wk 3- NSAIDS and glucocorticoids Flashcards
what are NSAIDs
antipyretic
analgesic
anti inflammatory
that work within 30mins-1 hour max anti inflammatory and analgesic benefits until felt until 2 weeks
paracetaol is
analgesic
antripyretic
conditions that are contraindiaated with NSAIDS
heart problems
hypertension
stomach problems
bleeding disorders (haemophilia)
asthma
renal impairment
surgery/dental work
driving- ADRs
1st/3rd pregnancy/lactation
drug interactions with
prolonged use
drugs that are contraindicated with NSAIDS
Warfarin (drugs that increase INR)
ACE inhibitors, diuretics, sartans (drugs that cause hyperkalaemia)
lithium/ methotreaxte (drugs that are renal excreted)
Loop diuretics (drugs with a renal MOA)
thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers (antihypertensive drugs)
Alendronate, corticosteroids (drugs that cause GI ulceration)
what can you use with someone with GI complications
paracetamol with/without codeine
gastro protection NSAID AND PPI
COX2 selective
1st and 3rd trimster pregnancy and NSAIDs
increase rate of miscarriage
-closure of foetal ductus arteriosus- closure before birth can lead to R heart failure
prevent ovulation
what NSAID is safe in breast feeding
ibuprofen
NSAIDS and ACE do what
decrease antihypertensive effects and increase risk of renal impairment
NSAIDS and lithium
decrease renal excretiton of lithium resulting in toxicity
NSAIDs and MTX
Decrease renal excretion and increase toxicity
NSAIDs and loop/thiazide diuretics
decrease renal function and increase risk of nephrotoxicity
warfarin and NSAIDS
increase risk of GI bleeding
triple whammy what does it do
loop diuretics- decrease glomerular filtration pressure
ace- decrease GFP
NSAIDs- decrease prostaglandin dependent renal vasodilation
how to minimise NSAID toxicity
- topicals
- paracetamol before NSAID
- minimising dose
- selectiving NSAID with lowest risk
- only using one NSAID
what does aspirin do
analgesic
antipyretic
anti inflammatory
antplatelet
what is low doses of aspirin used for
anticoagulant effect to reduce risk of CV event
what are normal doses of aspirin used for
analgesic or inflammation
aspirin MOA
irreversibly inhibits TxA2 in platelets causing vasodilation, platelet inhibitiion and antithrombogeneisis
lasts the lifetime of the platelet (10days)
caution with aspirin as a podiatrist
in children with fever or pain as its linked to reyes syndrome
topical NSAID over oral
indications: OA, muscle aches/pains
helps stimualate blood but doesnt penetrate joint
-can still cause GI bleeding but less likely to cause systemic effects
topical NSAID contraindicated in
GI bleeding
warfarin
MTX
open wounds/broken skin
infection
what NSAID for lowest risk of CV event
naproxen
corticosteroids / glucocorticods
anti inflammatory
immunosuppressive
anti mitotic
vasocontrictive
glucocorticoid MOA
bind to steroid receptors, translocate into cell nuclei to exert effects on glucocorticoid responsive gene
2 ways NSAIDs trigger soft tissue healing
Inflammatory response
Inflammatory mediators (neutrophils, macrophages) cause tissue repair
Local tissue damage
Phagocytosis and activation of fibroblasts and tissue regeneration
corticosteorids are contraindicated in
Diabetes: Avoid extensive use as systemic absorption can increase blood glucose
concentration
Immunicompromised patients: Avoid extensive use (months-years esp. more potent) as systemic absorption can result in further immunosuppression
Ulcerative Skin/infections/rosacea/acne/imparied circulation: Skin atrophy (e.g. in elderly) can be potentiated by topical corticosteroids & can ↑ their systemic absorption
Children: ↑ systemic absorption due to higher SA– weight ratio. Hydrocortisone is adequate initial Tx for most children. Use more potent products for short periods under close supervision to regain control of disease
Pregnanacy: use lowest potency for shortest time (category A)
topical corticosteroid indications
eczema
contact dermatitis
psoriasis
(inflammatory skin conditions)
adverse effects of corticosteroids
loss of dermal collagen
skin atrophy
straie formation
fragility
bruising
telangiectasia
infection
dermatitis
purpura (elderly)
using ointments, creams or lotions or sprays
ointments-dry scaly skin, pentrates well. may cause folliculitis
creams- dry skin, preferred for face
lotion- hairy/weeping regions
spray-without touch/hard to reach areas/painful
if syymptoms dont improve in how long with corticosteroid do you need to assess what?
3-7days
- stronger topical
- infection
- adherence
