NSAIDS, analgesiacs

Question 1

What is the mechanism of action of NSAIDS?

Answer 1

The action of NSAIDs is to inhibit the COX enzymes, so reduce sensation of pain.

Question 2

What are the indications of NSAIDS e.g. ibruprofen, naproxen?

Answer 2

Provide analgesia to mild, moderate pain and reduce pain related inflammation in gout, osteoarthritis, RA.

Question 3

What are the side effects of NSAIDS?

Answer 3

Gastric ulcers, perforation , obstruction, bleeding.

Question 4

What are the CI of NSAIDS?

Answer 4

GI bleed, GI ulcer, NSAID allergic reaction, renal impairment such as AKI/CKD as NSAIDS are renally cleared.

Question 5

What are the 3 types of analgesiacs, pain severity and examples?

Answer 5

• Non-opiods e.g. paracetamol,NSAID, pain severity 2-5/10
• Mild opiods e.g. codeine, co-codamol, pain severity 5-8/10
• Strong opioids e.g. morphine, pain severity 8+/10

Question 6

What are drug interactions for NSAIDS?

Answer 6

Drugs that can increase risk of NSAID side effects

• GI ulceration with use of corticosteroids
• renal impairment with use of ACEi and thiazide diuretics
• Risk of bleeding with use of warfarin

Question 7

What will be given with NSAIDs to prevent GI ulcers?

Answer 7

High risk of GI adverse events — a COX-2 inhibitor + proton pump inhibitor (PPI).

Moderate risk of GI adverse events — a COX-2 inhibitor should be prescribed alone, or an NSAID + PPI.

Low risk of GI events — a non-selective NSAID should be prescribed.