exercise training (potentially avoid during subacute/chronic injury healing, caution against over use, can impact cartilage repair)

Question 7

NSAIDS PK/PD CONSIDERATIONS

Answer 7

IBUPROFEN: can increase BP

ASPIRIN: unique role on thromboxane - blocks and decreases platelet aggregation increasing bleeding; can increase BP

Question 8

NSAIDS OTHER

Answer 8

IBUPROFEN: if GI risk use, watch for history of GI bleed and elderly w/ poor kidney function // if CV risk, generally considered safest

ASPIRIN: approx 80-90% of aspirin remains bound to plasma proteins, thus 10-20% distributed for therapeutic effects

CELECOXIB: the only COX-2 specific drug on the market. Avoid if CV risk. if GI risk, use this; *watch for history of GI bleed and elderly w/ poor kidney function