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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

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Presentation on theme: "Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)"— Presentation transcript:

1 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

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

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

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

5 NSAIDs – Other Effects Analgesic - decrease pain
Antipyretic - decrease fever 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)
acetylsalicylic acid In US since 1899 Cheaper than other NSAIDS Other uses Prevent heart attack & strokes Decrease risk of colon & G.I. cancer Usually orally administered Not banned …. but some combination products may be 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 (Doan’s) - 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
Normal dose 24 hr max How long before effect? Food 1st sign of OD Children’s Aspirin Reyes syndrome 10 days for pain / 3 days for fever

11 Dose Protocols Acetylsalicytic acid 650 mg. 4000 mg.
Every 4 hrs. 24 hr. max Acetylsalicytic acid mg mg. Choline salicylate mg mg. Magnesium salicylate mg mg. Children’s doses 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 More side effects than other NSAIDs Bruising
Not used w/ clotting disorders, etc GI side effects Nephrotoxicity Not w/ Gout Allergic Rxn OD Decreases effect of antacid

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

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

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

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

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

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

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

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

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

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

23 Contraindications Aspirin intolerance Pregnancy
Don’t take if allergic to aspirin In combination with Corticosteroids, anticoagulants, aspirin, alcohol

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

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