Nonsteroidal AntiInflammatory DrugsNSAIDs Drugs in this class have

Nonsteroidal Anti-Inflammatory Drugs(NSAIDs) Drugs in this class have analgesic, antipyretic and antiinflammatory actions in different measures.

Outlines Mechanism of action ¡ Classification ¡ Brand names ¡ Side effects ¡ Cautions & Contra-indications ¡ Counseling Points ¡

4 signs of inflammation Redness - due to local vessel dilatation ¡ Heat - due to local vessel dilatation ¡ Swelling – due to influx of plasma proteins and phagocytic cells into the tissue spaces ¡ Pain – due to local release of enzymes and increased tissue pressure ¡

Mechanism of action

A. Nonselective Cox inhibitors(traditional NSAIDs) 1. Salicylates: - Acetyl salicylic acid Brands: - Aspirin, Dispril Aspirin protect, Jusprin etc- (antiplatelets) 2. Propionic acid derivatives: Ibuprofen, Ketoprofen, Naproxen, Flurbiprofen etc.

Drugs-brand names Ibuprofen: Brufen, Advil, Dolgit, Profinal, Sapofen, Irfen, Ibugesic etc. Ketoprofen: - Profenid, Fastum, Oruvail etc. Naproxen: - Miranax, Nopain etc.

3. Anthranilic acid derivative Drug: - Mephenamic acid Brands: - Ponstan, Mafepain, Fendol, Fenamforte, Alfoxan etc. 4. Aryl-acetic acid derivatives Drugs: - Diclofenac, Aceclofenac etc. Brands: -Voltaren, Clofen, Grofenac, Olfen, Voltic, Rofenac, Diclogesic, Votrex etc.

5. Oxicam derivatives Drugs: - Piroxicam, Tenoxicam, Meloxicam Brands: - Piroxicam: - Feldene Meloxiacm: - Mobic Tenoxicam: - Tilcotil 6. Pyrrolo-pyrrole derivatives Drug: - Keterolac 7. Indole derivatives Drugs: - Indomethacin, Sulindac Brands: - Indorem, Indocid etc.

8. Pyrazolone derivatives ¡ Drugs: - Phenylbutazone, Oxyphenylbutazone etc 9. Sulphonanilides Drug: - Nimesulide

B. Selective cox-2 inhibitors Drugs: - Etoricoxib, Celecoxib, Parecoxib, Rofecoxib etc. Brands: - Etoricoxib: - Arcoxia Celecoxib- Celebrex C. 5 -LOX-COX Inhibitor Drug: - Licofelone

D. Analgesic-antipyretic with poor antiinflammatory action Paraminophenol derivatives Drug: - Paracetamol (acetaminophen) Brands: - Panadol, Calpol, Enelfa, Adol, Omol Tylenol, Fevadol, Pmol etc. Other drugs are Metamizol, Propiphenazone, Nefopam etc.

Common side effects ¡ Gastrointestinal: Abdominal pain, Nausea, Diarrhea Peptic ulceration, Dyspepsia, Gastric erosion, GI bleeding, perforation, esophagitis etc. Renal: - Sodium and water retention, Interstitial nephritis, Chronic renal failure etc.

Common side effects Hepatic: - Raised transaminases CNS: - Headache, mental confusion, behavioural disturbances, seizure precipitation etc. Haematological : Bleeding, thrompocytopenia, haemolytic anemia , agranuloctyosis etc. Anaphylactoid reactios: - Asthma exacerbetion, Angioedema, skin rashes, nasal polyposisetc, rhinitis etc.

Cautions & Contra-indications Geriatric patients : Renal functions are low Pregnant women : Ductus arterios closure, avoid during last trimester, delay of labour All NSAIDs are contraindicated in severe heart failure. Selective COX 2 inhibitors contraindicated with IHD, Cerebro vascular disease, peripheral arterial disease, moderate or severe heart failure(LVD, HTN) etc.

Counseling Points ¡ ¡ ¡ To take the medication with 240 ml of water 30 minutes before or 2 hours after meals, or with food or milk if gastric irritation occurs. Advise the patient on chronic NSAID therapy should monitor laboratory parameters especially bun, serum creatinine, LFT and CBC. Use of alcoholic beverages may increase GI irritation and bleeding.

Thanks Philip K Mathew Clinical instructor School of pharmacy