Nonsteroidal anti-inflammatory drugs prevention

Orthoformates have been used in the lipase-catalyzed esterification aimed at the kinetic resolution of racemic acids such as flurbiprofen, a nonsteroidal anti-inflammatory drug (Figure 6.18). Orthoformates trap the water as it is formed through hydrolysis, and therefore prevent the reverse reaction, and, at the same time, provide the alcohol for the esteriflcation [65]. 

In addition to their beneficial effects, some medications may actually cause cellular injury and disease. An example of this phenomenon involves nonsteroidal anti-inflammatory drugs (NSAIDS). These drugs include aspirin (a derivative of salicylic acid), ibuprofen (arylpropionic acid, Advil ), and acetaminophen (para-aminophenol derivative, Tylenol ). Because of their beneficial pharmacological effects, consumption of these agents has increased significantly in recent years. NSAIDS have the ability to treat fever, pain, acute inflammation, and chronic inflammatory diseases such as arthritis. They are also used prophylactically to prevent heart disease, stroke, and colon cancer. 

Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole, are commonly prescribed to treat symptoms of heartburn, acid reflux, chest pain, dyspepsia, and chronic cough. PPIs inhibit the transfer of protons into the stomach lumen. Pharmacological acid suppression is thus used to treat gastroesophageal reflux disease (GERD) and esophagitis, peptic ulcers, and Helicobacter pylori infection as well as to prevent ulcer development with concurrent nonsteroidal anti-inflammatory drug use. 

Anti-neoplastic activity of UDCA was demonstrated first in the context of ulcerative colitis-associated colorectal carcinogenesis. Subsequently, encouraging (but not definitive) results have been obtained in clinical trials of UDCA for prevention of sporadic colorectal adenoma recurrence, which should prompt further evaluation of UDCA for polyp prevention, particularly given its excellent safety profile compared with other candidate chemoprevention agents such as the nonsteroidal anti-inflammatory drugs. 

Clinical use Acetylsalicylic acid is the prototype of a nonsteroidal anti-inflammatory drug and is used in a large number of inflammatory and pain indications including musculoskeletal, soft tissue and joint disorders, headache, dysmenorrhoea and fever (Symposium on new perspectives on aspirin therapy 1983, various authors). Furthermore, acetylsalicylic acid is used as an antiplatelet drug in the acute treatment of myocardial infarction in combination with thrombolytics and for the prevention of myocardial infarction and stroke (Patrono, 1994). 

Kalf GF, Schlosser MJ, Renz JF, et al. 1989. Prevention of benzene-induced myelotoxicity by nonsteroidal anti-inflammatory drugs. Environ Health Perspect 82 57-64. 

Szekely CA, Thome JE, Zandi PP, Ek M, Messias E, Breitner JC, Goodman SN (2004) Nonsteroidal anti-inflammatory drugs for the prevention of Alzheimer s disease a systematic review. Neuroepidemiology 23 159-169... 

Analgesia is indicated if the patient is in pain preoperatively or it can be given pre-emptively to prevent postoperative pain. Severe preoperative pain is treated with a parenteral opioid such as morphine. Nonsteroidal anti-inflammatory drugs and paracetamol are commonly given orally preoperatively to prevent postoperative pain after minor surgery. For moderate or major surgery, these drugs are supplemented with an opioid towards the end of the procedure. 

Agrawal NM, Roth S, Graham DY, White RH, Germain B, Brown JA, Stromatt SC. Misoprostol compared with sucralfate in the prevention of nonsteroidal anti-inflammatory drug-induced gastric ulcer. A randomized, controlled trial. Ann Intern Med 1991 115(3) 195-200. 

Simon TJ, Berger ML, Hoover ME, Stauffer LA, Berline RG. A dose raugiug study of famotidiue iu prevention of gastroduodenal lesions associated with nonsteroidal anti-inflammatory drugs (NSAIDs) results of a US multicenter trial. Am J Gastroenterol 1994 89 1644. 

Goldstein JL, Larson LR, Yamashita BD. Prevention of nonsteroidal anti-inflammatory drug-induced gastropathy clinical and economic implications of a single- tablet formulation of diclofenac/misoprostol. Am J Manag Care 1998 May 4(5) 687-697. 

Aspirin and other nonsteroidal anti-inflammatory drugs can precipitate an attack in up to 20% of adults with asthma. The mechanism is related to cyclooxygenase inhibition, and 5-hpoxygenase inhibition can prevent the symptoms. The prevalence increases with age. The greatest frequency occurs in severe corticosteroid-dependent asthmatics in their fourth and fifth decades who also have perennial rhinitis and nasal polyposis (presence of several polyps). Other drugs that do not precipitate bronchospasm but which prevent its reversal are the 8-blocking agents. ... 

Stevenson DD. Diagnosis, prevention, and treatment of adverse reactions to aspirin and nonsteroidal anti-inflammatory drugs. J Allergy CUn Immunol 1984 74 617-622. 

Graham DY, Agrawal NM, Campbell DR, et al. Ulcer prevention in longterm users of nonsteroidal anti-inflammatory drugs Results of a double-bhnd, randomized, multicenter, active- and placebo-controlled study of misoprostol vs lansoprazole. Arch Intern Med 2002 152 169-175. 

Maetzel A, Eerraz MB, Bombardier C. The cost-effectiveness of misoprostol in preventing serious gastrointestinal events associated with the use of nonsteroidal anti-inflammatory drugs. Arthritis Rheum 1998 41 16-25. 

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