NSAIDs COX-2 inhibitors

Uncontrolled hypertension Valvular disorders function sympathomi meti cs) Offending medications (NSAIDs, COX-2 inhibitors, steroids, lithium, (i-blockers, calcium channel blockers, anti-arrhythmics, alcohol, thiazolidinediones)... 

According to NICE guidance, topical NSAIDs should be considered ahead of oral NSAIDs, COX-2 inhibitors or opioids for patients with osteoarthritis (NICE, 2008). They have not been shown to be any more effective than oral NSAIDs but they appear to have fewer side-effects (Bryant and Alldred, 2007). 

E Naproxen would be the reasonable choice because of the relatively infrequent (twice to three times daily) dosing regimen and more tolerable side effect profile compared with aspirin and indomethacin. Celecoxib and rofecoxib would be alternatives if the patient could not tolerate naproxen. These agents should be reserved for patients with known Gl bleeding disorders or intolerance to the other nonspecific NSAIDs. COX-2 inhibitors are still second-line therapy due to high cost and not well studied for the treatment of OA. 

Despite these complexities, COX-2-specific inhibitors relieve pain in many OA patients with a lower risk of GI adverse events than nonspecific NSAIDs. COX-2 inhibitors, members of the coxib class newly created by the World Health Organization, have become extremely widely used over a short period of time. These agents continue to be studied intensely not only for their efficacy and toxicity profile in rheumatic disease, but also for exciting potential applications such as the prevention of Alzheimer s disease and colorectal cancer. 

Figure VI-1-3 presents the pathways for the synthesis of PGe, PGE]( PGE2, PGF2a, IX Aj, and the i leukotrienes from the membrane phospholipids. It also shows the sites of action of the corticosteroids, i NSAIDS, COX 2 inhibitors, zileuton and zafirlukast, and other "-lukasts."...

It has been estimated that more than 100,000 hospitalizations take place every year in the United States due to the complications of taking NSAIDs. COX-2 inhibitors offer the hope of relief from arthritic diseases and pain... 

The appeal of NSAIDs, COX-2 inhibitors, and acetaminophen is that the unfavorable opioid-related side effects may be mitigated. Although opioids are potent and effective drugs for pain control, they are well known for adverse side effects such as excessive sedation, dose-dependent respiratory depression, pruritus, nausea, vomiting, biliary spasm, hypotension, constipation, and urinary retention. Minimizing these effects has the advantage of earlier ambulation post-operatively and consequently a shorter hospitalization, as weU as higher patient satisfaction and quality of recovery. 

Aside from their important role in multimodal analgesic therapy, they have also been extensively studied in preemptive analgesia. Preemptive analgesia is an anticipatory anesthetic approach that intends to prevent the pain and inflammatory response initiated by surgical incision and manipulation, and prevent the wind-up phenomenon . NSAIDs, COX-2 inhibitors, and acetaminophen have all demonstrated efficacy in the management of mild to moderate post operative pain. Additionally, they are... 

In day-to-day practice, clinicians must weigh the risk/benefit ratio for each medication they prescribe to patients. Given their widespread usage peri-operatively as well as non-peri-operatively, a basic understanding of NSAIDs, COX-2 inhibitors, and acetaminophen is certainly imperative. The following chapters provide an overview of key points regarding specific agents within these classes, such as their recommended doses. 

Non-opioid analgesics (NSAIDs, COX-2 inhibitors, APAP), including celecoxib, are part of the World Health Organization s (WHO) analgesic ladder for the treatment of mild to moderate cancer pain. There are no celecoxib dosing guidelines for the treatment of somatic pain associated with cancer. 

Aspirin, NSAIDs, COX-2 inhibitors may enhance antiplatelet effects and increase anticoagulation (including with vit Kantagonists). 

Aspirin, NSAiDs, COX-2 inhibitors - can enhance antiplatelet effects and anticoagulant effects (vit K antagonists). 

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