Pharm- NSAIDS

• 1. inflammation
• - erythema, edema, hyperalgesia
• - do not evoke inflammation by themselves; they potentiate proinflammatory mediators
• - involved in perio Dz
• 2. pain
• - lower threshold of C fiber nocireceptors
• 3. fever
• - increase PGE2 synthesis in hypothalamus, leading to raised body temp and decreased heat loss

inhibit the functions of prostaglandins by inhibiting cyclooxygenases

*anti-inflammatory, analgesic, antipyretic*

well-absorbed

metabolized by P450 enzymes in liver and excreted in urine

• analgesic for mild to moderate pain
• - not for pain of visceral orgin

• anti-inflammatory
• - arthritis, general pain from any joint Dz

• antipyretic
• - never in kids less than 20 y/o with a viral illness (risk of Reye's Syndrome)

• cancer prevention
• - aspirin use has been assoc. w/ decreased risk of colon, stomach, and esophageal cancer

• GI
• - nausea, diarrhea, ulcers

• renal
• - salt and water retention, edema

• CNS
• - headache, vertigo, dizziness

• vascular
• - inhibits platelet aggregation (elevated risk of bleeding and bruising)

irreversibly inhibits cyclooxygenase (COX inhibitor)

mild to moderate pain not of visceral orgin

reduces elevated body temp (no effect on regular temp)

• anti-platelet activity by decreasing thromboxane A2
• - prolonged bleeding time
• - stop use 1 week before surgery

lower dose decreases risk of TIA, MI, etc due to platelet activity

• salicylism
• - mild intoxication, headache, tinnitus, confusion

• salicylate poisoning
• - large dose can be fatal, esp in children
• - Tx by giving large dose of fluid to induce diuresis and alkalanize the urine

closure of ductus arteriosus

often more effective to Tx osteoarthritis, ankylosing spondylitis, etc when tolerated

headaches, aplastic anemia, diarrhea, ulcers, etc

15-30% of pts stop Rx due to side effects

not for use in pt w/ renal or peptic ulcer Dz

• potent analgesic
• moderately anti-inflammatory

• often given post-operatively
• equally effective as Demerol
• short-term substitute for opioids

rapidly absorbed

half life of 2 hrs

often better tolerated than aspirin, but still has GI effects

aspirin

ibuprofen

similar to ibuprofen, but longer half life (14 hours)

aspirin allergy, renal or kidney problems, etc

anti-inflammatory

Tx osteoarthritis

Tx rheumatoid arthritis

selective COX-2 inhibitor

no effect on bleeding time or platelet function

lower ulcer rate than non-selective NSAIDS

COX-2 is constitutive to the kidney, so effects are similar to those of other NSAIDS

HTN and edema have also been reported

substitute for aspirin

antipyretic

analgesic

NOT anti-inflammatory

no GI problems often seen with NSAIDS

liver damage at high doses

acetylcysteine