NSAIDS - Week 14

Question 1

What are the main adverse effects of NSAIDS?

Answer 1

• GI toxicity
• Renal impairment
• Major adverse cardiovascular events

Question 2

How do NSAIDS work ?

Answer 2

NSAIDs Inhibit prostaglandin synthesis from arachidonic acid by inhibiting COX.

Cox exists as COX - 1 and COX - 2.

COX -1 is the GOOD form; it stimulates prostaglandins, which protect stomach mucosa, maintain renal perfusion, and inhibit thrombus formation.

COX 2 is expressed in response to pain stimulation prostaglandins to produce pain and inflammation.

The therapeutic benefits are mediated by COX 2 inhibition, and the issues arise from COX 1 inhibition.

Question 3

What is the mechanism of action of Methotrexate?

Answer 3

Methotrexate inhibits dihydrofolate reductase, which converts dietary folic acid into tetrahydrofolate FH4, which is essential for DNA and protein synthesis. Therefore, it is useful in cancer.

Equally, methotrexate has anti-inflammatory and immunosuppressant effects at lower doses. Methotrexate appears to increase adenosine release from cells which to inhibit inflammation and cytokine release

Question 4

What is the maximum methotrexate that should be given? Why is this?

Answer 4

Once a week.

There is a risk of toxicity from inadvertent daily administration.

Question 5

What are some adverse effects of methotrexate ?

Answer 5

Mucosal damage
Bone marrow suppression
Renally excreted
Hepatic cirrhosis (long term)
Teratogenic