NSAIDs - Diclofenac

Question 1

What are NSAIDs used for?

Answer 1

1) PRN treatment of mild to moderate pain

2) pain related inflammation e.g. RA, OA

Question 2

How do NSAIDs work?

Answer 2

NSAIDs inhibit prostaglandin synthesis from arachidonic acid by inhibiting COX1 and mainlyCOX 2 enxymes.

Question 3

What are the side effects of NSAIDs?

Answer 3

• GI toxicity
• renal impairment
• increased risk of cardiovascular events e.g. MI / stroke,
• hypersensitivities reactions (bronchospasm and angioedema)
• fluid retention

Question 4

What does the COX-1 enzyme do?

Answer 4

COX-1 stimulates prostaglandin synthesis that is essential to:

• preserve GI mucosa
• maintain renal perfusion
• inhibit thrombus formation

Question 5

What does the COX-2 enzyme do?

Answer 5

COX-2 is expressed in response to inflammatory stimuli.

It produces prostaglandins that cause inflammation and pain.

Question 6

What are the contraindications of NSAIDs?

Answer 6

• severe renal impairment
• heart failure
• liver failure
• NSAID allergy

High risk of :

• PEPTIC ULCER DISEASE
• GI bleeding
• CV disease
• renal impairment

Question 7

What are the drug interactions of NSAIDs?

Answer 7

Drugs that increase risk of GI ulceration:

• low dose aspirin
• corticosteroids

Drugs that increase risk of GI bleed:

• anticoagulants (e.g. warfarin)
• SSRIs
• vanlafaxine (anti-depressant)

Drugs that increase risk of renal impairment:

• ACEi
• diuretics

Question 8

What is the maximum daily dose of diclofenac for OA?

Answer 8

150 mg daily

Question 9

What is the maximum dose of diclofenac for RA ?

Answer 9

100 mg twice daily

Question 10

Gastroprotection should be considered for all pt prescribed NSAIDs with increased risk of GI complications. What are the risk factors?

Answer 10

• AGE 65+
• previous peptic ulcer
• CV disease, diabetes
• drugs with GI side effects e.g. low dose aspirin, prednisolone.