NSAIDS

Question 1

Examples

Answer 1

• Aspirin, ibuprofen, diclofenac, indomethacin, naproxen
• COX-2 Selective: Celecoxib, Etoricoxib

Question 2

Indications

Answer 2

• Inflammatory arthritis e.g. rheumatoid arthritis. Osteoarthritis
• Acute gout
• Mild to moderate pain including dysmenorrhea

Question 3

Mechanism

Answer 3

• Inhibit COX-1 & COX-2 ->Inhibit PG production (decreased pain, vasodilation, swelling)
• Simultaneous inhibition of COX-1 -> SE

N.B. COX-2 selective inhibitors = celocoxib

Irreversible inhibitors = aspirin

Question 4

SE

Answer 4

Common: Headaches, dizziness

Important: GI ulceration/bleeding, Afferent arteriole vasoconstriction (RF), Bronchospasm, HTN (due to lack vasodilatory PG’s)

N.B. Coxibs (COX-2 selective NSAIDs) are associated with thrombotic events

Question 5

CI

Answer 5

• allergic disorders
• coagulation defects
• cardiovascular disease
• pregnancy/breastfeeding
• hepatic and renal impairment (avoid if severe)
• previous or active peptic ulceration

Question 6

Monitoring

Answer 6

• Repeat U&E - discontinue if renal dysfunction

Question 7

Interactions

Answer 7

• Multiple NSAIDs & anti-coagulants (warfarin) - increased bleeding risk
• Other nephrotoxic drugs e.g. aminoglycoside antibiotics, ACE inhibitors, ARBs (increased risk of nephrotoxicity)