NSAIDs Flashcards Preview

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Flashcards in NSAIDs Deck (19)
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1
Q

What are indications for NSAID use?

A
  • Mild-to-moderate pain
  • Pain related to inflammation - particularly MSK
2
Q

What inflammatory conditions are NSAIDs particularly useful for?

A
  • RA
  • Severe osteoarthritis
  • Acute gout
3
Q

What is the mechanism of action of NSAIDs?

A

Inhibits synthesis of prostaglandins from arachadonic acid by COX-1 and COX-2. The analgesic effects stem from COX-2 inhibition, which blocks COX-2 influence on the production of prostaglandins which cause inflammation and pain

4
Q

What is cyclooxygenase?

A

Enzymes that produce prostaglandins

5
Q

What is the function of COX-1?

A

COX-1 is the constitutive form. It stimulates prostaglandin synthesis that is essential to preserve integrity of the gastric mucosa; maintain renal perfusion (by dilating afferent glomerular arterioles); and inhibit thrombus formation at the vascular endothelium

6
Q

What is the function of COX-2?

A

COX-2 is the inducible form, expressed in response to inflammatory stimuli. It stimulates production of prostaglandins that cause inflammation and pain

7
Q

What are the side effects of COX-1 inhibition?

A
  • Damage to gastric mucosa
  • Renal hypoperfusion
  • Increased CV events risk
8
Q

What are side effects of COX-2 inhibition?

A

Inhibition of prostaglandin production - > inhibition of inflammation and pain

9
Q

How do NSAIDs affect the kidneys?

A

COX-1 inhibition leads to constriction of the afferent glomerular arteriole -> AKI. Also causes acute interstitial nephritis

10
Q

What are side effects of NSAIDs?

A
  • GI toxicity/ulcers
  • Renal impairment
  • Increased CV tisk - Stroke/MI
  • Hypersensitivity reactions
  • Fluid retention
11
Q

When do you need to be cautious when using NSAIDs?

A
  • Severe renal impairment
  • Heart Failure
  • Liver Failure
  • NSAID hypersensitivity
  • Peptic ulcer disease
  • GI bleeding
  • CV disease
12
Q

What interactions do you need to be aware of when using NSAIDs?

A
  • Low-dose aspirin
  • Corticosteroids
  • Anticoagulants
  • SSRIS
  • ACEi
  • Diuretics
  • Warfarin
13
Q

How long does treatment with Naproxen take to reach full effect?

A

3 weeks

14
Q

What advise would you give someone when giving them NSAIDs?

A
  • Warn of indigestion and to seek medical advise if thise occurs
  • Explain risk of long term use
  • Advise to stop use if acutely unwell - risk of AKI
15
Q

What are risk factors for GI complications with NSAID use?

A
  • >65 years
  • Previous peptic ulceration
  • CVD
  • Diabetes
  • Concurrent therapy with GI side effects
16
Q

What drugs do you need to be particularly careful with when using NSAIDs with regards to gastric side effects?

A
  • Low-dose aspirin
  • Prednisolone
17
Q

What would you want to consider prescribing in someone with increased GI risk factors who is prescribed NSAIDs?

A

Gastroprotection

18
Q

WHat are examples of NSAIDs?

A
  • Ibuprofen
  • Naproxen
  • Diclofenac
19
Q

What dose of ibuprofen would you consider starting someone on for acute pain?

A

300-400mg, 3-4 times per day