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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). NSAIDs - Effects 4 Anti-inflammatroy - inhibit synthesis of prostaglandins by blocking the cyclooxygenase.

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Presentation on theme: "Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). NSAIDs - Effects 4 Anti-inflammatroy - inhibit synthesis of prostaglandins by blocking the cyclooxygenase."— Presentation transcript:

1 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

2 NSAIDs - Effects 4 Anti-inflammatroy - inhibit synthesis of prostaglandins by blocking the cyclooxygenase (COX) enzyme 4 Types –COX –1 – found in stomach –COX –2 – found at injury site

3 Pain-Spasm Cycle Pain Spasm Hypoxia Cell Death Release of Chemical Mediators Stimulus (Prostaglandins)

4 Anti-inflammatory Effects 4 Inhibits chemical mediator – prostaglandin 4 Prostaglandin produces stomach mucosa 4 Inhibition of prostaglandin = less stomach mucosa = GI effects

5 NSAIDs – Other Effects 4 Analgesic - decrease pain 4 Antipyretic - decrease fever 4 Anti-platelet - slows blood clotting (increases clotting time)

6 Anti-platelet Effects Binds to COX-1 enzyme preventing production of thromboxane Aspirin binds permanently ++ Decrease risk of heart attack & stroke -- Discontinue before surgery -- Bruising effects in athletes in contact sports

7 Aspirin (and other Salicylates) 4 acetylsalicylic acid 4 In US since 1899 4 Cheaper than other NSAIDS 4 Other uses –Prevent heart attack & strokes –Decrease risk of colon & G.I. cancer 4 Usually orally administered 4 Not banned …. but some combination products may be 4 No performance enhancing effect

8 Types of Aspirin Buffered aspirin Antacids added to neutralize stomach acid & GI effects Delayed release aspirin Special coating delays dissolving action until in the small intestine What is also delayed? Aspirin with caffeine Acts faster – enhances effects

9 Other Salicylates Choline salicylate(Arthropan) - liquid form - less potent – need more Magnesium salicylate (Doans) - contains magnesium Topical salicylates - methyl salicylate (Icy Hot, Ben-Gay) - trolamine salicylate (Aspercreme) Bismus Subsalicylate (Pepto Bismal) Salsalate - Disalcid is available only by Rx.

10 Dosing Recommendations 4 Normal dose 4 24 hr max 4 How long before effect? 4 Food 4 1 st sign of OD 4 Childrens Aspirin –Reyes syndrome 4 10 days for pain / 3 days for fever

11 Dose Protocols Every 4 hrs.24 hr. max Acetylsalicytic acid 650 mg. 4000 mg. Choline salicylate 870 mg. 5220 mg. Magnesium salicylate 754 mg.4640 mg. Childrens doses 80 mg. Tablets / # determined by wt. ** initial loading dose of 975 mg. allowable but only one time! ** No more than 10 consecutive days!!

12 Aspirin Precautions 4 More side effects than other NSAIDs 4 Bruising 4 Not used w/ clotting disorders, etc 4 GI side effects 4 Nephrotoxicity 4 Not w/ Gout 4 Allergic Rxn 4 OD 4 Decreases effect of antacid

13 Avoid Aspirin if…. 4 Child/Adolescent 4 Pregnant 4 Low back pain 4 Bleeding disorders 4 Hx of GI problems 4 Long distance runners 4 Asthma 4 Kidney or liver problems

14 Avoid Aspirin in combo w/… 4 Anticoagulants 4 Corticosteroids 4 Other NSAIDS 4 Alcohol

15 Aspirin Guidelines for the ATC 4 Short term 4 Alcohol? 4 Recognize allergy / OD signs 4 Appropriate for …? 4 Reyes Syndrome 4 Before exercise 4 Runners bleed

16 Pros / Cons of Aspirin 4 Very effective for mild – moderate pain relief 4 Decreases risk of heart disease 4 Has anti- inflammatory and analgesic effects 4 Cheap and accessible 4 GI effects 4 Very powerful anti- platelet effects 4 Nephrotoxicity 4 Allergic reactions 4 Reyes syndrome

17 Nonsalicylate NSAIDS 4 Definition 4 Table 4.1 and NSAID Handout –Differentiated by: Availability - OTC vs prescription Duration of action Potency

18 Indications and Uses 4 Anti-inflammatory, analgesic, antipyretic, and anti-platelet 4 1 st analgesic then anti-inflammatory 4 Mild to moderate pain, inflammation 4 Anti-platelet effect less pronounced

19 Act similar to salicylates in body Not necessarily better than aspirin - but less side effects (Gentler on stomach) Arthritis, menstrual cramps, etc Indications (cont)…..

20 Administration »Orally – pills vs liquid »Ophthalmic »Injection »Topicals – not in US 4 Analgesic vs. anti-inflammatory regime 4 Limit to 3 days for fever, 10 for pain

21 Dosing Protocols for OCTs ***Stronger than aspirin so lower dose 4 Ibuprofen (Advil) –2 tablets (400 mg) every 4-6 hrs 4 Naproxen Sodium (Aleve) –1 tablet (220mg) every 8-12 4 Ketoprofen (Orudis KT) –1 tablet (12.5mg) every 4-6 hrs

22 Side Effects / Adverse Reactions 4 Similar to aspirin 4 Nephrotoxicity 4 Anaphylatic reaction 4 Overdose symptoms Tinnitis, headache, nausea, dizziness 4 Toxicity Breathing, irregular HB, tarry stools, hematuria, jaundice

23 Contraindications 4 Aspirin intolerance 4 Pregnancy 4 Dont take if allergic to aspirin 4 In combination with Corticosteroids, anticoagulants, aspirin, alcohol

24 Considerations for ATCs 4 Long term use? 4 Not on banned substances list 4 Does not interfere with energy metabolism 4 May have negative long term effect on collagen formation 4 Regular liver testing for…. 4 Care with distance runners / alcohol 4 Use w/ PRICE


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