Anti-inflammatory effects contraindications

Celecoxib, a non-steroidal anti-inflammatory drug, is a cyclo-oxygenase-2 selective inhibitor that is as effective as diclofenac and naproxen. It should be used for the shortest period required to control symptoms. Use is associated v/ith an increased risk of thrombotic events and the cyclo-oxygenase-2 selective inhibitors are contraindicated in cerebrovascular disease. Mobic is the proprietary preparation of meloxicam. 

Alternative products to diclofenac include naproxen and mefenamic acid, both of which are non-steroidal anti-inflammatory drugs. Co-codamol is a mixture of the opioid analgesic codeine and paracetamol and it does not possess the anti-inflammatory component. It may be used in pain management either where NSAIDs are contraindicated or in patients who are intolerant to the effects of NSAIDs. 

Acute gout is usually treated with an NSAID in full dose. Any such drug which is tolerated may be used (except aspirin which in low dose promotes urate retention, see below) indomethacin is often chosen because of its strong anti-inflammatory action and efficacy. If treatment is started early, the attack may be terminated in a few hours. Colchicine is useful if NSAIDs are contraindicated. If neither colchicine nor NSAIDs are tolerated, oral prednisolone 40 mg/d and tapered over a week is also effective. It requires only a moment s thought to appreciate that the uricosurics and allopurinol will not relieve an acute attack of gout. 

Based on several randomized trials, aspirin has become the preferred antiplatelet agent in the treatment of aU ACSs. Early aspirin administration to all patients without contraindications within the first 24 hours of hospital admission is a quality care indicator (see Table 16-3). The antiplatelet effects of aspirin are mediated by inhibiting the synthesis of thromboxane A2 through an irreversible inhibition of platelet cyclooxygenase-1. Following the administration of a non-enteric-coated formulation, aspirin rapidly (<10 minutes) inhibits thromboxane A2 production in the platelets. Aspirin also has anti-inflammatory actions, which decrease C-reactive protein and also may contribute to its effectiveness in ACS. In patients undergoing PCI, aspirin prevents acute thrombotic occlusion during the procedure. 

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