● Indomethacin (Indocin) : A powerful nonselective COX inhibitor that may also decrease T-cell proliferations. Useful for rheumatic conditions and can reduce gingival inflammation in an oral rinse administration. At higher dosages, one-third of users have reactions requiring discontinuing the drug. Side effects include abdominal pain, diarrhea, gastrointestinal hemorrhage, and pancreatitis. Headache is experienced in up to one-quarter of users and is associated with dizziness, confusion, and depression. May interact with other medications. Should not be used in individuals with nasal polyps or angioedema, as it may precipitate an asthma attack. ● Ketorolac (Toradol) : Used systemically primarily as an analgesic, rather than an anti-inflammatory, although it does have typical NSAID anti-inflammatory properties. Most typically given intramuscularly or intravenously after surgery, but an oral dose is available. When combined with an opioid, it can decrease the amount of opioid required by as much as 25-50%. Toxicities are similar to other NSAIDs, with renal toxicity perhaps more common with chronic use than that of other NSAIDs. ● Nabumetone (Relafen) : Nabumetone is the only nonacid NSAID currently available. Its half-life is greater than 24 hours, permitting a once-daily dose. It may be slightly less damaging to the stomach than other NSAIDs, but it is more expensive, which may be prohibitive in larger dosages. Like naproxen, nabumetone has been reported to cause photosensitivity and pseudoporphyria in some users. ● Sulindac (Clinoril) : Along with its use for rheumatic disease, it may have implications for inhibiting the growth of certain cancers. Like diclofenac, it may cause elevated serum aminotransferases more than most other NSAIDs (Farinde, 2023). Propionic acid NSAIDs ● Fenoprofen (Nalfon) : Most associated with rare toxicity of interstitial nephritis among all the NSAIDs. Other side effects include nausea, dyspepsia, peripheral edema, rash, central nervous system and cardiovascular effects, and tinnitus. Drug interactions. ● Flurbiprofen (Ansaid) : Extensive hepatic metabolism; comparable in strength to aspirin in studies with rheumatoid arthritis and osteoarthritis; available in a topical form; effective after surgery; side effects similar to other NSAIDS, with slightly more pronounced adverse effects including ataxia or tremors. ● Ibuprofen (Motrin, Advil) : Oral ibuprofen is often prescribed in low doses, at which it has analgesic but not anti-inflammatory effects. Topical cream and liquid gel forms may be more effective for absorption into fascia and muscle. Gastrointestinal irritation and bleeding occur less frequently than with aspirin. Use of aspirin and ibuprofen together may decrease overall anti-inflammatory effects. Therefore, treatment with ibuprofen in individuals with increased cardiovascular risks may limit the heart-protecting effects of aspirin. Aspirin is contraindicated in individuals with nasal polyps, angioedema, and bronchospastic reactivity to aspirin. It has also been associated with rash, pruritus, tinnitus, dizziness, headache, and fluid retention. Renal difficulties occur (as with all NSAIDs) but very rarely. ● Ketoprofen (Orudis) : Ketoprofen nonselectively inhibits COX and lipoxygenase but is similar to the other NSAIDs in its effectiveness for the treatment of rheumatoid arthritis and osteoarthritis. It adversely affects the gastrointestinal tract and central nervous system.
inflammatory drugs (NSAIDs) can reduce inflammation for varying lengths of time. NSAIDs are typically divided into groups based on their chemical structure and selectivity. Diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), fenoprofen (Nalfon), flurbiprofen (Ansaid), and ibuprofen (Motrin, Advil) are just some examples of nonsteroidal anti-inflammatory drugs (Ghlichloo & Gerriets, 2023). The common anti-inflammatory drugs (like aspirin, ibuprofen, and naproxen) all act by blocking the action of both the COX-1 and COX-2 enzymes. Blocking the COX-2 enzyme impedes the production of the prostaglandins that cause the pain and swelling of arthritis inflammation (Eustice, 2022). The NSAIDs include a large and chemically diverse group of drugs that possess analgesic, anti- inflammatory, and antipyretic (fever-reducing) properties. There are dozens of NSAIDs on the market, with new ones constantly becoming available. Some can be purchased as over-the-counter preparations, but larger doses of those drugs or other preparations are available only by prescription. The anti- inflammatory abilities of NSAIDS function by inhibiting the production of prostaglandins, which are responsible for producing inflammation and pain. NSAIDs have a number of potentially serious side effects. The most common is irritation of the stomach (Ghlichloo & Gerriets, 2023). NSAIDs are very useful in treating joint pain, swelling, and muscle pain. Although all NSAIDs appear to work in the same way, not every medication has the same effect on every person. Individuals should use only one NSAID at any given time. Most NSAIDS are an appropriate treatment for chronic conditions such as arthritis, muscle pain, gout, sprains, and strains. The most common side effect from NSAIDs is stomach upset or indigestion, especially in older patients. Taking NSAIDs with food or immediately following a meal lessens the chance of this occurring. Some NSAIDs products are less likely to upset the stomach. NSAIDs also prevent platelets (blood cells that help blood clot after an injury) from working correctly. When platelets don’t function as they should, bleeding is more difficult to stop. NSAIDs can also irritate the stomach, causing GI ulcers and bleeding. Stools that are darker than normal or unusual bruising, are both signs of bleeding, and a client who experiences these should be referred to a doctor. Other side effects include kidney and liver problems (Ghlichloo & Gerriets, 2023). NSAIDs should be used only under CLOSE physician supervision if a patient: ● Has asthma. There are three types of NSAIDs: salicylates (acetylated and nonacetylated), the traditional NSAIDs, and COX-2 selective inhibitors. All NSAIDs are gastric irritants, although newer formulations cause less gastric acid, in general, than aspirin. All newer NSAIDS are analgesic, anti-inflammatory, and antipyretic, and most (except the COX-2-selective agents and non-acetylated salicylates, discussed subsequently below) inhibit platelet aggression (Ghlichloo & Gerriets, 2023). Acetic acid NSAIDs ● Diclofenac (Cataflam, Voltarren) : Relatively nonselective as a COX inhibitor, adverse effects occur in about 20% of users, include symptoms of gastrointestinal distress, bleeding, and ulceration. Used post-surgically in certain operations. ● Etodolac (Lodine) : Somewhat more COX-2 selective than most NSAIDs; may cause less gastric toxicity in relation to ulcer disease that other nonselective NSAIDs. ● Has liver problems. ● Has heart problems. ● Has kidney problems.
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Book Code: MTX1325
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