Nonsteroidal antiinflammatory agents NSAIDs

Piroxicam (25 mg p.o. daily) is indicated in the treatment of osteoarthritis and rheumatoid arthritis. Piroxicam, a nonsteroidal antiinflammatory agent (NSAID), has analgesic and antiinflammatory properties. It has a long half-life of 50 hours. Piroxicam should be used cautiously in patients with a history of peptic ulcer disease, angioedema, or cardiac disease because the drug may worsen these conditions, and in patients with decreased renal function because it may cause a further reduction in renal function (see also Table 3). 

Nonsteroidal Antiinflammatory Drugs. Nonsteroidal antiinflammatory dmgs (NSAIDs) include, among the numerous agents of this class, aspirin (acetylsaflcyhc acid), the arylacetic acids indomethacin and sulindac, and the arylpropionic acids, (5)-(147) and (R)-(148) ibuprofen, (5)-(149) and (R)- (150), flurbiprofen naproxen (41), and fenoprofen (see Analgesics, antipyretics, and antiinflammatory agents Salicylic acid and related compounds). 

There are two major classes of pain medications, nonopioids and opioids. The nonopioids used to treat mild pain include agents such as acetaminophen, both steroid and nonsteroidal antiinflammatory drugs (NSAIDs), and acetylsalicylic acid. Anticonvulsants suppress neuronal firing and are also helpful in neuropathic pain. Antiinflammatory agents (e.g., NSAIDs or corticosteroids) may be particularly helpful when bony involvement occurs and are often used for low-intensity pain. Steroids decrease inflammatory edema and are useful in cases of nerve and spinal cord compression, lymphedema, visceral pain caused by organ enlargement, and bone pain. Finally, short-term corticosteroid therapy may also produce euphoria (thus ameliorating less severe depressions) as well as reverse anorexia. 

S)-Naproxen (36), a potent nonsteroidal antiinflammatory drug (NSAID), is a best-selling agent for arthritis and represents a billion dollar a year market.50 Extensive research is aimed at the formation of the active 5-enantiomer because the /f-isomer is a potent liver teratogen. An asymmetric reduction has been proposed for the manufacture of 36 but has yet to be put into practice. Monsanto has reported that a 4-step manufacture process was in development for naproxen (Scheme 12.10).51... 

Chronic heart failure is typically managed by reduction in physical activity, low dietary intake of sodium (less than 1500 mg sodium per day), and treatment with vasodilators, diuretics and inotropic agents. Drugs that may precipitate or exacerbate CHF—nonsteroidal antiinflammatory drugs (NSAIDs), alcohol, (3-blockers, calcium channel-blockers and some antiarrhythmic drugs—should be avoided if possible. Patients with CHF complain of dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and dependent edema. 

Analgesics, antipyretics, nonsteroidal antiinflammatory drugs (NSAIDs), drugs used to treat gout and disease-modifying agents used in rheumatic disorders (DMARDs)... 

Veterans were also exposed to a variety of over-the-counter (for example, nonsteroidal antiinflammatory drugs [NSAIDS]) and prescription drugs (such as antibiotics), vaccines, and a prophylactic, pyridostigmine bromide (PB) for nerve agent exposure. Although many of these drugs were administered orally and not topically, their presence in the bloodstream could have a significant effect on the dermal... 

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