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Pharmacology NSAIDS

NSAIDS and other analgesics, OA, RA

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