pharmacotherapeutics clinical use, drug interactions and adverse drug reactions for: Non-steroidal anti-inflammatory drugs (NSAIDs) o pharmacotherapeutics clinical use _ NSAIDS inhibit cyclo-oxygenase (COX-1 and COX-2) activity, thus inhibiting prostaglandin synthesis. _ COX-1 is present in all tissues and cells, especially platelets; endothelial cells; the GI tract; and renal microvasculature, glomeruli, and collecting ducts. _ COX-2 is an “inducible” enzyme that is synthesized mainly in response to pain and inflammation. _ NSAIDs are primarily used for their anti-inflammatory activity but are also effective analgesics for the relief of mild to moderate pain _ Absorption Rapidly absorbed after oral administration Food delays absorption. _ Metabolism NSAIDs are metabolized by liver and excreted in urine. Acetaminophen is metabolized by liver. When acetaminophen is taken regularly or in large doses, the stores of glutathione become depleted and hepatic necrosis may occur. _ Clinical use: Rheumatoid arthritis o Use NSAID or celecoxib to reduce joint pain and swelling. o Follow American College of Rheumatology suggestions for treatment. o Increased risk for complications, so monitor closely Osteoarthritis o Acetaminophen or NSAIDs can be used for pain. Gout o Indomethacin, naproxen, and sulindac Mild to moderate pain o Nonopioid analgesia includes NSAIDs and acetaminophen. o Ibuprofen and naproxen most commonly used Primary dysmenorrhea o NSAIDs (ibuprofen or naproxen) are drugs of choice. Tendonitis and bursitis o Indomethacin SR, naproxen, and sulindac Fever o Ibuprofen is drug of choice. Drug of choice for mild to moderate pain in o Pregnancy o Patients with history of GI bleed o Aspirin allergy, blood coagulation disorders, upper GI disease Drug of choice for fever o Above adults o Children o Especially children with fever during flu-like illness
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