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Pharmacology NSAIDS
NSAIDS and other analgesics, OA, RA
| Question | Answer |
|---|---|
| What do NSAIDS do? | Reduce pain, inflammation and fever |
| What kind of conditions are NSAIDS used to treat? | Acute: Gout, trauma, surgery Chronic: RA, OA, Musculoskeletal complaints |
| What percentage of the over 65's have a regular prescription for nsaids? | 10 - 20% |
| What are the most common side effects of NSAIDs? | GI tract problems |
| what does the inflammatory response require for activation? | Inflammatory cell activation - leucocytes Inflammatory cytokines - cytokines |
| What are the inflammatory mediators? | Cytokines, kinins, proteases, nitric oxide and vaso active amines (histamine, seratonin), complement |
| What is the principle action of paracetamol? | Inhibition of prostaglandin synethsis |
| WHy are COZ - 2 selective NSAIDS better than non - selective NSAIDS? | Cox-2 selective nsaids were thought to lead t anti-inflammatory effects without the GI side effects. However, they also have a role in platelet function which can lead to more thrombo-embolic events - can only be used short term |
| What side effects affect the GI tract and why? | Dyspepsia, nausea, vomiting, ulcer formation (30-50%), intestinal irritation, haemorrhage (1%) WHY: inhibition of protective prostaglandins - PGE2/PGI2 inhibit gastric acid secretion, increase mucosal blood flow and are cytoprotective |
| Adverse affects on the renal system? Why? | Intestinal nephrites, nephrotoxicity, renal failure >yrs WHY: Inhibition of pGE2 and PGI2, mediated vasodilation of renal medulla, and glomeruli, decreased creatinine clearence |
| Other adverse side effects as a result of using NSAIDS? | Bronchospasm, skin rash, allergic reaction, worsen oa? WHY: hypersensitivity, decreased regulation of articular cartilage |
| What are DMARDS? | Disease modifying anti- rheumatic drugs |
| How do DMARDS work? | Immune modulators - restore normal immune environment Alter disease activity, outcome and progression, and provide symptom relief Slow onset of action (weeks-months) Require regular monitoring |
| Symptoms of Osteoarthritis? | Age or injury related cartilage damage Pain and swelling Cellular mechanism not well understood Oedema on the joints Heberden's nodes (distal interphalangeal joints) Bouchard's nodes (proximal interphalangeal joints) Symetrical Polyarticular |
| Treatment of Osteoarthritis? | Paracetamol/NSAIDS Physiotherapy Exercise Avoid weight gain injection joint replacement |
| NSAIDS interactions with oral anticoagulants? | increase risk of GI bleeding All have anti platelets effects |
| Nsaids interaction with Anti-hypertensives? | Reduce hypotensive effect |
| Nsaids interaction with Diuretics? | Reduce diuretic affect |
| NSAIDS interaction with ACE inhibitors K+ sparing diuretics | Hyperkalaemia |
| NSAIDS interaction with Lithium? | Increases Lithium levels |
| NSAIDS with methotrexate? | Increase methotrexate levels |
| Symptoms of Rheumatoid Arthritis? | Progressive systemic inflammatory disease joint erosion multi-system extra-articular manifestations Pain, swelling, stiffness |
Created by:
Sophie_dystectic
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