○ Genitourinary : Fluid retention, reduction in creatinine clearance, and acute tubular necrosis with renal failure. ○ Hepatic : Acute reversible hepatotoxicity. ○ Cardiovascular : Hypertension and moderate to severe noncardiogenic pulmonary edema. ○ Hematologic : Altered hemostasis through effects on platelet function. ○ Other : Skin eruption, sensitivity reactions, tinnitus, and hearing loss. In most cases, the choice of an NSAID is based on risk of toxicity and cost-effectiveness. In general, the gastrointestinal and renal side effects of ketorolac limit its use. On a toxicity index, indomethacin and meclofenamate were associated with the greatest toxicity, while salsalate, aspirin, and ibuprofen were least toxic of all the non- selective COX inhibitors. For users with renal dysfunction, Aspirin (Acetylsalicylic acid, ASA Bayer ® ) Commonly known as aspirin , acetylsalicylic acid is this country’s most widely used drug, both singularly and in combination with many prescription and patent medicines. Used for many different aches and pains, aspirin can injure Contraindications of aspirin ● Allergy : Aspirin is contraindicated in people with known allergy to nonsteroidal anti-inflammatory drug products and in patients with the syndrome of asthma, rhinitis, and nasal polyps. Aspirin may cause severe urticaria, angioedema, or bronchospasm (asthma). ● Reye’s syndrome : Aspirin should not be used in children or teenagers for viral infections, with or without fever, because of the risk of Reye’s syndrome with concomitant use of aspirin in certain viral illnesses. ● Alcohol warning : People who consume three or more alcoholic drinks every day should be counseled by their doctor about the bleeding risks involved with chronic, heavy alcohol use while taking aspirin. ● Coagulation abnormalities : Even low doses of aspirin can inhibit platelet function, leading to an increase in bleeding time. This can adversely affect people with inherited (hemophilia) or acquired (liver disease or vitamin K deficiency) bleeding disorders. ● Gastrointestinal side effects : GI side effects include stomach pain, heartburn, nausea, vomiting, and gross GI bleeding. Although minor upper GI symptoms, such as dyspepsia, are common and can occur anytime during Drug interactions with aspirin ● Angiotensin converting enzyme (ACE) inhibitors : The hyponatremic and hypotensive effects of ACE inhibitors may be diminished by the concomitant administration of aspirin due to its indirect effect on the renin-angiotensin conversion pathway. ● Acetazolamide : Concurrent use of aspirin and acetazolamide can lead to high serum concentrations of acetazolamide (and toxicity) due to competition at the renal tubule for secretion. ● Anticoagulant therapy (heparin and warfarin) : People on anticoagulation therapy are at increased risk for bleeding because of drug interactions and the effect on platelets. Aspirin can displace warfarin from protein binding sites, leading to prolongation of both the prothrombin time and the bleeding time. Aspirin can increase the anticoagulant activity of heparin, increasing bleeding risk. ● Anticonvulsants : Salicylate can displace protein-bound phenytoin and valproic acid, leading to a decrease in the total concentration of phenytoin and an increase in serum valproic acid levels.
nonacetylated salicylates may have fewer side effects. Fenoprofen is used less because it is associated with interstitial nephritis. Two nonselective NSAIDs, diclofenac and sulindac, are more associated with liver function abnormalities than any other NSAIDs. In most cases, physicians seek a good fit between an individual’s needs and sensitivities and an NSAID that best suits those needs. All nonacetylated salicylates are useful anti-inflammatories, although they may be less effective analgesics than aspirin. There are significantly less effective than aspirin as cyclooxygenase inhibitors, so are more desirable when cyclooxygenase inhibition is not wanted, which is the case in individuals with asthma, bleeding tendencies, and renal dysfunction. Individuals taking nonacetylated salicylates should be monitored for serum salicylate levels (Eustice, 2022). the stomach, interfere with the absorption of several vitamins (especially C, K, and folic acid), and pose a special risk for pregnant women and patients with ulcers (Arif & Aggarwal, 2023). therapy, physicians should remain alert for signs of ulceration and bleeding, even in the absence of previous GI symptoms. Physicians should inform patients about the signs and symptoms of GI side effects and what steps to take if they occur. ● Peptic ulcer disease : People with a history of active peptic ulcer disease should avoid using aspirin, which can cause gastric mucosal irritation and bleeding. ● Renal failure : Avoid aspirin in people with severe renal failure (glomerular filtration rate less than 10 mL/minute). ● Hepatic insufficiency : Avoid aspirin in people with severe hepatic insufficiency. ● Sodium restricted diets : People with sodium-retaining states, such as congestive heart failure or renal failure, should avoid sodium-containing buffered aspirin preparations because of their high sodium content. Aspirin has been associated with elevated hepatic enzymes, blood urea nitrogen and serum creatinine, hyperkalemia, proteinuria, and prolonged bleeding time (Arif & Aggarwal, 2023). ● Beta blockers : The hypotensive effects of beta blockers may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow, and salt and fluid retention. ● Diuretics : The effectiveness of diuretics in people with underlying renal or cardiovascular disease may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow and salt and fluid retention. ● Methotrexate : Salicylate can inhibit renal clearance of methotrexate, leading to bone marrow toxicity, especially in the elderly or renal impaired. ● Nonsteroidal anti-inflammatory drugs (NSAIDs) : The concurrent use of aspirin with other NSAIDs should be avoided because this may increase bleeding or lead to decreased renal function. ● Oral hypoglycemics : Moderate doses of aspirin may increase the effectiveness of oral hypoglycemic drugs, leading to hypoglycemia.
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