Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
# Definition
NSAIDs are a group of non-steroidal drugs that have anti-inflammatory, analgesic, and antipyretic effects. They all have common side effects.
# Side effects
To remember the side effects of NSAIDs, you can use the following mnemonic:
- N: Nausea, dyspepsia
- S: Swelling
- A: Allergy
- I: Renal dysfunction
- D: Gastric ulcer
- S: Stroke/ Myocardial infarction
# Contraindications
NSAIDs are contraindicated in the following cases:
1. Peptic ulcer
2. Renal impairment
3. Coagulation disorder
4. Pregnancy and lactation
# Role of COX-1 and COX-2
- COX-1: Structural enzyme, beneficial to the body. Inhibition of COX-1 is desired for antiplatelet aggregation effect (inhibition of TXA2).
- COX-2: Inducible enzyme, causing inflammation, pain relief, fever reduction.
# Phospholipid metabolism diagram
(Diagram illustrating phospholipid metabolism with arachidonic acid as the final product.)
# Why is Aspirin rarely used for pain relief and fever reduction nowadays?
Aspirin requires high doses to be effective, leading to many side effects. Nowadays, many other drug groups are more effective and safer. Salonpas is methyl salicylate.
# Classification of NSAIDs
- Non-selective (COX-1 = COX-2): Example Aspirin
- Preferential COX-2 inhibition (COX-2/COX-1 = 2-100 times): Example Meloxicam
- Selective COX-2 inhibition (COX-2/COX-1 > 100 times): Example Etoricoxib. This group is more effective in anti-inflammation but has side effects on cardiovascular system (increased blood clot formation).
# Opposing roles of Thromboxan A2 and Prostacyclin (PGI2)
- TXA2: Procoagulant
- PGI2: Anti-coagulant
# NSAID drug groups
1. Salicylic acid derivatives: Aspirin, methyl salicylate
2. Propionic acid derivatives: Ibuprofen
3. Acetic acid derivatives: Diclofenac, indometacin
4. Elonic acid derivatives: Meloxicam, piroxicam
5. Para aminophenol derivatives: Paracetamol
6. Selective COX-2 inhibitors “coxib”: Etoricoxib, celecoxib
Note: Adverse effect and side effect are the same concept.
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