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Nonsteroidal Anti-Inflammatory Drug (NSAID)
Prototype: Aspirin
- Nonsteroidal Anti-Inflammatory Drug(NSAID)Prototype: Aspirin
- MECHANISM OF ACTION:
- -irreversible inhibition of cyclooxygenase (COX-1 and COX-2)
- -suppresses platelet aggregation
- -decreases prostaglandin synthesis
- -reduces inflammation, pain, and fever
- USES:-suppression of inflammation
- -analgesia (pain reduction)
- -reduction of fever in adults
- -dysmenorrhea
- -suppression of platelet aggregation to protect against MI and stroke
- -prevention of colorectal cancer
- ADVERSE EFFECTS:-gastric distress (heartburn and nausea)
- -GI bleeding, gastric ulceration and perforation
- -not used in children b/c of the risk of Reye's syndrome-fetal harm (prolongs labor, premature closing of the patent ductus)
- -hypersensitivity in patients with allergies
- -renal impairment
- -bleeding
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First Generation - Nonaspirin NSAIDs
Prototype: Ibuprofen (Advil, Motrin)
Other NSAIDs:
-Fenoprofen (Nalfon)
-Flurbiprofen (Ansaid)
-Ketoprofen
-Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
-Oxaprozin (Daypro)
-Diclofenac (Voltaren, Cataflam) - risk of liver failure
-Voltaren gel and Flector patch
-Diclofenac plus Misoprostol (Arthrotec)
-Diflunisal (Dolobid)
-Etodolac
-Indomethacin (Indocin)
-Ketorolac (Toradol) - available IM or IV
-Mefenamic acid (Ponstel)
- MECHANISM OF ACTION:
- -reversible inhibition of COX-1 and COX-2
- -inhibits prostaglandin synthesis
- -has anti-inflammatory, analgesic, and antipyretic actions
- USES:
- -fever
- -pain
- -arthritis
- -dysmenorrhea
- -closure of the ductus arteriosus in preterm infants
- ADVERSE EFFECTS:
- -bleeding
- -gastric ulceration
- -renal impairment
- -cross-hypersensitivity with aspirin
- -may precipitate Reye's syndrome
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Second Generation NSAID (COX-2 Inhibitor)
Prototype: Celecoxib (Celebrex)
- MECHANISM OF ACTION:
- -selective inhibition of COX-2
- -decreases prostaglandin synthesis at the site of injury
- -reduces pain and inflammation
- -spares COX-1 inhibition
- -minimal gastric, renal, and platelet effect
- USES:
- -osteoarthritis
- -rheumatoid arthritis
- -dysmenorrhea
- -acute pain
- ADVERSE EFFECTS:
- -dyspepsia
- -mild renal impairment
- -not used in patients with sulfonamide allergy
- -premature closure of ductus arteriosus
- -no inhibition of platelets
- -increased risk of MI and stroke
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Acetaminophen (Tylenol)
Analgesic and Antipyretic
- MECHANISM OF ACTION:
- -reduces prostaglandin synthesis in the CNS
- -has no anti-inflammatory properties
- USES:
- -pain and fever
- -preferred in children
- -no GI injury, no effect of platelets or kidneys
- ADVERSE EFFECTS:
- -toxic metabolite builds up in ETOH abusers
- -hepatic necrosis can occur
- -max dose is 4 grams/day
- -acetylcysteine (mucomyst) given for overdose
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