NSAIDs Flashcards

1
Q

What are the two types of NSAIDs?

A
  • Non-selective

- Selective

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2
Q

What are the non-selective NSAIDs?

A
  • Ibuprofen
  • Diclofenac
  • Naproxen
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3
Q

What is an example of a selective NSAID?

A

Parecoxib

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4
Q

What is the main advantage of selective NSAIDs?

A

Target inflammatory cells and less likely to cause GI irritation

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5
Q

How do NSAIDs work?

A

Block production of prostaglandins from arachidonic acid by inhibiting COX-1 and COX-2
Prostaglandins are mediators of inflammation and pain

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6
Q

What are the routes of administration of NSAIDs?

A
  • PO

- IV

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7
Q

What are the indications for NSAIDs?

A
  • Mild to moderate pain, e.g. dental pain, dysmenorrhoea
  • Inflammatory pain, particularly MSK pain
  • Dental pain
  • Dysmenorrhoea
  • Back pain and soft tissue disorders
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8
Q

What are the cautions and contraindications for NSAIDs?

A
  • Asthma
  • Active gastric ulceration or bleeding
  • NSAID hypersensitivity
  • Renal impairment
  • Severe heart failure and liver failure
  • Pregnancy and breastfeeding - avoid in 3rd trimester
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9
Q

What mnemonic can be used to remember some contraindications for use of NSAIDs?

A

NSAID

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10
Q

What does the mnemonic NSAID stand for?

A
  • Nursing a baby (pregnant/breastfeeding)
  • Severe bleeding
  • Asthma
  • Issues with renal function
  • Drug allergy
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11
Q

What drugs can NSAIDs interact with to cause increased risk of GI ulceration?

A
  • Corticosteroids

- Aspirin

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12
Q

What drugs can NSAIDs interact with to cause increased risk of GI bleeding?

A
  • Anti-coagulants
  • Other NSAIDs
  • SSRIs
  • Venlafaxine
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13
Q

What drugs can NSAIDs interact with to cause increased risk of renal impairment?

A

Nephrotoxic drugs e.g. aminoglycosides, ACEi, ARBs

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14
Q

What drugs can NSAIDs interact with to cause increased risk of lithium toxicity?

A

Lithium

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15
Q

What monitoring should patients have prior to starting NSAIDs?

A

U+Es

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16
Q

What are some possible side-effects of NSAIDs?

A
  • Headaches
  • Dizziness
  • Nausea
  • GI irritation/ulceration/bleeding
  • Renal impairment
  • Diarrhoea
  • Bronchospasm
17
Q

Who can NSAIDs cause bronchospasm in?

A

Asthmatics

18
Q

Why can NSAIDs cause renal impairment?

A

They reduce renal blood flow

19
Q

What are all NSAIDs associated with an increased risk of?

A

Thrombotic events, regardless of baseline cardiovascular risk factors or duration of NSAID treatment

20
Q

What counselling is required with NSAIDs?

A
  • Reducing GI effects
  • Allergic reaction
  • Alcohol
21
Q

How can the GI effects of NSAIDs be reduced?

A
  • Take drug with food to minimise indigestion

- In long-term NSAID use, PPI should be taken to protect gastric mucosa

22
Q

What should the patient be told regarding allergic reactions with NSAIDs?

A

If swelling of the face, eyes, lips, or tongue develops, or if breathing difficulties occur, stop taking the drug and call an ambulance immediately

23
Q

What should the patient be told regarding alcohol with NSAIDs?

A

Alcohol increases the risk of GI bleeding, and therefore is not recommended for moderate drinks to use NSAIDs, and those who exceed recommended daily limits of alcohol should exercise greater caution